Lipid Testing
Your body needs some cholesterol to help your cells to function. Too much cholesterol, though, greatly increases your risk of heart disease, heart attacks, and strokes.
There are no symptoms for high cholesterol, so the only way to know if you have too much is through a cholesterol test. These are also known as lipid panels or lipid profiles.
There are two types of cholesterol: low density lipoprotein (LDL) and high-density lipoprotein (HDL).
LDL is known as the “bad” cholesterol because it contributes to blockages in the arteries.
HDL is considered the “good” cholesterol since it can protect against heart attack or stroke.
It’s better to have higher levels of HDL cholesterol and lower levels of LDL cholesterol.
You may also see triglycerides on your lipid panel. This is another type of fat in the bloodstream that also links to heart disease.
Another lipoprotein that carries cholesterol is lipoprotein (a), or Lp(a). It’s a very complex lipoprotein that appears to increase the risk for both heart disease and stroke. Lp(a) looks like LDL cholesterol with some key differences. LDL has a single apolipoprotein B attached to its surface. Lp(a), however, has an apolipoprotein B attached to its surface, and that apolipoprotein B has an apolipoprotein (a) attached to it. Lp(a) also contains oxidized phospholipids (OxPL).
Each of these components come together and results in a lipoprotein that can cause artery blockages, artery clogging, and inflammation.
| Total Blood Cholesterol Levels | LDL Cholesterol Levels | ||
| High Risk | 240 mg/dL and above | High Risk | 190 mg/dL and above |
| Borderline High Risk | 200 – 239 mg/dL | ||
| Desirable without history of atherosclerotic cardiovascular disease (ASCVD) | Less than 200 mg/dL | Desirable without history of ASCVD | Less than 100 mg/dL |
| Desirable with history of ASCVD | Less than 150 mg/dL | Desirable with history of ASCVD | Less than 55 mg/dL |
| HDL Cholesterol Levels | Triglyceride Levels | ||
| High Risk for Men | Less than 40 mg/dL | Very High Risk | 500 mg/dL and above |
| High Risk for Women | Less than 50 mg/dL | High Risk | 200 – 499 mg/dL |
| Borderline High Risk | 150 – 199 mg/dL | ||
| Desirable | Less than 150 mg/dL | ||
| Lipoprotein(a) Levels | ||
| High Risk | 50 mg/dL and above | 125 nmol/L and above |
| Borderline High Risk | 30 – 49 mg/dL | 75 – 99 nmol/L |
| Desirable | Less than 30 mg/dL | Less than 75 nmol/L |
There are several things to consider when it comes to lowering your cholesterol. Changes to diet, exercise, and personal lifestyle habits can all be adjusted to help reduce your cholesterol levels.
If you have LDL cholesterol over 190 mg/dL and a family history of early heart disease, it could be a genetic disorder known as familial hypercholesterolemia (FH). If you think you might have FH, talk to your doctor or connect with an FH specialist.
Currently, the only FDA-approved therapy to lower Lp(a) is lipoprotein apheresis. It’s a dialysis-like procedure where a machine physically removes both Lp(a) and LDL cholesterol from the blood stream on a weekly or bi-weekly basis. This 3-hour process involves removing blood from one arm, passing it through a special column to extract the LDL and Lp(a), and returning the blood to the other arm. For apheresis to be approved, a person must have an Lp(a) greater than 60 mg/dl, have FH, and known vascular disease.
Three other potential treatments are being studied in clinical trials. Should these medications prove to be safe, effective, and reduce vascular risk, they may be available within 4-5 years.
Even without medication, you can work to reduce all other risk factors. If you are overweight, try to get to a healthier weight. If you smoke, please quit. There are not easy changes to make, but the sooner you do it – the better. If you have other complications, like high blood pressure or diabetes, take all prescribed medications.
Anyone who has an elevated Lp(a) should work on lowering their LDL cholesterol as much as possible. People with no history of vascular disease should aim for less than 100 mg/dl. People with vascular disease strive for levels less than 70 mg/dl (and even lower is better).Specialized lipid testing is also referred to as lipoprotein particle testing. It’s ordered by doctors to check your risk status.
When doctors do these tests, they’re looking for “discordance.” This happens when LDL cholesterol does not estimate risk as well as other lipid measurements. This happens in roughly 20% of people, but most of those individuals are overweight, obese, or have diabetes.
The short answer is no.
When people have FH, there is almost never discordance – meaning LDL cholesterol is enough to assess risk. All LDL particles will cause plaque to build up in the arteries, regardless of size. When you have FH, you have more LDL particles than someone without FH. No LDL particles are good for you.
If you want additional testing, you can try genetic testing and measuring your lipoprotein(a) levels. Additionally, the American Heart Association recommends testing for apolipoprotein B as it can help in determining how much Lp(a) is contributing to heart and stroke risk.
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Bucholz EM, Rodday AM, Kolor K, Khoury MJ, de Ferranti SD. Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999–2014). 2018;137:2218–2230. -
Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., . . . Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 139(25). doi:10.1161/cir.0000000000000625
