August 13, 2025 • 18 mins
Nearly half of all heart attack patients have cholesterol levels considered “normal” by standard tests. In this episode of The Health Pulse, we explore the limitations of traditional cholesterol panels and how advanced lipid testing uncovers hidden cardiovascular risks long before symptoms appear.
We break down the power of markers like LDL particle number (LDL-P), apolipoprotein B (ApoB), small dense LDL, and lipoprotein(a)—plus inflammatory markers that reveal whether arterial plaques are stable or primed to rupture. You’ll learn why these tests are stronger predictors of heart disease than LDL-C alone, and how they can personalize your prevention strategy.
From targeted dietary changes and exercise protocols to anti-inflammatory lifestyle shifts and precision medication use, advanced testing moves prevention from generic advice to data-driven action. If you have a family history of early heart disease, insulin resistance, or unexplained risk factors, this episode could be your wake-up call.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:25):
Welcome to the Deep Dive.
Today we're really getting intosomething quite startling.
There's this fact from theAmerican Heart Association.
It says nearly half of allpeople who have a heart attack
actually have cholesterol levelsthat are considered normal.
Yeah, it's a statistic thatreally makes you stop and think,
doesn't it?
It really does, because youknow cardiovascular disease is
(00:46):
still the number one killerglobally.
Yet for so many of us, thatstandard cholesterol test we get
the one measuring totalcholesterol, ldl-c, hdl-c,
triglycerides.
Speaker 3 (00:56):
Fool, it might be giving a false sense of security
.
Speaker 2 (01:00):
It often misses the hidden dangers.
Speaker 3 (01:01):
Exactly.
The reality is not allLDL-collectrol is the same.
Things like the number ofparticles, how big they are,
what they're actually composedof, these can totally change
your actual risk, even if thebasic numbers look okay, right,
so that's our mission today inthis deep dive, why are standard
tests sometimes misleading?
What do these advanced markersreally show us, who really
(01:22):
benefits most?
And you know, crucially, whatcan you actually do with this
information?
And that's precisely whereadvanced lipid testing comes in.
It looks beyond those surfacelevel numbers to find those
silent risks, the ones standardtests just don't pick up.
This allows for well, much moretargeted, much more effective
prevention.
Speaker 2 (01:40):
Okay, so for years that standard lipid panel, it's
been the go-to, the cornerstonefor checking heart risk and yeah
, it has its place, definitelycatches major issues.
But, like we said, it's gotsome pretty big blind spots.
It really is.
Can you maybe explain why justlooking at LDL-C, the bad
cholesterol number, can be somisleading?
Speaker 3 (02:00):
Absolutely.
The main problem is that LDL-Cmeasures the cholesterol content
inside the LDL particles.
It doesn't tell you the actualnumber of those particles.
Think of it like traffic yourLDL-C might be low, suggesting
not much cargo, but you couldstill have a huge number of LDL
particles, a massive traffic jamof tiny cars and it's a sheer
(02:21):
number of those particles, thosecars, that increases the chance
of them bumping into anddamaging your artery walls.
Speaker 2 (02:27):
So more cars on the road, even if they aren't fully
loaded, means more potential foraccidents, basically.
Speaker 3 (02:33):
Precisely.
Or you could have a high LDL-C,lots of cargo, but if it's
carried in fewer, larger,fluffier particles, your risk
might actually be lower thansomeone with a lower LDL-C but
tons of small particles.
And the research maxed this out.
Study after study shows thatLDL particle number, which we
call LDL-P, and another marker,apolipoprotein B or APO-B, are
(02:56):
much better predictors of heartattacks and strokes than LDL-C
alone.
Speaker 2 (03:01):
Okay, so it's not just the total weight of the
cargo, but how many deliverytrucks are actually out there
potentially causing trouble.
That really explains thatnormal cholesterol heart attack
thing, doesn't it?
Speaker 3 (03:10):
It does.
Up to half of heart attackpatients have LDL-C levels
considered normal by standardguidelines.
Speaker 2 (03:16):
It's like looking at a lake that looks calm on top,
but you're completely missingthe dangerous currents
underneath.
Advanced lipid testing, then,is like putting on scuba gear
and actually seeing what's goingon below the surface, and it
shows you the full picture.
Speaker 3 (03:30):
Much clearer picture.
Speaker 2 (03:31):
yes, so if the basic test is missing, all this, what
exactly are these advanced lipidtests measuring?
This is where it gets reallyinteresting, I think.
Speaker 3 (03:42):
It is.
We're going beyond justslightly better numbers.
We're uncovering genuinelyhidden risk factors.
Speaker 2 (03:47):
Okay, break it down for us.
What are the key markers?
Speaker 3 (03:49):
Okay, so first there's LDL particle number,
LBLP, as we just talked about.
This is the actual count of LDLparticles.
More particles, even if theyaren't packed with cholesterol,
mean more chances to get intothe artery wall and start the
plaque process.
High LDL-P is strongly linkedto atherosclerosis progressing.
Speaker 2 (04:06):
Right, the traffic volume Got it.
Speaker 3 (04:07):
Then you have LDL particle size and pattern.
This looks at whether your LDLparticles are mostly large and
buoyant, which we call pattern A, generally less harmful, less
atherogenic.
