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Back when researchers first discovered the correlation between cholesterol levels and heart disease, many of us thought we'd discovered the root cause of coronary heart problems. We thought that doctors were finally in a position to intervene and save patients from a deadly disease. Those on the frontline felt on top of the world. The researchers were wrong. How do I know? Because I was one of them. In fact, I participated in one of the original studies to determine the effects of lowering cholesterol on heart-disease risk. Since that study included only male participants, I was surprised one afternoon to see a woman waiting for me. Her question was simple: ‘My husband's cholesterol numbers were perfect, and you told him that based on those numbers he was at low risk of heart disease. So why did he drop dead of a heart attack?’ As you can imagine, I was devastated, but at the time I didn't have an answer to give her. Almost 20 years have passed and I now believe that I can finally offer her, and many others, an answer. I admit that more common determinants like high blood pressure, diabetes and smoking are crucial to understanding heart disease. And it's certainly true that the correlation between heart disease and cholesterol was a discovery of critical importance, and the standard cholesterol blood test - total cholesterol, LDL.HDL and triglycerides - became (and remains) routine at every physical. Our mistake was in thinking that it gave us all we needed in a blood test for heart disease. The sheer, horrifying frequency of ‘surprise’ heart attacks was the tip-off that the cholesterol breakthrough was perhaps a false summit. If we use the total-cholesterol test as our sole predictor of heart-disease risk, we miss many cases. I believe that contrary to what you've heard and read - normal cholesterol results aren't the only measures of your risk. The good news is we now have the ability to go beyond basic cholesterol and screen for a broader spectrum of risk factors that show up in your blood. While there are a number of these ‘metabolic markers’, one of the most important is an especially small, dense form of LDL. If you have it - and one study indicates that 50 percent of men with heart disease do - you're three times more likely to have coronary artery disease, even if everything else (such as body weight and your standard-cholesterol-test result) is perfect And, that risk doubles to six times if you have a lot of these LDL particles. Scary? Yes. But many mainstream cardiologists would disagree with me since they regard LDL as being of academic interest only. Also, fortunately, we know that small LDL responds remarkably well to lifestyle changes such as diet and exercise. This means that many of those stealth heart attacks are preventable. Maybe even yours. If the LDL in your blood consists of predominantly small, dense LDL particles, we say that you have the LDL pattern B (people whose LDL is predominantly large have LDL pattern A). Why is this such a big deal? Firstly, the size of these particles makes it easier for them to weasel their way into the artery walls, where they cause all kinds of damage. And the presence of small LDL also implies the presence of a truly nasty metabolic stew. The stew includes rapid progression of partially blocked arteries; arteries that are more prone to sudden spasm; an increased number of blood fats after a meal; lousy removal of cholesterol from the blood supply; platelet stickiness that increases the likelihood of a heart attack caused by a blood clot; insulin resistance; plaque instability and more. You may not have all of these things, but all of them are associated with small LDL (other associations are obesity and age). People with small LDL are also more likely to have low HDL, or ‘good’ cholesterol, which means that cholesterol isn't taken out of blood vessels as well as it might be. Low HDL is associated with an increased risk of cardiovascular disease. These are some of the very good reasons why we worry so much about catching and treating small LDL. That's not to completely ignore the more conventional route. The traditional risk factors like age, high total cholesterol, low HDL, hypertension and diabetes can be used to predict heart disease effectively but imperfectly. Tests for special lipoprotein factions and genes are underway, but none of them have reached application in practice. The Small-LDL Paradox There's another danger to having LDL pattern B: if you have small LDL and have heart disease, the disease will get worse twice as fast as it will in someone who doesn't have small LDL. But treating it can seriously retard the development of blockages and, in many cases, stop the progress of the disease more easily than a person without these small particles could. In a small percentage of cases, you can actually cause the disease to regress. In other words, LDL-pattern-B patients have the most rapidly progressive disease, but they also respond best to treatment. Still not convinced you should be tested ? Consider this: people with small LDL may also have elevated levels of the metabolic marker apo B, the combination of which may increase the risk of coronary artery disease by six times. Worse, the presence of small LDL, elevated apo B, and high insulin ratchets your risk up to an alarming 20 times normal. A Happy Ending Here's some good news: although the size of your LDL particles is genetically linked, your risk can be modified. In fact, we can actually convert you from a high-risk LDL pattern B to a low-risk pattern A. And the treatment isn't complicated or expensive. Weight control, a diet relatively low in saturated fat and simple sugars, and an adequate amount of exercise will often do the trick. So if you have this risk factor, don't despair. Just get busy. Sandra Prior runs her own bodybuilding website at http://bodybuild.rr.nu.
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