If your doctor reports a normal LDL cholesterol, ask for your ApoB or LDL particle count. If it hasn’t been done, demand it immediately, as these metrics are crucial for understanding your lipid-related cardiovascular risk.
When assessing cardiovascular risk, understand that the risk follows particle metrics (ApoB or LDL-P) more closely than cholesterol metrics (LDL-C). To fully understand your risk, measure both to identify potential discordance.
Ignoring an elevated LDL particle count or ApoB level is ‘playing with fire,’ as the overwhelming amount of literature indicates a significant increased risk for atherosclerotic disease over 20-30 years.
Avoid phytosterol supplements, as evolution suggests the human body is designed not to absorb them, and there is data indicating they may be more atherogenic than cholesterol, especially for hyperabsorbers.
If you are supplementing with phytosterols, or if a physician prescribes them, it is crucial to monitor phytosterol levels in the bloodstream to identify if you are a ‘hyperabsorber,’ in which case supplementation should be avoided due to potential toxicity.
If your triglyceride levels are above 400 mg/dL (or even 150-200 mg/dL), do not rely on the calculated LDL cholesterol (Friedewald formula) as it becomes erroneous; instead, seek a direct LDL-C measurement.
Do not get a lipid profile during an acute physiological stress or illness (e.g., sepsis, trauma), as lipid levels will be transiently altered and will not accurately reflect your baseline risk.
When discussing lipid metrics with your physician, specify ‘LDL cholesterol’ or ‘LDL particle number’ instead of just ‘LDL’ to ensure accurate communication and avoid misidentification as an ‘ignoramus’.
If your physician is unwilling to order an ApoB or LDL particle count, you can often obtain these assays directly through services like LabCorp in the United States without a prescription.
If you have legitimate questions about lipids, engage with Dr. Lipid (Tom Day Springs) on Twitter by asking questions or sending direct messages, as he often answers legitimate inquiries.