Speaker 2 (04:17):
Less likely to cause plaque.
Speaker 3 (04:19):
Exactly, or if they're mostly small and dense,
which is pattern B, these smalldense ones are nastier.
They're mostly small and dense,which is pattern B.
These small, dense ones arenastier.
They're more easily damaged oroxidized, they trigger more
inflammation and they slip intothe artery wall more easily.
We often see pattern B inpeople with insulin resistance
or diets high in refined carbs.
Speaker 2 (04:36):
So the small, dense ones are like tiny, sticky
little troublemakers compared tothe big, fluffy ones.
Speaker 3 (04:42):
That's a great way to put it and related to this is
apolipoprotein B, or APOB.
This one's incredibly important.
Why?
Because every single particlethat can cause atherosclerosis
LDL, vldl, lpa, all the bad guyscarries exactly one APOB
molecule on its surface.
Speaker 2 (04:58):
Oh interesting.
So one APOB per bad particle.
Speaker 3 (05:02):
One per particle.
So measuring APOB gives you adirect count of the total number
of potentially harmfulparticles.
It's considered one of theabsolute best predictors of
cardiovascular risk we have.
Speaker 2 (05:13):
Wow, okay, that seems really crucial.
Speaker 3 (05:15):
It is.
And to balance that, we alsolook at apolipoprotein A1 or
ApoA1.
That's the main protein on yourHDL, your good cholesterol
particles.
So the ratio of ApoB to ApoA1gives you a really powerful
snapshot of the balance betweenharmful and protective
lipoproteins in your system.
Speaker 2 (05:31):
Okay, the balance Makes sense.
Speaker 3 (05:32):
Yeah.
Next up is lycoprotein, or LPA.
This is kind of a unique one.
It's basically a type of LDLparticle with an extra protein
attached, and it's largelydetermined by your genetics.
High LPA significantlyincreases heart disease risk,
independently of othercholesterol levels.
Even if everything else looksperfect, high LPA is a major
(05:55):
risk factor.
Speaker 2 (05:55):
The genetic wild card .
You called it earlier.
Speaker 3 (05:57):
Exactly.
Then there's LPPLA2.
This is an enzyme that'sspecifically involved in
inflammation within the bloodvessel walls.
High levels suggest there'sactive inflammation happening in
your arteries, potentiallymaking plaque unstable.
Speaker 2 (06:10):
So it signals active trouble brewing.
Speaker 3 (06:13):
Active inflammation, yes, which is a key part of risk
.
And finally, advanced testsoften look at HDL particle
number and function.
It's not just how much HDLcholesterol you have, HDLC, but
how many HDL particles areworking and how well they're
doing their job, which is calledreverse cholesterol transport.
Speaker 2 (06:30):
Their job of cleaning up the arteries, basically.
Speaker 3 (06:31):
That's right, pulling cholesterol out of the walls
and taking it back to the liver.
More particles doing their jobeffectively is better.
Speaker 2 (06:38):
Okay, wow, that's a lot more detailed.
So it's clear advanced testingisn't about replacing the
standard one necessarily, butabout adding this layer of
precision.
Speaker 3 (06:48):
Exactly, precision and personalization.
Speaker 2 (06:50):
So you can catch things before they become, you
know, really serious problems.
Speaker 3 (06:54):
And what's so fascinating, I think, is how
these markers really connect thedots.
They explain the mechanismsbehind heart disease much better
.
They tell us why someone withnormal total cholesterol can
still have a heart attack.
Speaker 2 (07:08):
Right, it's not just about the total amount of
cholesterol floating around.
Speaker 3 (07:11):
No, it's often about the type of particles, the
number of them and how they'reinteracting with inflammation in
your body.
Speaker 2 (07:18):
Which brings us back to LDL, particle number and APOB
.
Again, you keep highlightingthose.
Speaker 3 (07:23):
Because they're such powerful predictors.
It boils down to this the moreparticles there are, regardless
of how much cholesterol isinside each one, the more
opportunities there are forthose particles to penetrate the
artery wall and initiate damage.
That's the direct link toatherosclerosis.
Speaker 2 (07:38):
Okay, and what about those small dense LDL particles?
You mentioned the stealthcholesterol.
Yes, let's focus direct link toatherosclerosis.
Okay, and what about thosesmall dense?
Speaker 3 (07:43):
LDL particles.
You mentioned the stealthcholesterol.
Yes, let's focus on those for amoment.
These small dense LDL particlesare particularly problematic.
They oxidize or get damagedmuch more easily than larger LDL
.
This oxidized LDL is a majortrigger for inflammation in the
artery wall.
Plus, because they're small,they can wiggle their way into
the artery lining more easily.
(08:03):
We see a lot of these in peoplewith insulin resistance,
metabolic syndrome or diets highin sugar and refined carbs.
And here's the kicker Havingmostly small dense LDL can
potentially triple your risk ofheart disease, even if your main
LDL-C number looks perfectlyfine.
Speaker 2 (08:19):
Triple the risk, wow, okay.
And then there's LPA, thegenetic wildcard.
Speaker 3 (08:22):
Right, lpa is a big one because it adds risk on top
of everything else.
