A Fresh Look at Cholesterol and Vascular Health

Vascular Disease continues to be the number one killer worldwide.  At the same time Statins (cholesterol lowering medications) are being prescribed in higher and higher amounts every year.  With millions of people taking Statins every day, one would think that vascular disease would be on the decline.  However, these medications are having a very small impact on the incidence of heart attacks.  Why is that?

There is simply more to the story than Total Cholesterol, LDL and HDL.  The basic “lipid panel” or cholesterol screen done through a routine doctor’s visit is not telling us enough.  There is so much more going on in our bodies that needs to be considered.  I want to describe just a few of these considerations for you here. 

Size Matters

Perhaps one of the biggest misconceptions we have about the cholesterol concept is that HDL and LDL are types of cholesterol.  Cholesterol is actually just a molecule that is packaged within little “bubbles” or particles we call HDL and LDL.  These particles carry the cholesterol in different directions.  HDL is considered “good” because it carries cholesterol back to the liver to be processed.  LDL is “bad” because it carries cholesterol from the liver to the tissues where these little particles can get lodged in the arterial wall and cause plaque.  But it is important to understand that it is not the cholesterol within these particles that kills us.  It is the particle itself! 

So the question then becomes… “How big are these particles?”  The larger the LDL, the less likely that it will stick to the artery and cause plaque development. But if they are small and dense they have a higher tendency to stick. 

To help people understand this scenario I like to use the sidewalk analogy.  Let’s say that there is a newly paved sidewalk.  No cracks.  Think of this as the arterial wall of a newborn.  Perfect, smooth, without blemish.  You can imagine a ball (an LDL particle) rolling easily across this sidewalk.  Now think about a really old and broken sidewalk, full of cracks and pits.  This represents an inflamed arterial wall.  If you were to roll a ball across it, there is a higher likelihood that the ball would stop and get stuck. The more cracks, the higher the inflammation; the smoother, the less inflammation.  If the LDL particles are large, that would be like rolling a basketball across a cracked sidewalk.  These particles will still likely roll on.  But a handful of marbles?  Not so much.  They will tend to get stuck.  So large particles and a smooth non-inflamed artery is key here.  

Inflammation within the artery itself is perhaps one of the most significant factors involved in vascular disease.  Since there is no pain from an inflamed artery, the first symptom a person will experience will be a vascular incident like a heart attack or stroke. 

Three Hazards

Vascular inflammation injures the arteries and over time leads to vascular disease.  Working to reduce inflammation systemically does much more for the health of the vascular system than just lowering the amount of cholesterol within an LDL particle.  There are so many other benefits which come from lowering inflammation, aside from vascular disease, that to ignore it is a huge oversight clinically speaking.  There happens to be a great blood test for measuring inflammation in the artery called hsCRP. This stands for high sensitivity C-Reactive Protein.  I like to see this test done on all of my patients.  This one simple test can offer a lot of insight into the inflammatory status of the person and can establish a bench mark for that individual’s cardiovascular risk. 

But let’s go a step further.  These LDL and HDL particles can degrade like anything else.  So in some people they are breaking down into extremely small particles which get stuck in those sidewalk cracks like chewing gum! These particles are called Remnant Lipoprotein (RLP) and can be measured with a simple blood test.  And once again, Statin medications do not help lower these particles.  So far only natural compounds have shown to help. 

Another common hazard to the health of the blood vessel is a nasty little molecule called Homocysteine.  This is another silent killer which hardly ever gets tested for in the mainstream (because there is no prescription medication that lowers it).  I test for this on all of my patients and find it rather alarming how often it comes back elevated!  Homocysteine is an inflammatory irritant to the artery and can be a contributing factor to elevations in hsCRP, otherwise referred to in this article as a cracked sidewalk.  It is also an independent risk factor for stroke and vascular dementia.  If you have never had this looked at I strongly urge you to do so.  There are some common genetic factors which can contribute to an elevation in Homocysteine.  These cases require supplementation to keep under control.  Simply eating healthy and exercising alone cannot keep Homocysteine within healthy levels. 

Taking Control of Inflammation

There are many other causes of vascular disease and poor health in general: high levels of blood sugar, Insulin, and Omega 6 Fatty Acids (which a therapeutic dose of high quality fish oil can help balance out).  There are also hormone factors, immune factors, and others.  But taking back control of the inflammatory situation in the arteries and working to shift the particle sizes to the larger variety can go a very long way to living a longer, more productive and healthier life without the use of prescriptions.

I offer a blood test from SpectraCell Laboratories that looks at everything I just discussed and more.  It tests blood sugar and Insulin status, basic cholesterol levels and particle size, as well as those smaller fragments I described above.  It looks at Homocysteine levels, hsCRP and the Omega 3 to Omega 6 status.  It even looks at Leptin which is a hormone that plays a part in how we register hunger and store or burn fat. The good news is that SpectraCell works with just about any insurance plan.  The cost of this whole panel is only $45 for the patient. 

If you have concerns about vascular disease, have a personal or family history of heart attacks or strokes, or if you just want to be on top of your wellness and prevention I cannot recommend this blood test enough.  This is a top notch cardiology panel without all the cost or fuss.  A panel like this provides a lot of valuable insight and could offer many options before needing all of those prescription medications.  Get in touch soon to schedule a consultation and let’s get this discussion going!