Patient Library / Cardiovascular Disease / Elevated Cholesterol
Elevated Cholesterol
Standard cholesterol testing tells you very little about actual cardiovascular risk, the full picture requires a different kind of assessment.
Total cholesterol and LDL-C are poor predictors of individual cardiovascular risk, yet they drive the majority of statin prescribing. What actually matters is LDL particle number, particle size, lipoprotein(a), ApoB, oxidized LDL, and the inflammatory environment these particles enter. A proper cardiovascular risk assessment changes who needs treatment and what that treatment should be.
LDL-C Is a Poor Proxy
Two people with identical LDL-C can have very different cardiovascular risk depending on particle size and number. Small, dense LDL particles are far more atherogenic than large, buoyant ones, and standard testing doesn't distinguish between them.
ApoB Is What Counts
ApoB measures the total number of atherogenic particles, a better single predictor of cardiovascular risk than LDL-C. Some patients with 'normal' LDL-C have high ApoB and significant risk; others with 'high' LDL-C have predominantly large particles and low risk.
Metabolic Drivers Come First
Insulin resistance shifts LDL toward small, dense particles and raises triglycerides. Hypothyroidism impairs LDL receptor clearance. Addressing these metabolic drivers often normalizes the lipid profile without targeted lipid-lowering interventions.
What You Need to Know
Frequently Asked Questions
References & Further Reading
This article is for education and is not a substitute for individual medical advice. For background reading, these independent health authorities offer evidence-based information:
- Cholesterol — U.S. National Library of Medicine (MedlinePlus)
- High Blood Pressure — U.S. National Library of Medicine (MedlinePlus)
- High Cholesterol: Risk & Prevention — Heart & Stroke Foundation of Canada
- Omega-3 Supplements: In Depth — NIH National Center for Complementary and Integrative Health
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Read moreHow I Treat This
These are the services I most commonly draw on when working with elevated cholesterol.
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