High LPA is an independent riskfactor and critically it's
mostly genetic, meaning diet andexercise don't usually lower it
very much.
Speaker 2 (08:32):
So knowing your LPA number is really important for
understanding your baselinegenetic risk.
Speaker 3 (08:37):
Absolutely.
If it's high, it signals theneed for perhaps earlier
screening for plaque buildup,being much more aggressive about
managing other risk factors youcan control and maybe
considering newer therapies thatare being developed
specifically to target LPA.
Speaker 2 (08:50):
Got it.
And you also mentionedinflammation markers like LPPLA2
and HSCRP.
Why is assessing inflammationso critical?
Speaker 3 (08:59):
Because many, maybe even most, heart attacks aren't
caused by a slow, gradualnarrowing of the artery until
it's completely blocked.
They happen when an existingplaque often one that wasn't
even causing major blockagebecomes inflamed and ruptures.
Speaker 2 (09:14):
Ah, so it breaks open suddenly.
Speaker 3 (09:16):
Exactly.
It ruptures, a clot formsinstantly on that ruptured
surface and that clot blocks theblood flow.
It's often a sudden eventtriggered by inflammation, so
knowing your level of vascularinflammation gives you insight
into how stable or unstable yourplaque might be.
Speaker 2 (09:30):
Okay, that makes sense.
So the real takeaway here, thekey insight, is that advanced
lipid testing shifts the wholequestion.
It's not just how muchcholesterol do you have.
Speaker 1 (09:39):
Yeah.
Speaker 2 (09:39):
It's how likely is the cholesterol you do have to
actually cause damage.
That's not just how muchcholesterol do you have, it's
how likely is the cholesterolyou do have to actually cause
damage.
Speaker 3 (09:43):
That's the crucial distinction.
Speaker 2 (09:45):
And getting that right could literally be the
difference between missing ahuge hidden risk and catching it
early enough to do somethingabout it Precisely.
So this is all fascinating, butwhat does it mean for you, the
listener, who should actually bethinking about getting these
advanced tests?
While you know almost anyonecould potentially benefit, are
(10:06):
there specific groups who standto gain the most?
Speaker 3 (10:08):
Definitely, there are groups where this testing is
particularly valuable.
First, think about people witha family history of early heart
disease If your father orbrother had a heart attack or
stroke before age 55, or yourmother or sister before 65.
Speaker 2 (10:23):
That suggests a genetic component.
Speaker 3 (10:30):
Exactly.
It strongly suggests theremight be something genetic going
on, like high LPA or a tendencytowards those small dense LDL
particles things.
A standard test would totallymiss.
Speaker 2 (10:36):
Okay, family history, who else?
Speaker 3 (10:38):
Second, individuals with normal cholesterol but
other risk factors.
This is a big category.
Maybe your cholesterol numberslook okay but you have high
blood pressure or maybeprediabetes, high fasting
insulin, signs of metabolicsyndrome, maybe carrying extra
weight around the middle.
Speaker 2 (10:53):
So other signs that metabolism isn't quite right.
Speaker 3 (10:55):
Yes, these individuals often have those
hidden harmful patterns likehigh particle numbers or small
dense LDL, even if their LDL-Cis technically normal.
Advanced testing can uncoverthat discordance Right.
That makes sense.
Third, and this is reallyimportant, people with insulin
resistance or type 2 diabetes.
Diabetes significantly changeslipoprotein metabolism.
(11:16):
It often leads to highertriglycerides, lower good HDL
and specifically an increase inthose small dense, more
dangerous LDL particles.
Plus often lower numbers of HDLparticles too.
Even if their LDL-C lookscontrolled on medication, the
particle profile might still bequite risky.
Speaker 2 (11:34):
Okay, so diabetes is a clear flag.
Speaker 3 (11:35):
A very clear flag.
Fourth, an interesting groupathletes and people on low-carb
or ketogenic diets who see theirLDL-C go up.
Sometimes LDL-C can jump quitehigh on these diets.
Speaker 2 (11:47):
Yeah, you were about that.
Speaker 3 (11:48):
But particle testing often shows that these
individuals have developed largebuoyant LDL particles, pattern
A and their AMOB.
That total count of badparticles might actually be low
or normal.
In this case, the high LDL-Cisn't necessarily indicating
high risk and advanced testingcan clarify that, potentially
avoiding unnecessary worry ormedication.
Speaker 2 (12:10):
Ah, so it provides crucial context for those
specific situations.
Speaker 3 (12:13):
It does.
And finally, patients withborderline or just unexplained
results.
If your doctor says yourcholesterol is borderline, or
maybe your triglycerides arealways a bit high and no one's
quite sure why, advanced testingcan cut through the ambiguity
and show whether there's agenuinely concerning pattern or
something more benign.
Speaker 2 (12:29):
Okay, show whether there's a genuinely concerning
pattern or something more benign.
Okay, so to sum that up familyhistory, metabolic issues, even
with normal cholesterol,diabetes, specific dietary
changes like keto causing highODLC or just unclear results
these are all really strongreasons to consider diving
deeper.
Speaker 3 (12:43):
Absolutely.
In those cases it can providecritical information, either
reassurance or a clear call toaction.
