by Dr. Laura Korman, DC 

Q: What is the truth about cholesterol’s role in cardiovascular function?  

A: The role cholesterol plays in heart disease is one of the most confusing and misleading topics in healthcare today. Cholesterol is portrayed as the villain to cardiovascular health, and we are often advised to keep our blood levels as low as possible by avoiding cholesterol in our diets or taking potentially harmful medications. This advice is often followed without ever considering the many vital functions of cholesterol and what “ideal” cholesterol levels might be.  

Cholesterol is one of the most important substances the body produces, and its total number is not the primary culprit of heart disease. The real problem is the amount of cholesterol that is oxidized from free radicals and inflammation, due to factors such as our environments, diets and lifestyle habits. 

Cholesterol is a waxy substance that is primarily produced in the liver and, to a smaller degree, from our diets. It is the building block of every cell membrane, and it is required to make vitamin D, as well as cortisol and sex hormones such as estrogen, progesterone and testosterone. It is a source of energy and produces bile acids, which help the body metabolize dietary fats and absorb fat soluble vitamins.  

Cholesterol is also a critical element of the brain and nervous system. Up to 25% of the cholesterol in the human body can be found in the brain, and its levels are extremely important for the development of the nervous system of infants and children, as well as cognitive function in both the young and elderly alike. Cholesterol’s speculative association with heart disease is a fairly new phenomenon. 

Heart disease was uncommon in the United States in the early 1900s, but reached its spot as the number one killer of Americans by the mid 1950s. During this time, we witnessed an increase in the consumption of processed foods and inflammatory vegetable and seed oils, as well as a simultaneous decrease in outdoor physical activity. These changes in the American diet and lifestyle have been shown to increase systemic inflammation and oxidative stress which causes advanced aging to the body and chronic illnesses including heart disease.  

Despite the trillions of dollars in research and the best medical interventions available, the American Heart Association said in 2012 that Americans have a 48% chance of developing this deadly disease. Interestingly, studies have also shown that 50% of people who experience a heart attack have “normal” cholesterol levels.  

In order to accurately assess a person’s risk of developing heart disease, we need to not only look at traditional lipid panels including cholesterol and triglycerides. We must also investigate inflammatory markers like CRP(hs), homocysteine and insulin, as well as nontraditional blood tests including a Nuclear Magnetic Resonance (NMR) Lipoprofile test. Many leading experts believe this to be the most sophisticated lab test to understand the numbers and sizes of cholesterol lipoproteins and their association with a risk for heart disease. 

The NMR takes an extensive look at the actual particle sizes of the LDL fraction of cholesterol. The small LDL particles contain less antioxidants, and are more susceptible to oxidative damage. These particles can enter the arterial wall, and are associated with atherosclerosis and a higher risk of heart disease. The larger LDL particles, on the other hand, are rich in antioxidants and present a much lower heart disease risk.  

This test will determine if you have a Pattern A, which contains a higher percentage of large LDL particles and lower cardiovascular risk, or Pattern B, which contains mostly small LDL particles and higher risk for heart disease. Either way, the positive news is that changes to diet and lifestyle can help the body produce more of the antioxidant-rich protective lipoprotein particles to lower your risk of developing cardiovascular disease. Your primary care doctor might not be familiar with the NMR test, and it also might not be covered by insurance.   

If you are interested in having this test ordered, or you want to run any of the inflammatory blood markers to look at your risk for cardiovascular disease, please locate a doctor who specializes in functional medicine or call our office at 941-629-6700.