One of the most popular lab tests is Cholesterol total. This biomarker provides a good picture of how your body deals with lipids and fat. But how to interpret it? Is the total more important than the other factors?
An overview of cholesterol
Total cholesterol can be determined in two ways. It can be measured directly in the blood, or it can be calculated. The calculation takes into account the two main forms of cholesterol - HDL (high-density lipoprotein) and LDL (low-density lipoprotein) - as well as a small fraction of triglycerides. Each of these three components affects total cholesterol. Here is a short definition of the three cholesterol values:
- HDL: High-density lipoprotein is a protective form of cholesterol that helps to remove harmful particles from the blood circulation before they can cause damage to blood vessels. This process earned it the nickname "good cholesterol."
- LDL: low-density lipoprotein is basically a dangerous form of cholesterol that leads to the hardening of arteries. If LDL builds up, it can lead to blockages - which can cause serious cardiovascular problems. LDL is therefore called the "bad cholesterol".
- Triglycerides: a form of stored fat that circulates in the bloodstream. Elevated Triglycerides are usually caused by being overweight, consuming too many calories, alcohol, lack of exercise, liver damage or by a genetic disorder.
How do you interpret the results?
To answer the above question, it is important to know which biomarker (or combination of the three) is responsible for skewing total cholesterol. Three scenarios can be responsible for high total cholesterol:
- High total cholesterol, high LDL cholesterol, low HDL cholesterol and high triglycerides
Major alert! This is the most dangerous combination of lipid markers. In this ratio, where a high LDL is paired with a low HDL, the risk of developing cardiovascular disease is high. It is very important to lower LDL cholesterol and raise HDL cholesterol to help fight the "bad" LDL. The ratio of HDL to LDL is very important.
- High total cholesterol, normal LDL, high HDL, normal triglycerides
In this case, high total cholesterol is less alarming because it is largely due to elevated HDL (good cholesterol). The fact that HDL is high and LDL is normal makes for a favorable HDL: LDL ratio. Extremely high HDL cholesterol can also be caused by genetic predisposition.
- High total cholesterol, normal LDL cholesterol, normal HDL cholesterol, very high triglycerides
Although triglycerides contribute only a small amount to the total cholesterol value, very high levels can drastically affect this value and can be alarming. High triglycerides, especially without high HDL or LDL values, can indicate problems in the liver, where triglycerides are made. You should then test your liver values (ASAT, ALAT and GAMMA GT) to see if the problem is caused by the liver. - In that case the liver values are increased. Elevated triglycerides can be harmful to the cardiovascular system, but can also lead to acute pancreatitis (inflammation of the pancreas), which requires immediate medical attention.
What about the size of the LDL particles?
There is much ado among health gurus about the size of LDL particles. As mentioned earlier, LDL is low-density lipoprotein. The "low" density is due to its high fat content, which is not really a dense substance (think salad dressing when it separates - the oil floats to the top). HDL, on the other hand, has a lower fat-to-protein ratio than LDL, making it more dense.
LDL is particularly troublesome because of its ability to oxidize, which causes it to penetrate the blood vessels and harden there. This can cause blockages over time. At this point, particle size becomes important: smaller LDL particles can be more easily retained in the arteries. The larger LDL particles appear to be less dangerous.
Unfortunately, the size of LDL particles is a new discovery in science. While it is promising, it should not yet be used to determine and monitor a person's risk of cardiovascular disease.
Since this requires much further research, Blood Values Test has not yet included LDL particle size in our fat profile. In the meantime, it seems that there is a link between small LDL particles and high triglycerides coupled with low HDL.
How to make the "bad" a little better
The oxidation and hardening of LDL is largely responsible for heart disease. Therefore, lowering LDL is the most important issue to address when you want to improve heart health (tip: increase soluble fiber and limit saturated fat intake).
Once you reach optimal levels, protecting the LDL from oxidation is just as important. Free radicals (the same ones that cause inflammation) are the main stimulus for oxidation. They are opposed by antioxidants, hence the name. Therefore, it is advisable to eat anti-inflammatory foods to limit the damage of LDL.
Common antioxidants are vitamins A, C, and E, as well as selenium. These are abundant in dark leafy vegetables, bright red, orange or yellow fruits and vegetables, citrus, berries, broccoli, bell pepper, and nuts and seeds - eat a daily serving of at least one of these foods. Dark chocolate and red wine in moderation are also high antioxidant foods.
What tests can you do?
With the medical check-up general blood test and the National Health Check-up, the entire fat profile is measured. So it is not always the case that you can add up HDL and LDL, because every part of the cholesterol profile is measured separately at Blood Values Test. From this measured value, the :
- Cholesterol /HDL ratio
- Cholesterol LDL/HDL risk index
calculated, for an even better interpretation of your fat profile.
Of course it is also possible to measure the fat profile separately or to supplement this test with other blood values of your choice. In this way you can compose your own customized test without a referral from your doctor.
Explanation of the results of the cholesterol tests
The desired amount of cholesterol is 5.0 mmol/l or lower. This does not increase the risk of cardiovascular disease.