Speaker 2 (12:52):
And it's worth mentioning, there are panels
available, like the QLM AdvancedCardio IQ Elite panel, that
bundle all these key markerstogether to give you that
comprehensive view.
Speaker 3 (12:58):
Yes, those integrated panels are very helpful for
getting the full picture in onego.
Speaker 2 (13:03):
Now, getting the test is one thing, but it's only
really valuable if it leads toaction right.
Speaker 3 (13:07):
Absolutely.
The data is only powerful ifyou use it.
Speaker 2 (13:10):
The real strength of advanced lipid testing seems to
be in enabling trulypersonalized prevention, moving
beyond just generic advice likeeat less fat or exercise more.
Speaker 3 (13:25):
Exactly.
It lets you tailor strategiesbased on your specific lipid
profile.
It becomes data driven.
So let's talk about someconcrete examples.
Okay, Say, your results showhigh ApoB or high LDL particle
number.
What might you do?
Well, dietary changes couldinclude reducing refined carbs
and perhaps processed seed oils,while really boosting soluble
fiber think avocados, chia seeds, flax seeds, psyllium husk and
prioritizing omega-3 fats fromsources like wild salmon,
(13:48):
sardines, macros.
Speaker 2 (13:49):
So targeting the particle number specifically
through diet.
Speaker 3 (13:51):
Yes.
Now what if the main issue is apredominance of small dense LDL
particles, pattern B?
Here the focus might shift evenmore strongly towards reducing
sugar and processedcarbohydrates, maybe increasing
nutrient-dense healthy fats andquality protein, to really work
on improving insulin sensitivity, as that's often linked.
Speaker 2 (14:11):
Right Tackling the insulin resistance connection.
Speaker 3 (14:14):
If triglycerides are high.
The big levers are oftenlimiting fructose, especially
from sugary drinks, desserts,and cutting back on alcohol
intake.
Speaker 2 (14:22):
OK, diet makes sense.
What about exercise?
Can that be tailored to?
Speaker 3 (14:25):
Yes, definitely.
For example, resistancetraining, lifting weights, has
been shown to improve thefunction of your HDL particles,
helping them do their cleanupjob better.
Speaker 2 (14:34):
Interesting, not just cardio.
Speaker 3 (14:36):
Not just cardio and things like high-intensity
interval training or HIIT can beparticularly effective for
lowering triglycerides and caneven help shift LDL particles
towards that larger, lessharmful pattern over time.
Speaker 2 (14:50):
So mixing up your exercise routine based on your
results could be beneficial.
Speaker 3 (14:54):
It can be.
And then there's inflammation.
If your HSCRP or LPPLA2 iselevated, that's a clear signal
to double down onanti-inflammatory strategies.
This means prioritizing sleep,aiming for seven to nine hours,
consistently Actively managingstress is huge meditation, deep
breathing, spending time innature whatever works for you
(15:14):
and, of course, incorporatinganti-inflammatory foods turmeric
, ginger, green tea, berries,leafy greens, fatty fish.
Speaker 2 (15:21):
Right the life-solving factors for
inflammation.
Speaker 3 (15:23):
And sometimes targeted supplementation can
play a role, always bestdiscussed with your doctor, of
course.
Omega-3 fatty acids,particularly EPA and DAJ, are
well known for loweringtriglycerides and can help
reduce small LDL particles.
Niacin, in certain forms andunder medical supervision, might
help lower LPA for some people,but it needs careful handling.
(15:43):
Magnesium is also important foroverall vascular health and
insulin sensitivity.
Speaker 2 (15:48):
Okay, and what about medications?
Speaker 3 (15:49):
Well, this advanced testing can provide much clearer
justification for whenmedications are truly needed If
you have very high particlenumbers or genetically high LPA,
or persistent inflammationdespite lifestyle efforts.
It strengthens the case forconsidering statins or maybe
newer agents like PCSK9inhibitors or those emerging
(16:10):
therapies specifically targetingLPA.
It helps make that decisionmore precise and evidence-based.
Speaker 2 (16:17):
So it helps target medication more effectively too.
Speaker 3 (16:19):
Yes, ensuring the right people get the right
treatment at the right time.
Speaker 2 (16:22):
Okay, so let's try and wrap this up.
The core message seems prettyclear.
Speaker 3 (16:26):
I think so.
Heart disease remains theworld's biggest killer, partly
because, well, too many crucialrisks just go undetected by
standard methods.
Speaker 2 (16:36):
Right, those standard cholesterol tests.
While they have a place, theycan often give this false sense
of security or just completelymiss key factors driving risk.
Speaker 3 (16:43):
They paint an incomplete picture.
Speaker 2 (16:44):
And that's really where advanced lipid testing
comes in and, frankly, changesthe game by looking beyond just
the basic cholesterol numbers,by measuring particle number,
particle size, apob, thatgenetic wildcard, lpa and those
key inflammation markers.
Speaker 3 (16:59):
You can identify dangerous patterns much, much
earlier, long before they leadto an actual event.
Speaker 2 (17:04):
And having that deeper level of information that
empowers both you, the listener, and your doctor to create
genuinely personalizedprevention plans.
