Cholesterol is our enemy right? It blocks our arteries and causes heart attacks. So you are told by your doctor that you have high cholesterol and “you need to improve your diet and exercise more”. Well, I have news for you, it is more complicated than that. Cholesterol should not be the primary focus. Rather than being our enemy, it is the innocent bystander that gets the bad rap.

Cholesterol is a steroid hormone and is carried around the body in particles called lipoproteins because every cell in your body needs it. This important hormone is also used to make Vitamin D and all of the other hormones in your body including estrogen, progesterone, and testosterone.

When we measure cholesterol, we are measuring the amount of cholesterol within different types of fat-carrying proteins called “lipoproteins”, the mosts common being high density lipoprotein (HDL) and low density lipoprotein (LDL). Your standard lipid panel measures your LDL, HDL, total cholesterol and non-HDL cholesterol. However, there are many other types of cholesterol carried by many lipoproteins including VLDL, sdLDL, IDL, and Lp(a).

HDL cholesterol is often called “good cholesterol”. Although higher HDL cholesterol is often correlated with better health outcomes, correlation does not equal causation and we know relatively little about the physiology of HDL cholesterol. Having a very high HDL cholesterol may even suggest a dysfunctional molecule that is correlated with POORER health outcomes.

Now, let’s talk about LDL cholesterol often referred to as “bad cholesterol”. LDL is typically thought to be the cause of “atherosclerosis” or plaque build up in the arteries. However, cholesterol itself is not inherently dangerous and does not cause atherosclerosis. Cholesterol is actually 100% vital to every cell in your body. So, why does higher cholesterol seem to be associated with “bad” things?

Let’s return to lipoproteins, the carriers of cholesterol. Lipoproteins are simply the protein vehicles that carry cholesterol around your body. When we measure the basic cholesterol panel, we are measuring the cargo inside and the type of car delivering it. But how does cholesterol get inside our cells? ApoB is a protein that wraps around and transports the lipoprotein, loaded up with cholesterol, into your cells. ApoB happens to carry more LDL around than other types of cholesterol.

Indeed, we now believe that Apo B is the “bad” molecule that causes atherosclerosis, leading to heart attack and strokes. It does so by driving cholesterols right INTO artery walls, where they become oxidized, leak content and ultimately, cause atherosclerosis. The LDL cholesterol particles that are not carried by the ApoB lipoprotein, does not cause heart disease. LDL cholesterol that is not carried by ApoB can be driven to the liver, processed and cause no harm. By measuring the ApoB lipoprotein, we get a value of truly plaque promoting lipoproteins.

Most doctors simply measure your total cholesterol, LDL and HDL. This isn’t a very complete picture. In addition to looking at ApoB levels, we will also believe it is important to measure other cardiac risk markers that make your cholesterol more “sticky” thus more likely to get caught up on the artery wall. These markers include hs-CRP, homocysteine, fasting blood sugar, A1C, insulin along with other risk assessments such as visceral fat score and coronary calcium score or coronary CT angiogram. At Robinson MD, we believe that it is SO IMPORTANT to get the bigger picture so that we have more objective data to track and help guide you to achieve your best health possible.