Cholesterol: It's More Than Just a Number

Understanding Your Labs, Longevity, and Aging Well

Cholesterol: It's not just a number

Why Are We Talking About Cholesterol?

As we age, the health of our blood vessels becomes one of the biggest predictors of how well — and how long — we live. Heart attacks, strokes, vascular dementia, and even some forms of arthritis all share a common thread: damage to our blood vessels over time.

Cholesterol and inflammation are two major contributors to this damage. When we understand our cholesterol numbers — beyond just "high" or "low" — we can take smarter steps to prevent disease, protect our brains and hearts, and age with strength and vitality.

This blog post will break down what your cholesterol numbers mean, why inflammation matters, and how these factors are deeply connected to longevity. No complex medical jargon — just clear explanations you can use to take charge of your health.

A Few Words to Know First:

• Cholesterol: A waxy, fat-like substance found in your blood. It's essential for building cells, but too much can cause problems.

• Lipoprotein: Particles that carry cholesterol through the bloodstream. Different types carry cholesterol in "good" or "bad" ways.

• Atherogenic (ath-er-o-jen-ic): Promoting the formation of fatty plaques in the arteries.

• Inflammation: The body's natural response to injury or irritation. Chronic inflammation can silently damage blood vessels over time.

The Basics: What Is Cholesterol?

When you get a standard cholesterol panel, you usually see:

Total Cholesterol

• Made up of your LDL-C, HDL-C, and a portion of triglycerides.

• A high total cholesterol isn't always alarming if your HDL-C ("good" cholesterol) is very high and your LDL-C ("bad" cholesterol) is low.

LDL-C (Low-Density Lipoprotein Cholesterol)

• Often called "bad cholesterol" because it can deposit into artery walls.

• Higher LDL particle number (not just concentration) increases cardiovascular risk.

HDL-C (High-Density Lipoprotein Cholesterol)

• Often called "good cholesterol," it helps remove cholesterol from the bloodstream.

• Having too little HDL-C is associated with an increased risk of heart disease.

• The "sweet spot" for HDL-C is typically considered to be 60–100 mg/dL.

• Very high HDL-C levels (above 100 mg/dL) may warrant further investigation.

  • In some cases, extremely high HDL-C could reflect dysfunctional HDL particles that are not protective and may even increase cardiovascular risk.

• When can HDL-C be very high?

  • Elite athletes sometimes have high HDL-C levels due to excellent metabolic and cardiovascular health.

  • Certain genetic conditions (like CETP deficiency) can cause very high HDL-C levels, but these particles may not function normally.

Key Point: It's not just the amount of HDL-C that matters — it's how well it functions. Advanced testing like HDL mapping can provide deeper insight.

Triglycerides

• A type of fat found in the blood.

• High triglycerides are associated with insulin resistance, metabolic syndrome, and increased heart disease and pancreatitis risk.

• Elevated triglycerides often accompany low HDL-C and small, dense LDL particles — a particularly risky combination for cardiovascular health.

• Normal fasting triglycerides should be less than 150 mg/dL.

• Levels above 200 mg/dL may warrant further evaluation and intervention.

Why Doctors Recommend Fasting for Cholesterol Tests: Fasting for 8–12 hours ensures that triglyceride levels are measured accurately. Eating before your blood draw especially fatty or sugary foods, can artificially raise triglyceride levels and make it harder to interpret your cholesterol results correctly.

Non-HDL Cholesterol

• Total Cholesterol minus HDL-C.

• Reflects all the "bad actors" (LDL, VLDL, IDL, Lp(a)).

• Considered a better predictor of heart disease than LDL alone.

  
  

Inflammatory Markers - Beyond the Basics

Cholesterol isn't the only player in heart disease. Inflammation drives plaque instability and rupture, leading to heart attacks and strokes. Key markers include:

hs-CRP (High-Sensitivity C-Reactive Protein)

• A highly cardiac-specific inflammation marker.

• Elevated hs-CRP predicts a higher risk of heart attack and stroke even in people with "normal" cholesterol.

• Important Note: hs-CRP can be falsely elevated if someone is acutely ill (like a cold), recently vaccinated, or recovering from surgery. Timing matters when interpreting this result.

Homocysteine

• An amino acid; elevated levels damage blood vessels.

• Linked to a higher risk of stroke, blood clots, and dementia.

• Check out my blog post on Homocysteine to learn more.

Oxidized LDL (OxPL-apoB, oxLDL)

• Measures oxidized (damaged) LDL particles.

• Oxidized LDL is more inflammatory and more likely to cause plaque buildup.

Other Emerging Markers

• Lp-PLA2: An enzyme associated with inflammation in blood vessels, especially inside vulnerable plaques.

• Myeloperoxidase (MPO): A marker of vascular inflammation and oxidative stress.