Speaker 3 (17:13):
Exactly, Whether that involves fine-tuning your diet
in specific ways, using targetedexercise strategies really
focusing on reducinginflammation, or knowing when
medication is truly warranted.
Speaker 2 (17:24):
It moves prevention from guesswork to precision.
So, as we finish up, maybesomething for you to think about
.
What's one aspect of your ownhealth, maybe something you
thought you had a good handle onthat you now realize might have
a deeper, hidden story justwaiting to be uncovered?
Speaker 1 (17:44):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:25):
Welcome to the Deep Dive.
Today we're really getting intosomething quite startling.
There's this fact from theAmerican Heart Association.
It says nearly half of allpeople who have a heart attack
actually have cholesterol levelsthat are considered normal.
Yeah, it's a statistic thatreally makes you stop and think,
doesn't it?
It really does, because youknow cardiovascular disease is
(00:46):
still the number one killerglobally.
Yet for so many of us, thatstandard cholesterol test we get
the one measuring totalcholesterol, ldl-c, hdl-c,
triglycerides.
Speaker 3 (00:56):
Fool, it might be giving a false sense of security
.
Speaker 2 (01:00):
It often misses the hidden dangers.
Speaker 3 (01:01):
Exactly.
The reality is not allLDL-collectrol is the same.
Things like the number ofparticles, how big they are,
what they're actually composedof, these can totally change
your actual risk, even if thebasic numbers look okay, right,
so that's our mission today inthis deep dive, why are standard
tests sometimes misleading?
What do these advanced markersreally show us, who really
(01:22):
benefits most?
And you know, crucially, whatcan you actually do with this
information?
And that's precisely whereadvanced lipid testing comes in.
It looks beyond those surfacelevel numbers to find those
silent risks, the ones standardtests just don't pick up.
This allows for well, much moretargeted, much more effective
prevention.
Speaker 2 (01:40):
Okay, so for years that standard lipid panel, it's
been the go-to, the cornerstonefor checking heart risk and yeah
, it has its place, definitelycatches major issues.
But, like we said, it's gotsome pretty big blind spots.
It really is.
Can you maybe explain why justlooking at LDL-C, the bad
cholesterol number, can be somisleading?
Speaker 3 (02:00):
Absolutely.
The main problem is that LDL-Cmeasures the cholesterol content
inside the LDL particles.
It doesn't tell you the actualnumber of those particles.
Think of it like traffic yourLDL-C might be low, suggesting
not much cargo, but you couldstill have a huge number of LDL
particles, a massive traffic jamof tiny cars and it's a sheer
(02:21):
number of those particles, thosecars, that increases the chance
of them bumping into anddamaging your artery walls.
Speaker 2 (02:27):
So more cars on the road, even if they aren't fully
loaded, means more potential foraccidents, basically.
Speaker 3 (02:33):
Precisely.
Or you could have a high LDL-C,lots of cargo, but if it's
carried in fewer, larger,fluffier particles, your risk
might actually be lower thansomeone with a lower LDL-C but
tons of small particles.
And the research maxed this out.
Study after study shows thatLDL particle number, which we
call LDL-P, and another marker,apolipoprotein B or APO-B, are
(02:56):
much better predictors of heartattacks and strokes than LDL-C
alone.
Speaker 2 (03:01):
Okay, so it's not just the total weight of the
cargo, but how many deliverytrucks are actually out there
potentially causing trouble.
That really explains thatnormal cholesterol heart attack
thing, doesn't it?
Speaker 3 (03:10):
It does.
Up to half of heart attackpatients have LDL-C levels
considered normal by standardguidelines.
Speaker 2 (03:16):
It's like looking at a lake that looks calm on top,
but you're completely missingthe dangerous currents
underneath.
Advanced lipid testing, then,is like putting on scuba gear
and actually seeing what's goingon below the surface, and it
shows you the full picture.
Speaker 3 (03:30):
Much clearer picture.
Speaker 2 (03:31):
yes, so if the basic test is missing, all this, what
exactly are these advanced lipidtests measuring?
This is where it gets reallyinteresting, I think.
Speaker 3 (03:42):
It is.
We're going beyond justslightly better numbers.
We're uncovering genuinelyhidden risk factors.
Speaker 2 (03:47):
Okay, break it down for us.
What are the key markers?
Speaker 3 (03:49):
Okay, so first there's LDL particle number,
LBLP, as we just talked about.
This is the actual count of LDLparticles.
More particles, even if theyaren't packed with cholesterol,
mean more chances to get intothe artery wall and start the
plaque process.
High LDL-P is strongly linkedto atherosclerosis progressing.
Speaker 2 (04:06):
Right, the traffic volume Got it.
Speaker 3 (04:07):
Then you have LDL particle size and pattern.
This looks at whether your LDLparticles are mostly large and
buoyant, which we call pattern A, generally less harmful, less
atherogenic.
Speaker 2 (04:17):
Less likely to cause plaque.
Speaker 3 (04:19):
Exactly, or if they're mostly small and dense,
which is pattern B, these smalldense ones are nastier.
They're mostly small and dense,which is pattern B.
These small, dense ones arenastier.
They're more easily damaged oroxidized, they trigger more
inflammation and they slip intothe artery wall more easily.
