Just when you have everything comfortably figured out some scientist or doctor or study throws a curve ball at you. Cholesterol was something we all finally got. We knew that if our cholesterol was 200 or under and our LDL, HDL and triglycerides were in the appropriate ranges, well, we were good to eat ice cream for dinner.

Good and bad cholesterol was the key. Plenty of good and control of the bad and we were pretty bombproof, at least according to my doctor and underwriters and medical directors at life insurance companies. In this area all of them actually agreed that given the right amounts of everything our chances of CAD (coronary artery disease) were slim. Life insurance underwriters were so confident on this that several years ago they changed their stance to allow for treated cholesterol at the best rate class as long as the numbers were in line.

Now comes the curve ball. What if someone said that not all bad cholesterol (LDL) is bad? Well, it turns out that studies have concluded that there are large and small LDL particles. I immediately assumed that larger particles would be the problem child, but it turns out that smaller LDL particles can be the culprit in throwing off all the common assumptions of LDL and HDL.

As it turns out “LDL does its damage by penetrating the inner lining of artery cells. Smaller LDL particles appear to do more damage. When LDL particles are small, heightened risk remains even when overall LDL counts are at ideal levels” according to the Mayo Clinic. This means that even at ideal lipid levels a person could be at a higher risk of a heart attack.

The larger particles are actually rounder and tend to roll down arteries the way a golf ball goes through a pipe in miniature golf. In this scenario, even high LDL numbers wouldn’t be considered an increased risk factor. The catch for doctors is that the test is not readily available and for underwriters too expensive. According to Johns Hopkins, “One widely used test, called the NMR LipoProfile, analyzes the size of lipoprotein particles in the blood by measuring their magnetic properties. Several others, including the LipoPrint and the Berkeley (from Berkeley HeartLab) use electrical fields to distinguish the size and other attributes of lipoprotein particles.”

So, for us that are left wondering whether to continue to go to the health fair there is another, pretty reliable way to determine if our LDL is indeed bad or really kind of neutral. Depending on the study, if your triglycerides are above normal, 120-150 or higher, and your HDL is below 40, there is a significantly higher chance that you have small particle LDL.

The good news is that in many cases the same treatment that would be used for high total cholesterol or high LDL, statins, coupled with a healthier diet and cardiovascular exercise can reduce the number of small LDL particles and increase the number of large particles.

Bottom line. While cardiologists seem to have a pretty keen interest in this phenomenon, don’t look for the average family doc or life insurance underwriters to change their views.

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