Advanced cholesterol panel
Picture a highway with 100 passengers. If they are driving 10 to a minivan, there are only 10 large vehicles on the road, and it is not too congested. If all 100 are riding in individual small cars, there’s a lot more traffic. That is how large and small LDL cholesterol appears in arteries. Lots of LDL particles clog up the artery highway. Those LDL riders in cars can also be hard and dense, like a golf ball, or large and soft, like a sponge. The small, dense LDL particles do a lot more damage to arteries. (Here are some foods that lower cholesterol naturally.)
This is why two people with an LDL level of 100 mg/dl can have different heart disease risks, because it’s possible that they have widely different particle numbers and sizes. If someone has fewer than 1,000 LDL particles in a blood sample and they are large in size, their risk for hardening of arteries is low. A second person might have a particle number of 2,000 be loaded with small “golf balls” that are knocking into and entering arteries to cause plaques. (Don’t miss these silent signs of clogged arteries.)
An advanced cholesterol panel blood test can tell you more about your LDL particle number and size.
High-sensitivity C-reactive protein
This is a marker for inflammation, which slowly erodes blood vessels and other organs. (Here are some foods that fight inflammation.) In the past decade, a blood test for high-sensitivity C-reactive protein has changed the assessment of patients dramatically. If your hs-CRP is normal (usually less than 0.1 mg/dl), your arteries do not appear inflamed by your diet, lifestyle, or other risk factors. On the other hand, if your hs-CRP is elevated, something is wrong with your lifestyle or health, and we should identify and correct them. This is one of the tests for heart disease that I order for every patient at least once a year.