Do you ever wonder why some individuals with lower cholesterol have heart attacks and coronary artery disease while some individuals with higher cholesterol do not? Is there more to heart disease than cholesterol alone? While cholesterol certainly has been proven to be a major risk factor in coronary artery disease and heart attacks, the latest research certainly shows there is much more to the equation.

Cholesterol is often named a bad guy and many pharmaceutical drugs have been manufactured to lower its value. But is cholesterol really important in the body? Cholesterol is a precursor to all of our steroidogenic hormones, also known as sex hormones or anabolic hormones. Cholesterol is metabolized into pregnenolone, which is responsible for the making of all of our anabolic sex hormones. With the blocking of cholesterol and lowering cholesterol to sub optimal values, we block the important manufacturing of many of the hormones that our body needs. So if cholesterol is in fact needed in our body, how do we combat the risk of coronary artery disease?

Vascular aging and metabolic cardiology is an area of great interest among those who are working in metabolic medicine. The basis of cardiovascular disease in recent studies has been shown to involve inflammation and oxidative stress. This is also known as autoimmune vascular dysfunction. Oxidative stress involves reactive oxidative species also known as ROS. These are messengers that set off signals of inflammation through genes that can cause inflammation and damage to our blood vessels. When looking at standard lipid profiles, typical measurements of total cholesterol, LDL, HDL, and triglycerides are often obtained. But what is the rest of the story?

Recent research in biochemistry and lipid management has allowed us to create testing which is much more comprehensive. This testing is known as expanded lipid profiles. We now know that LDL, often called bad cholesterol, must undergo oxidation to be damaging to the vessel wall. This involves the process of oxidative stress that is listed above. Two markers often looked at in advance lipid management to measure oxidative stress are C-reactive protein and homocysteine. When elevated these markers often indicate inflammation within the blood vessel and higher risk of atherosclerosis. Advance lipid testing also allows us to look at both the core particle size and number as well as the density of HDL and LDL. Research has shown us that small dense LDL is much more dangerous than larger buoyant LDL. Let’s take to individuals with the same LDL total cholesterol number. One individual has larger LDL while the other has smaller LDL. The individual was smaller LDL can have up to 70% more particles and be at much greater risk for coronary artery disease. HDL can also be fractionated, and buoyant HDL is more protective against atherosclerosis.

Cholesterol management should involve in-depth analysis prior to reaching over-the-counter for a quick fix. With expanded lipid profiles that are now available to anyone, the management of cholesterol and coronary heart disease risk can be performed accurately and safely. The goal in lipid management should include LDL reduction, making sure LDL is not dense, stabilized endothelial vessel lining, and reduced oxidative stress. Analyze HDL for its protective characteristics as extremely high HDL is often dysfunctional and not cardioprotective. Risk factors of heart disease greatly increase with elevation of C-reactive protein and LDL combined. When therapeutic intervention becomes necessary, always consider some natural alternatives. Omega 3’s have been shown to be very protective and reduce the risk of cardiovascular disease. Vitamin K2 as MK-7 has also been shown to reduce atherosclerotic plaque. Resveratrol and N-acetyl cysteine have been shown to block oxidative stress. Niacin, also known as vitamin B3, has been shown to be effective in lowering the VLDL(triglycerides) and lowering dense LDL. Oral estrogens have been shown to lower dense LDL and are often an important consideration in postmenopausal women. Plant sterols have a role in cholesterol management as well. So if you are wondering if cholesterol in your body is doing you any harm, seek advanced lipid testing and with your physician outline a treatment program that is both comprehensive and safe in lowering your risk of cardiovascular disease.