Cardiovascular disease is a major cause of death in the U.S. There are a number of factors that contribute to cardiovascular disease and cholesterol is the most often blamed contributor. I do not believe that elevated cholesterol causes heart disease but I do believe that there is probably a correlation.

Since my primary goal is the optimization of health, I want to measure as many metrics as possible so that I can most accurately determine optimal health.

The standard ‘Cholesterol Test’ gives me four values: Total Cholesterol (TC), Triglycerides (TG), High-Density Lipoproteins (HDL), and Low-Density Lipoproteins (LDL). However, there is some suggestion that other lipid measurements may better predict cardiovascular disease risk. I would argue that additional information can be especially beneficial and help guide therapy. My suggestion does not have a plethora of scientific data for support but there is certainly no harm in my approach. To that end, I nearly universally obtain the Vertical Auto Profile (VAP) Test for cholesterol.



LDL is measured directly on this test so there is no need to be fasting!

There are 3 components to Total LDL: LDL4+3+2+1, Lp(a), & IDL. To improve your Total LDL you should consider plant stanols & sterols as these substances bind cholesterol in the gut and prevent it from being reabsorbed.


Tthis measures the amount of “bad” cholesterol carried by LDL particles. Plant stanols & sterols and high-fiber diets are also generally recommended to improve these numbers as well.


This is often an inherited (genetic) risk factor. It is an LDL-like particle and attaches to the walls of arteries very well. Niacin has been shown to improve this particle.


This is a carrier of triglycerides that increases risk for heart disease. Limit refined carbs and ensure appropriate levels of Omega-3 fatty acids to improve these particles.


HDL is the “good” or ‘protective’ cholesterol. HDL2 is the protective form of HDL. It acts like a garbage truck and take the “bad” cholesterol out of circulation. HDL3 is the least protective sub-particle. Improve these by smoking cessation and optimizing nutrition.


This is another type of “bad cholesterol” produced in the liver and is the main carrier of triglycerides. It is also a marker of pre-diabetes. VLDL1&2 are the larger particles and VLDL3 is the smaller and has the higher risk for cardiovascular disease. VLDL can be improved by optimizing nutrition, stopping smoking, and taking Omega-3 fatty acids.


These are fats in your bloodstream that can come from carbohydrates &/or fats in your diet. It is associated with increased risk of diabetes and heart disease. Optimal nutrition, omega-3 fatty acids, limiting alcohol, and stopping smoking can improve your triglycerides. Also, understand that you will not be able to get your triglycerides under control until your blood sugar is controlled first.


This is your Total Cholesterol minus your HDL and seems to be one of the better predictors of cardiovascular disease risk. Optimizing nutrition, stopping smoking, limiting alcohol, and plant stanols/sterols can help your Non-HDL-C.


The sum of IDL & VLDL3. These are also improved with the interventions listed above.


Pattern A is the ‘light & fluffy’ LDL and seems to have a lower risk of cardiovascular disease. Pattern B is the ‘small, dense’ LDL and corresponds to a higher risk. Dr William Davis wrote a book called ‘Wheat Belly’ (which I HIGHLY recommend) and is largely based on improving LDL density to the light & fluffy variety by eliminating wheat from the diet. It is worth reading and I certainly recommend cutting out wheat from everyone’s diet.


The number of “bad” cholesterol LDL & VLDL particles. Fewer is better! Improve this by the lifestyle changes listed above.


The number of “good” HDL cholesterol particles in your blood. More is better! Same interventions as listed above.


Yep, it’s the ratio of the 2 and correlates with cardiovascular disease risk. The higher the ratio the higher the risk.


Optimal reduction in cardiovascular disease risk is accomplished by improving health. This is best accomplished by addressing the ‘Healthy Trinity’. If the Healthy Trinity is optimally addressed and there are still significant risk factors on your labs, or you have significant cardiovascular disease risk, then we would consider specific medications.

Proper nutrition where we eat lean meats, fruits and vegetables and limit (or eliminate) sugar, grains, legumes, and dairy is the best first step to improving overall health.

As always, your feedback is welcome!

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