What Is Plaque — and Why Does It Matter?

• Plaque refers to a buildup of cholesterol, fats, calcium, and inflammatory cells inside the walls of your arteries.

• Over time, plaque can harden and narrow the arteries, limiting blood flow to your heart, brain, and other parts of your body.

• Stable plaque tends to grow slowly. It can still cause problems (like angina or reduced blood flow), but it's less likely to rupture suddenly.

• Unstable plaque is softer and inflamed. It can suddenly rupture, causing a clot to form — and that clot can block blood flow entirely, leading to a heart attack or stroke.

Why inflammation matters: Chronic inflammation makes plaque more unstable. When doctors measure inflammatory markers like hs-CRP or oxidized LDL, they're looking for signs that plaques might be more vulnerable to rupture.

Other Important Labs and Ratios to Know

VLDL (Very Low-Density Lipoprotein)

• Carries triglycerides through the bloodstream.

• High VLDL levels contribute to plaque formation and cardiovascular risk.

Small Dense LDL (sdLDL)

• A more dangerous form of LDL.

• Small, dense LDL particles can penetrate the artery walls more easily and trigger inflammation.

ApoB and ApoA1

• ApoB: Found on all atherogenic particles (LDL, VLDL, IDL, Lp(a)). Higher ApoB means a greater number of "bad" particles.

• ApoA1: Found on HDL particles, reflecting protective cholesterol.

• The ApoB: ApoA1 ratio strongly predicts heart attack and stroke risk.

Cholesterol Ratios

• Total Cholesterol/HDL-C Ratio: Higher ratios indicate higher risk.

• LDL-C/HDL-C Ratio: Useful to assess the balance between harmful and protective cholesterol.

Key Point: Looking at particle numbers, size, and balance often provides more profound insights than traditional cholesterol numbers alone.

HDL Mapping and Cholesterol Balance

HDL Mapping

• It is not just the amount of HDL but how functional it is.

• Testing HDL particle size and function gives a better picture of true cardiovascular protection.

• Smaller, dysfunctional HDL particles don't protect the arteries well.

Cholesterol Balance Testing

• Measures how much cholesterol your body absorbs versus how much it makes.

• Important because some people are "hyper absorbers" (absorb more cholesterol from food), and others are "hyper synthesizers" (make more cholesterol internally).

• Why it matters: It helps guide treatment.

  • For example, a hyperabsorber might benefit more from dietary changes and medications like ezetimibe.

  • A hyper synthesizer might benefit more from statins.

Diet, Genetics, and Cholesterol: Why It's Personal

While diet plays an important role in cholesterol management, it's not the whole story.

• Some individuals make significant dietary changes — even adopting a fully plant-based or vegan diet — yet still struggle with high cholesterol levels.

• This is often due to genetic factors that influence how much cholesterol your body produces (synthesis) or absorbs from food.

• "Hyperabsorbers" absorb more cholesterol from plant- and animal-based foods.

• "Hypersynthesizers" may make more cholesterol internally, regardless of dietary intake.

Key Point: Diet is a powerful tool — but not everyone responds to it similarly. Personalized, proactive care — including advanced lab testing and individualized treatment plans — is crucial for true cardiovascular prevention.

Why Metabolic Labs Matter Too

When thinking about cardiovascular and cholesterol labs, it's also important to evaluate metabolic health:

• Hemoglobin A1c (HbA1c): A measure of average blood sugar over the past 2–3 months.

• Fasting Blood Sugar: Helps detect diabetes or prediabetes.

• HOMA-IR (Homeostatic Model Assessment of Insulin Resistance): Estimates how resistant your body is to insulin, an early marker of metabolic dysfunction.

Why it matters: Poor metabolic health dramatically increases the risk of atherosclerosis, heart disease, and stroke. Insulin resistance often leads to unfavorable lipid profiles (high triglycerides, low HDL-C, small dense LDL).

Final Thoughts: Putting It All Together

Cholesterol is more than just a number. It's a story about your body — about how your blood vessels are aging, how your immune system is behaving, and how you can influence your future health.

Understanding total cholesterol, LDL, HDL, non-HDL, triglycerides, VLDL, small dense LDL, inflammatory markers like hs-CRP and oxLDL, ApoB and ApoA1, cholesterol ratios, genetic factors, and metabolic labs like HbA1c and HOMA-IR empowers you to have a more informed conversation with your healthcare team.

I hope this post helped you see that there is much more to cholesterol than just a number. Ask questions, stay curious, and think proactively about your health. Rather than simply treating disease, focus on personalized, proactive care — care that centers around the quality of your life. As always, GeriAcademy does not provide medical advice; our goal is to equip you with information you can discuss with your healthcare provider. For more insights, check out additional blog posts at GeriAcademy.com.