Size Does Matter in Heart Disease

Many people are familiar with the statistic that the number one killer in this country is heart disease including women.  The hallmark to preventing heart disease is of course good nutrition and regular exercise.  In case you aren't so perfect in this category or even sometimes just based on good 'ole genetics you may face increased risk of heart disease which typically starts as increased cholesterol.

The most common test for evaluation of cholesterol is a standard cholesterol panel which examines total cholesterol, hdl (high density lipoprotein), triglycerides (think of this as "sugary" cholesterol) and ldl (low density lipoprotein).  Most people think that this is enough in terms of getting the most information they can in regards to their cholesterol profile but to truly understand why this information is not enough you have to understand how cholesterol contributes to heart disease.

Think of cholesterol as glue in the vessels of your body.  Because of this "glue" your vessels don't exactly function in the same way that they should and it causes them to be stiffer and causes your heart to work harder.  Now it would be common sense to think that the bigger areas of "glue" would be riskier than the smaller more newer deposits  but that is not the case.  Often the newer smaller areas are more unstable therefore they are more likely to break off and flow through the bloodstream to areas you don't want them to causing problems like heart attacks, strokes, and blood clots.  Make sense?

Now research has shown that there are different sizes of LDL and HDL particles and some are much more dangerous than others.  This is where sometimes standard cholesterol testing can not provide you with all of the information in terms of heart disease risk because it does not check on the size of the particles of your cholesterol.  Clearly heart disease risk is more that just the cholesterol number as according to the National Cholesterol Education Program half of people who have a heart attack have "normal" cholesterol levels.  

Standard cholesterol testing can leave some people with the picture that they are not at risk because of their normal results.  The National Cholesterol Education Program has previously introduced new risk factors that can only be identified with advanced lipoprotein testing.   This type of testing tests for the size of the ldl particles in addition to the quantity.   These types of tests are available at specialized labs and can sometimes be covered by insurance.


All patients can be considered for this test.  It may be especially useful for those who:

  • Have a family history of heart disease or diabetes

  • Have been diagnosed with heart disease or diabetes

  • Are already taking cholesterol lowering medications

  • Have been diagnosed with Metabolic Syndrome

  • Are overweight

  • Have low HDL-the good cholesterol

  • Have high LDL-the bad cholesterol

  • Have high triglycerides

If you have not had this type of testing you may want to consider asking your doctor about this type of testing at your next doctor's appointment.  If your doctor does not provide this type of testing there are doctors who can provide online consultations to order this type of testing for you.