We often see pattern B inpeople with insulin resistance
or diets high in refined carbs.
Speaker 2 (04:36):
So the small, dense ones are like tiny, sticky
little troublemakers compared tothe big, fluffy ones.
Speaker 3 (04:42):
That's a great way to put it and related to this is
apolipoprotein B, or APOB.
This one's incredibly important.
Why?
Because every single particlethat can cause atherosclerosis
LDL, vldl, lpa, all the bad guyscarries exactly one APOB
molecule on its surface.
Speaker 2 (04:58):
Oh interesting.
So one APOB per bad particle.
Speaker 3 (05:02):
One per particle.
So measuring APOB gives you adirect count of the total number
of potentially harmfulparticles.
It's considered one of theabsolute best predictors of
cardiovascular risk we have.
Speaker 2 (05:13):
Wow, okay, that seems really crucial.
Speaker 3 (05:15):
It is.
And to balance that, we alsolook at apolipoprotein A1 or
ApoA1.
That's the main protein on yourHDL, your good cholesterol
particles.
So the ratio of ApoB to ApoA1gives you a really powerful
snapshot of the balance betweenharmful and protective
lipoproteins in your system.
Speaker 2 (05:31):
Okay, the balance Makes sense.
Speaker 3 (05:32):
Yeah.
Next up is lycoprotein, or LPA.
This is kind of a unique one.
It's basically a type of LDLparticle with an extra protein
attached, and it's largelydetermined by your genetics.
High LPA significantlyincreases heart disease risk,
independently of othercholesterol levels.
Even if everything else looksperfect, high LPA is a major
(05:55):
risk factor.
Speaker 2 (05:55):
The genetic wild card .
You called it earlier.
Speaker 3 (05:57):
Exactly.
Then there's LPPLA2.
This is an enzyme that'sspecifically involved in
inflammation within the bloodvessel walls.
High levels suggest there'sactive inflammation happening in
your arteries, potentiallymaking plaque unstable.
Speaker 2 (06:10):
So it signals active trouble brewing.
Speaker 3 (06:13):
Active inflammation, yes, which is a key part of risk
.
And finally, advanced testsoften look at HDL particle
number and function.
It's not just how much HDLcholesterol you have, HDLC, but
how many HDL particles areworking and how well they're
doing their job, which is calledreverse cholesterol transport.
Speaker 2 (06:30):
Their job of cleaning up the arteries, basically.
Speaker 3 (06:31):
That's right, pulling cholesterol out of the walls
and taking it back to the liver.
More particles doing their jobeffectively is better.
Speaker 2 (06:38):
Okay, wow, that's a lot more detailed.
So it's clear advanced testingisn't about replacing the
standard one necessarily, butabout adding this layer of
precision.
Speaker 3 (06:48):
Exactly, precision and personalization.
Speaker 2 (06:50):
So you can catch things before they become, you
know, really serious problems.
Speaker 3 (06:54):
And what's so fascinating, I think, is how
these markers really connect thedots.
They explain the mechanismsbehind heart disease much better
.
They tell us why someone withnormal total cholesterol can
still have a heart attack.
Speaker 2 (07:08):
Right, it's not just about the total amount of
cholesterol floating around.
Speaker 3 (07:11):
No, it's often about the type of particles, the
number of them and how they'reinteracting with inflammation in
your body.
Speaker 2 (07:18):
Which brings us back to LDL, particle number and APOB
.
Again, you keep highlightingthose.
Speaker 3 (07:23):
Because they're such powerful predictors.
It boils down to this the moreparticles there are, regardless
of how much cholesterol isinside each one, the more
opportunities there are forthose particles to penetrate the
artery wall and initiate damage.
That's the direct link toatherosclerosis.
Speaker 2 (07:38):
Okay, and what about those small dense LDL particles?
You mentioned the stealthcholesterol.
Yes, let's focus direct link toatherosclerosis.
Okay, and what about thosesmall dense?
Speaker 3 (07:43):
LDL particles.
You mentioned the stealthcholesterol.
Yes, let's focus on those for amoment.
These small dense LDL particlesare particularly problematic.
They oxidize or get damagedmuch more easily than larger LDL
.
This oxidized LDL is a majortrigger for inflammation in the
artery wall.
Plus, because they're small,they can wiggle their way into
the artery lining more easily.
(08:03):
We see a lot of these in peoplewith insulin resistance,
metabolic syndrome or diets highin sugar and refined carbs.
And here's the kicker Havingmostly small dense LDL can
potentially triple your risk ofheart disease, even if your main
LDL-C number looks perfectlyfine.
Speaker 2 (08:19):
Triple the risk, wow, okay.
And then there's LPA, thegenetic wildcard.
Speaker 3 (08:22):
Right, lpa is a big one because it adds risk on top
of everything else.
High LPA is an independent riskfactor and critically it's
mostly genetic, meaning diet andexercise don't usually lower it
very much.
Speaker 2 (08:32):
So knowing your LPA number is really important for
understanding your baselinegenetic risk.
Speaker 3 (08:37):
Absolutely.
If it's high, it signals theneed for perhaps earlier
screening for plaque buildup,being much more aggressive about
managing other risk factors youcan control and maybe
considering newer therapies thatare being developed
specifically to target LPA.
