Reading Your Lipid and Lipoprotein(a) Test Results
When you first receive results from your bloodwork, all the numbers and acronyms can be confusing and overwhelming. Let’s walk through the results that are important to understanding your journey to the LDL Safe Zone.
This is sometimes called the “good” cholesterol because higher levels are associated with a lower risk for cardiovascular events. HDL brings excess cholesterol from other areas of the body and returns it to the liver for recycling.
However, having high HDL is not enough to outweigh the harmful effects of high LDL.
This number is key. This “bad” cholesterol is what can build up in the arteries and causes heart attacks and strokes.
LDL is a lipoprotein that carries cholesterol in the blood. It is not actually cholesterol, but it carries cholesterol through the body. When LDL’s job is done, it returns to the liver for recycling. If that recycling process is impaired, LDL can build up in our artery walls.
Higher LDL levels are known to cause cardiovascular disease. If your LDL is very high, it is likely due to or at least influenced by genetics. Changing your diet can lower LDL, on average by 10-15%. If you have very high LDL, you may need one or more medications to lower it to the Safe Zone. Don’t wait to get there – you can always start medication and work on your diet at the same time.
The Safe Zone for your LDL varies based on your medical and family history. The American College of Cardiology and American Heart Association 2018 Cholesterol Guidelines recommends lowering LDL to below:
- 100 mg/dL for those without existing heart disease.
- 70 mg/dL for someone with heart disease.
In 2022 the American College of Cardiology recommended the ideal LDL level for someone with heart disease and additional risk factors is less than 55 mg/dL.
If your LDL is over 190 mg/dL and you have a family history of early heart attack, heart disease, and/or stroke, you may have an inherited disorder known as familial hypercholesterolemia (FH).
This is another type of fat in the bloodstream that’s linked to heart disease and stroke. Basically, triglycerides store unused calories and deliver energy to your cells when they need them.
Triglyceride levels change throughout the day and respond quickly to what you eat or drink. That’s why you need to fast before you have your cholesterol panel done. A high triglyceride number can make your total cholesterol level high, even if your LDL is low. If your triglyceride level is too high, your test results may say your LDL could not be calculated. Very high triglycerides (over 500 mg/dL) can cause pancreatitis and should be treated urgently. Diet and medications for triglyceride reduction are different from those used to lower LDL. It is also important to point out that exercise can play a key role in lowering triglycerides and alcohol can raise triglycerides. In fact, a single alcoholic beverage in some people can significantly raise triglycerides.
Lipoprotein(a), also known as Lp(a)
High lipoprotein(a), also known as Lp(a) is another important risk factor for developing cardiovascular disease. It’s different from LDL and can lead to blockages in the arteries, inflammation, and blood clotting. Some people have both high LDL and high lipoprotein(a), increasing their risk.
A lipoprotein(a) test is not included in a regular lipid panel and most people have never had their Lp(a) tested. To understand your risk for cardiovascular disease, you should ask to have your Lp(a) tested. Most people do not need regular Lp(a) testing – it is either high or it is not high and it does not generally change very much. If it is high, the recommended course of action is to manage all of your other cardiovascular risk factors, including lowering your LDL.
Having high LDL and high Lp(a) are serious cardiovascular risk factors no matter how high you HDL is. High HDL does not protect you from high LDL or high Lp(a).
If your Lp(a) level is greater than 125 nmol/L or greater than 50 mg/dL, you have high Lp(a).
Frequently Asked Questions
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. But these changes may not be enough for many people with high cholesterol. There are safe and effective medications to help lower cholesterol.
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 healthcare provider or connect with a Family Heart Care Navigator.
Currently, the only FDA-approved therapy to lower Lp(a) is lipoprotein apheresis. It is procedure where a machine physically removes both Lp(a) and LDL cholesterol from the blood stream on a weekly or bi-weekly basis. This approximately 3-hour process involves removing blood from the body, passing it through a special column to extract the LDL and Lp(a), and returning the blood to the body. Currently, for apheresis to be approved, a person must have an Lp(a) greater than 60 mg/dl, have FH, and known vascular disease.
Other potential treatments are being studied in clinical trials.
Even without Lp(a) lowering medication, you can work to reduce all other risk factors. If you are overweight, try to get to a healthier weight. If you smoke, quit. These are not easy changes to make, but the sooner you do it – the better. If you have other risk factors, 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. For people with no history of cardiovascular disease it is recommended they lower their LDL to less than 100 mg/dL. For people with cardiovascular disease less than 70 mg/dL is recommended (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 doesn’t estimate risk as well as other measurements. This happens in roughly 20% of people, but most commonly for individuals who 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 Lp(a) levels.