LDL Composition Important

[MichaelJH]

A raised level of LDL cholesterol has long been associated with heart disease. This article suggests the composition is more important. LDL has sub-types A, B and I.

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[SpiritoftheFloyd]

Interesting. My last test just showed HDL, non HDL, LDL and cholesterol/HDL ratio. I assume they don't currently test for the breakdown of LDL types?

[MichaelJH Heart Star in reply to SpiritoftheFloyd]

I managed to get a print out of all my last set of test results and yes LDL is not broken down. Last week I had X-rays of both hips, right knee and left ankle because of arthritis (?). When I go for the results I will ask about tests to show the breakdown but imagine it might get nowhere as when I asked for Lp(a) some years ago.

[Ader42]

It has been known for many years that there are a variety of types of LDL.

Normal LDL is large and fluffy and no danger at all (Type A). This is why a total cholesterol level value is of little use apart from use in a TC/HDL ratio which is a useful indicator of CVD risk. It’s also why a high LDL score is also of limited use unfortunately.

The danger is modified LDL of which there are different types. Most commonly known is small dense LDL (sdLDL or Type B) which is caused by refined flour and sugar. (So don’t eat cakes and biscuits).

sdLDL does not get recognised by the liver so can’t be recycled, hangs around longer and it’s thought can get lodged in artery lesions because it is smaller than regular LDL.

As sdLDL is smaller than regular LDL you can get an LDL-p test to find out how much of your LDL is small and dense (harmful) and how much of your LDL is large and fluffy (useful).

Even though these tests have been available around the world for many years the NHS is so out of date that they don’t do it. Maybe the increased cost of LDL-p tests is a factor? Perhaps if they do the maths and decide that it will cost more than £n to save one life they won’t authorise it?

In Canada and Australia it’s a common-place test I understand. You can get it done privately in the UK.

Another modified type of LDL is that which has an attached Lipoprotein(a) molecule. These too are not taken back by the liver and so also hang around and are a major risk factor. You can get a Lipoprotein(a) test on the NHS if your doctor or cardiologist are onboard. Apparently as many as 3/10 people have high LP(a). This is hereditary. There is no treatment for high LP(a) apart from bi-weekly blood filtering for those at most danger, but this is very uncommon (not sure if it’s done in the UK).

High LP(a) is not affected by either food or diet and there are no medicines.

Obviously medicines that lower LDL across the board such as Statins will reduce the overall count of LP(a) LDL but is unlikely to reduce risk as you will still have lots of LP(a) and you will die without any LDL at all.

Triglycerides are very important too - they have more recently discovered remnant cholesterol in Triglycerides, sometimes called “ugly” cholesterol. It is thought that these too can go into plaque. So aim to get your Triglyceride levels down. There aren’t many ways to measure remnant cholesterol yet, ball park is 20% of your TG level. Triglyceride levels do vary a lot though from day to day which makes it difficult to measure remnant cholesterol and risk in general from TG levels.

Unfortunately normal LDL has been much maligned even though it is part of the body’s solution to a problem (damaged arteries).

[Hidden in reply to Ader42]

Can I ask you Adel is a reading of 2.2 high for a Triglyceride level. .?

Many thanks

Elaine.

[Ader42 in reply to Hidden]

2.2 is considered Borderline High. Normal level is below 1.7

[Hidden in reply to Ader42]

Thank you.

[MichaelJH Heart Star in reply to Hidden]

My last blood test gave a total cholesterol of 3.0 and LDL of 1.6. I will have to dig out the results but would imagine mine is below 1. 0.

[Hidden in reply to MichaelJH]

My serum LDL cholesterol is 4, I’ve got an appointment in a few weeks which my doctor told me to pre book pre blood test. The doctor has seen the results and has put no further action required, patient informed but nobody has told me anything 🤯 The only reading over the acceptable level was the 2.2 high for a Triglyceride level.

I will give her a call tomorrow 😁 thanks Michael

Elaine ❤️

[MichaelJH Heart Star in reply to Hidden]

Will check my results later and post back if anything seems relevant.

[Ader42 in reply to MichaelJH]

2 years ago my TC was 9, my LDL was 7 and my TG 1.3 - I am waiting on results to see what my figures are now - I had a HA two weeks ago and so am on a statin and am interested to find out how my lipids change on the statin and aim to find out why my LDL is high - I suspect it’s LP(a) rather than sdLDL.

To lower TG, cut out sugar and flour.

[MichaelJH Heart Star in reply to MichaelJH]

Sorry for the delay - I had to double check as it does not add up to me.

Total cholesterol 3.0

LDL 1.6

HDL 1.0

Triglycerides 0.9

I thought the Total was the sum of the other three but they add up to 3.5. Anyone got any thoughts?

[Ader42 in reply to MichaelJH]

Triglycerides are not Cholesterol, but they do contain some Cholesterol. Btw, your LDL level is not measured directly but is calculated from TC, HDL & TG. If your TG level is high then your reported LDL level is less accurate. The formula is usually LDL = TC - HDL - (Tg/5). Also TG levels do tend to vary quite a lot day to day making the LDL level reported on standard lipid panels even less accurate. Your HDL is low, eat some eggs!

[Gail1967]

Finding this all fascinating- waiting for further lipid results after a visit to hospital last week to search for answers. Have cholesterol levels all within what is considered good levels yet had cabg x 4 at 51 even though no risk factors apply. So I know it’s genetic and if lipid test shows the b on ldl has contributed it will make sense.

[MichaelJH Heart Star in reply to Gail1967]

My father, his brother and their father all died prematurely from heart attacks. When I developed angina I was told it was because I was diabetic despite a cholesterol of 4.2 and in range BP. Cardiologist and surgeon agreed family history was horrendous, and that diabetes was a complication not a cause! One nurse tried to blame smoking as when asked I told the cardiologist I had smoked for two years but nothing since 1975. He agreed diesel fumes since we're probably more damaging! Some people love the blame game. One person said I must have been a fat child to have got (Type I) diabetes - total moron!

[Hidden in reply to MichaelJH]

There's a lot of "that" going on (that does concern me lately).

Are they basically saying, "we got to say something to fill things (as Doctors)!".

Cholesterol doesn't seem to be associated with narrowing the artery.

I notice the trend in my GP (only in my recent telephone consultation).

I know someone who's very young with T1/2D. T1/2Ds sometimes seem to go together if you are not careful? What amazes me is that his Dad (diagnosed with T2D) asks him if his son enjoyed the MacDonald meal at such and such place. It appears that his Son loves his fast food and his Dad seems to encourage his fast food diet. His Dad tells me that he nearly died from Cardiac complications, leading to multi-organ failure. He's only 20 years old.

[MichaelJH Heart Star in reply to Hidden]

When I was in my teens another young diabetic died of kidney failure - he was but 19!

[Hidden in reply to MichaelJH]

It's a fact that T1D is the most vicious type of D!

I also carry a gene for T1D myself, likely Dad, who was on a very strange diet.

Iggy of S was on Macrobiotic for many years. I often wondered if he had some metabolic issues going on.

[Ader42]

Funnily enough if he is eating big macs, it’s probably the bread bun that is doing him most damage.