Speaker 2 (08:50):
Got it.
And you also mentionedinflammation markers like LPPLA2
and HSCRP.
Why is assessing inflammationso critical?
Speaker 3 (08:59):
Because many, maybe even most, heart attacks aren't
caused by a slow, gradualnarrowing of the artery until
it's completely blocked.
They happen when an existingplaque often one that wasn't
even causing major blockagebecomes inflamed and ruptures.
Speaker 2 (09:14):
Ah, so it breaks open suddenly.
Speaker 3 (09:16):
Exactly.
It ruptures, a clot formsinstantly on that ruptured
surface and that clot blocks theblood flow.
It's often a sudden eventtriggered by inflammation, so
knowing your level of vascularinflammation gives you insight
into how stable or unstable yourplaque might be.
Speaker 2 (09:30):
Okay, that makes sense.
So the real takeaway here, thekey insight, is that advanced
lipid testing shifts the wholequestion.
It's not just how muchcholesterol do you have.
Speaker 1 (09:39):
Yeah.
Speaker 2 (09:39):
It's how likely is the cholesterol you do have to
actually cause damage.
That's not just how muchcholesterol do you have, it's
how likely is the cholesterolyou do have to actually cause
damage.
Speaker 3 (09:43):
That's the crucial distinction.
Speaker 2 (09:45):
And getting that right could literally be the
difference between missing ahuge hidden risk and catching it
early enough to do somethingabout it Precisely.
So this is all fascinating, butwhat does it mean for you, the
listener, who should actually bethinking about getting these
advanced tests?
While you know almost anyonecould potentially benefit, are
(10:06):
there specific groups who standto gain the most?
Speaker 3 (10:08):
Definitely, there are groups where this testing is
particularly valuable.
First, think about people witha family history of early heart
disease If your father orbrother had a heart attack or
stroke before age 55, or yourmother or sister before 65.
Speaker 2 (10:23):
That suggests a genetic component.
Speaker 3 (10:30):
Exactly.
It strongly suggests theremight be something genetic going
on, like high LPA or a tendencytowards those small dense LDL
particles things.
A standard test would totallymiss.
Speaker 2 (10:36):
Okay, family history, who else?
Speaker 3 (10:38):
Second, individuals with normal cholesterol but
other risk factors.
This is a big category.
Maybe your cholesterol numberslook okay but you have high
blood pressure or maybeprediabetes, high fasting
insulin, signs of metabolicsyndrome, maybe carrying extra
weight around the middle.
Speaker 2 (10:53):
So other signs that metabolism isn't quite right.
Speaker 3 (10:55):
Yes, these individuals often have those
hidden harmful patterns likehigh particle numbers or small
dense LDL, even if their LDL-Cis technically normal.
Advanced testing can uncoverthat discordance Right.
That makes sense.
Third, and this is reallyimportant, people with insulin
resistance or type 2 diabetes.
Diabetes significantly changeslipoprotein metabolism.
(11:16):
It often leads to highertriglycerides, lower good HDL
and specifically an increase inthose small dense, more
dangerous LDL particles.
Plus often lower numbers of HDLparticles too.
Even if their LDL-C lookscontrolled on medication, the
particle profile might still bequite risky.
Speaker 2 (11:34):
Okay, so diabetes is a clear flag.
Speaker 3 (11:35):
A very clear flag.
Fourth, an interesting groupathletes and people on low-carb
or ketogenic diets who see theirLDL-C go up.
Sometimes LDL-C can jump quitehigh on these diets.
Speaker 2 (11:47):
Yeah, you were about that.
Speaker 3 (11:48):
But particle testing often shows that these
individuals have developed largebuoyant LDL particles, pattern
A and their AMOB.
That total count of badparticles might actually be low
or normal.
In this case, the high LDL-Cisn't necessarily indicating
high risk and advanced testingcan clarify that, potentially
avoiding unnecessary worry ormedication.
Speaker 2 (12:10):
Ah, so it provides crucial context for those
specific situations.
Speaker 3 (12:13):
It does.
And finally, patients withborderline or just unexplained
results.
If your doctor says yourcholesterol is borderline, or
maybe your triglycerides arealways a bit high and no one's
quite sure why, advanced testingcan cut through the ambiguity
and show whether there's agenuinely concerning pattern or
something more benign.
Speaker 2 (12:29):
Okay, show whether there's a genuinely concerning
pattern or something more benign.
Okay, so to sum that up familyhistory, metabolic issues, even
with normal cholesterol,diabetes, specific dietary
changes like keto causing highODLC or just unclear results
these are all really strongreasons to consider diving
deeper.
Speaker 3 (12:43):
Absolutely.
In those cases it can providecritical information, either
reassurance or a clear call toaction.
Speaker 2 (12:52):
And it's worth mentioning, there are panels
available, like the QLM AdvancedCardio IQ Elite panel, that
bundle all these key markerstogether to give you that
comprehensive view.
Speaker 3 (12:58):
Yes, those integrated panels are very helpful for
getting the full picture in onego.
Speaker 2 (13:03):
Now, getting the test is one thing, but it's only
really valuable if it leads toaction right.
Speaker 3 (13:07):
Absolutely.
