Cholesterol, Heart Disease and Current Research


Statistically, 50% of people seen in the emergency room with a heart attack have “normal” cholesterol levels. That’s right- normal cholesterol levels! Let’s look at the all the indicators in your cholesterol “number” to find out how this could possibly happen.

First, prevention of cardiovascular disease it is not as simple lowering your cholesterol levels to under 180. Your total cholesterol number is actually a combination of several different components or fractions some of which reduce and others increase your risk of heart disease.

To start, there are 2 main subdivisions of your total cholesterol level: HDL cholesterol is considered “good” as it reduces inflammation and plaque build-up in your blood vessels and LDL cholesterol is considered “bad” as it promotes the build-up of arterial plaque and hardening of the arteries. But there is a lot more to the story.

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There are other fractions of cholesterol that are more intricate markers of your risk for cardiovascular disease and stroke. Current research is trending to using a more comprehensive lipid panel to indicate your real risk for heart disease. These lab markers include:

  • VLDL
  • LDL P
  • HDL-P
  • LP-PLA2
  • Lipoprotein a
  • Particle size
  • Apo Fractions

The bottom line an analysis of your complete cholesterol (lipid) profile with all sub-fractions is essential. Pharmaceuticals and nutraceuticals both help to balance these markers; however, it often includes the incorporation of diet and lifestyle modification, to optimize your good cholesterol fractions.

A major problem is when  cholesterol becomes “oxidized” due to inflammation.  In an oxidized state it actually becomes sticky and adheres to blood vessel walls creating plaque build-up and hardening of the arteries. Again, there are specific lab tests for inflammation, the most common being: hs-CRP, fibrinogen, and homocysteine. A comprehensive lab assessment of your cardiovascular risk would need to include these variables.

A third challenge driving increased cardiovascular disease is insulin resistance, or pre-diabetes. Current research indicates insulin resistance can be determined by the ratios of the different cholesterol markers mentioned above. Again, a good reason to get a full lipid panel test.

The final step would be to look at the size and number of your cholesterol particles as a predictor of cardio-vascular risk. Keeping it simple, less but large particle size is better than many but small particles. Imagine the large fluffy cholesterol particles just floating around, hanging out so to speak, whereas the small particle size molecules are like bullets bouncing around at high speed and create more damage. So get that particle size checked and make them fluffy!

As for number, think of a 5 lbs sack of potatoes. It could have 3 Idaho potatoes in the sack, or 25 fingerling potatoes! More cholesterol particles means more risk.

At this point it is important to realize that every cell in your body needs cholesterol and your liver makes cholesterol for every cell in the body. So your body will always make cholesterol, the goal becomes to make big, fluffy cholesterol particles that are mostly in the HDL category.

A cholesterol lowering diet consists of green and colored vegetables, raw nuts, (especially almonds), vegetable protein, lean meat, fish, beans, and soluble fiber (oats, wheat bran, apples). A modified Mediterranean diet, with reduced saturated fats, restricted sugars and minimal grains is excellent. In fact, a 21 day diet (the SP Purification Program) has shown to dramatically reduce cholesterol levels.

Cholesterol management is more than just getting your LDL level to 180 or less or simply taking niacin or a statin drug. It is about knowing all or your cholesterol fractions, their ratios, and the particle size and addressing them individually. Lifestyle factors, diet, exercise, pharmaceuticals and nutraceuticals all play a role is obtaining an optimum cholesterol profile to reduce your risk for heart disease – use them judiciously.

Dr. Donald DeFabio is a dual board certified Chiropractic Physician in Berkeley Heights, NJ and author of Health Management: The DeFabio Difference. He is the Director of DeFabio Spine and Sports Rehab, LLC where Acupuncture, Chiropractic, Nutrition, and Personal Training are integrated for a comprehensive approach to your health management. The office may be reached at  or

The opinions expressed herein are the writer's alone, and do not reflect the opinions of or anyone who works for is not responsible for the accuracy of any of the information supplied by the writer.

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