Slightly elevated: A cholesterol level between 5 mmol/l and 6.5 mmol/l slightly increases the risk of cardiovascular disease. A lipid profile can be used to examine how much 'good' (HDL) and 'bad' (LDL) cholesterol is present in the blood. Depending on this examination, it will be determined whether (and which) treatment is necessary.
Elevated: A cholesterol above 6.5 mmol/l increases the risk of cardiovascular disease. On the basis of a lipid profile and other tests, the cause of the high cholesterol can be further investigated. If the cause is known, an appropriate treatment will be prescribed. High cholesterol is also common in patients who are being treated and who have not yet reached their target value. The target value is usually determined on the basis of LDL cholesterol. See also http://www.hartstichting.nl/risicofactoren/hoog_cholesterol/wanneer_te_hoog/
The cholesterol level fluctuates naturally. It is sensible to have these values measured regularly.
Patients with cardiovascular disease and/or type 2 diabetes have an extra interest in a low cholesterol level. Stricter target values have therefore been drawn up for these patients, namely an LDL cholesterol level of at least 2.5 mmol/l and a total cholesterol level of less than 4.5 mmol/l.
HDL cholesterol is "good" cholesterol and therefore a high HDL value is better than a low one. An HDL lower than 1.04 mmol/L is considered a higher risk of cardiovascular disease. Values between 1.04 and 1.55 mmol/L generally mean moderate risk and values above 1.55 indicate low risk of cardiovascular disease. It is common to look at the ratio of total cholesterol to HDL cholesterol. This ratio must be less than 5, but less than 3.5 is best. However, it is very important to look at the results of the individual tests when assessing this ratio. For a correct interpretation, consultation with the GP is necessary. Recent developments show that not only the concentration of the HDL is important, but also the efficacy of the HDL particle. It happens that the cholesterol is lowered during illness, a few days after a heart attack or during stress. In pregnancy, the HDL cholesterol is often abnormal (higher or lower) compared to the normal situation. Therefore it is better to do the test at least 6 weeks after pregnancy.
A high HDL-cholesterol is favorable and a high LDL-cholesterol and a high triglyceride level is unfavorable. HDL cholesterol is responsible for the transport of cholesterol from the artery wall to the liver. The higher the HDL cholesterol, the better the removal of excess cholesterol to the liver.
The test measures the amount of LDL cholesterol in the blood. LDL belongs to the group of so-called lipoproteins, which transport fats - such as cholesterol and triglycerides - in the body. LDL mainly transports cholesterol from the gastrointestinal tract to the vessel wall. Increased concentrations of LDL cholesterol are undesirable because they cause cholesterol to be deposited on the walls of the blood vessels. This can lead to a stiff vessel wall, reduced blood flow and even blockage of the blood vessel. This can cause cardiovascular disease, which can lead to a heart attack or stroke. LDL cholesterol is also called the "bad" cholesterol. For most healthy people, the value of LDL cholesterol between 2.0 and 4.5 mmol / l. However, the target value for LDL cholesterol is less than 3.0 mmol / l. Of all the forms of cholesterol, LDL cholesterol is considered the most important risk factor for causing cardiovascular disease. An appropriate diet and more exercise (for those with a sedentary lifestyle) can improve your cholesterol values over time.
LDL/HDL risk index Cholesterol ratio
The cholesterol ratio is a good predictor of your risk of cardiovascular disease. The cholesterol ratio is the ratio between the total cholesterol and the HDL cholesterol in your body. The calculation of the cholesterol ratio: Total cholesterol / HDL cholesterol = Cholesterol ratio
The total cholesterol consists of LDL cholesterol + triglycerides + HDL cholesterol. An increased total cholesterol, especially an increased LDL cholesterol, is an important risk factor for the occurrence of cardiovascular diseases. Triglycerides also have a bad influence on the health of the vessel wall. On the other hand, several studies have shown a strong beneficial relationship between the concentration of HDL cholesterol and the risk of cardiovascular disease. That is, a high HDL-cholesterol reduces the risk.
The opposite effects of the bad fats (LDL and triglycerides) and the good HDL cholesterol, is the reason that the cholesterol ratio can be used as a risk predictor. To reduce the risk, it is important that the balance between good and bad is as favourable as possible. So it is beneficial if the total cholesterol is low while the HDL cholesterol is high, resulting in a low cholesterol ratio. However, if in addition to a low HDL, you have a high LDL or triglyceride level, the cholesterol ratio and thus the risk of cardiovascular disease is increased.
An optimal cholesterol ratio is 4 or lower
Triglycerides are fats in the blood that are used by the body as a source of energy. If your triglycerides are elevated, this can accelerate the process ofarteriosclerosis and eventually even causecardiovascular disease. It is therefore important to keep your triglyceride values low.
Suggestions in lowering your triglycerides.
- Increase use of monounsaturated fatty acids (e.g. olive oil, rapeseed oil, sunflower oil) to replace bad fats
- Make sure you get enough vitamin C
- Avoid refined carbohydrates such as sugar
- Drink less alcohol
Suitable foods include: Avocado, Blue grape, Lentils, Nut oil, Olive oil, Pine nuts, Pumpkin oil or seeds, Leeks, Garlic, Spring onion, Linseed, Sesame paste or seed, Shi take, Soy, Soy yogurt, Bean sprouts, Fish, Walnuts, White beans.