The data is only powerful ifyou use it.
Speaker 2 (13:10):
The real strength of advanced lipid testing seems to
be in enabling trulypersonalized prevention, moving
beyond just generic advice likeeat less fat or exercise more.
Speaker 3 (13:25):
Exactly.
It lets you tailor strategiesbased on your specific lipid
profile.
It becomes data driven.
So let's talk about someconcrete examples.
Okay, Say, your results showhigh ApoB or high LDL particle
number.
What might you do?
Well, dietary changes couldinclude reducing refined carbs
and perhaps processed seed oils,while really boosting soluble
fiber think avocados, chia seeds, flax seeds, psyllium husk and
prioritizing omega-3 fats fromsources like wild salmon,
(13:48):
sardines, macros.
Speaker 2 (13:49):
So targeting the particle number specifically
through diet.
Speaker 3 (13:51):
Yes.
Now what if the main issue is apredominance of small dense LDL
particles, pattern B?
Here the focus might shift evenmore strongly towards reducing
sugar and processedcarbohydrates, maybe increasing
nutrient-dense healthy fats andquality protein, to really work
on improving insulin sensitivity, as that's often linked.
Speaker 2 (14:11):
Right Tackling the insulin resistance connection.
Speaker 3 (14:14):
If triglycerides are high.
The big levers are oftenlimiting fructose, especially
from sugary drinks, desserts,and cutting back on alcohol
intake.
Speaker 2 (14:22):
OK, diet makes sense.
What about exercise?
Can that be tailored to?
Speaker 3 (14:25):
Yes, definitely.
For example, resistancetraining, lifting weights, has
been shown to improve thefunction of your HDL particles,
helping them do their cleanupjob better.
Speaker 2 (14:34):
Interesting, not just cardio.
Speaker 3 (14:36):
Not just cardio and things like high-intensity
interval training or HIIT can beparticularly effective for
lowering triglycerides and caneven help shift LDL particles
towards that larger, lessharmful pattern over time.
Speaker 2 (14:50):
So mixing up your exercise routine based on your
results could be beneficial.
Speaker 3 (14:54):
It can be.
And then there's inflammation.
If your HSCRP or LPPLA2 iselevated, that's a clear signal
to double down onanti-inflammatory strategies.
This means prioritizing sleep,aiming for seven to nine hours,
consistently Actively managingstress is huge meditation, deep
breathing, spending time innature whatever works for you
(15:14):
and, of course, incorporatinganti-inflammatory foods turmeric
, ginger, green tea, berries,leafy greens, fatty fish.
Speaker 2 (15:21):
Right the life-solving factors for
inflammation.
Speaker 3 (15:23):
And sometimes targeted supplementation can
play a role, always bestdiscussed with your doctor, of
course.
Omega-3 fatty acids,particularly EPA and DAJ, are
well known for loweringtriglycerides and can help
reduce small LDL particles.
Niacin, in certain forms andunder medical supervision, might
help lower LPA for some people,but it needs careful handling.
(15:43):
Magnesium is also important foroverall vascular health and
insulin sensitivity.
Speaker 2 (15:48):
Okay, and what about medications?
Speaker 3 (15:49):
Well, this advanced testing can provide much clearer
justification for whenmedications are truly needed If
you have very high particlenumbers or genetically high LPA,
or persistent inflammationdespite lifestyle efforts.
It strengthens the case forconsidering statins or maybe
newer agents like PCSK9inhibitors or those emerging
(16:10):
therapies specifically targetingLPA.
It helps make that decisionmore precise and evidence-based.
Speaker 2 (16:17):
So it helps target medication more effectively too.
Speaker 3 (16:19):
Yes, ensuring the right people get the right
treatment at the right time.
Speaker 2 (16:22):
Okay, so let's try and wrap this up.
The core message seems prettyclear.
Speaker 3 (16:26):
I think so.
Heart disease remains theworld's biggest killer, partly
because, well, too many crucialrisks just go undetected by
standard methods.
Speaker 2 (16:36):
Right, those standard cholesterol tests.
While they have a place, theycan often give this false sense
of security or just completelymiss key factors driving risk.
Speaker 3 (16:43):
They paint an incomplete picture.
Speaker 2 (16:44):
And that's really where advanced lipid testing
comes in and, frankly, changesthe game by looking beyond just
the basic cholesterol numbers,by measuring particle number,
particle size, apob, thatgenetic wildcard, lpa and those
key inflammation markers.
Speaker 3 (16:59):
You can identify dangerous patterns much, much
earlier, long before they leadto an actual event.
Speaker 2 (17:04):
And having that deeper level of information that
empowers both you, the listener, and your doctor to create
genuinely personalizedprevention plans.
Speaker 3 (17:13):
Exactly, Whether that involves fine-tuning your diet
in specific ways, using targetedexercise strategies really
focusing on reducinginflammation, or knowing when
medication is truly warranted.
Speaker 2 (17:24):
It moves prevention from guesswork to precision.
So, as we finish up, maybesomething for you to think about
.
What's one aspect of your ownhealth, maybe something you
thought you had a good handle onthat you now realize might have
a deeper, hidden story justwaiting to be uncovered?
Speaker 1 (17:44):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
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