Cholesterol

The issue of cholesterol - and lipids in general - in health care is a confusing one, not only for patients, but for many health care professionals, as well. The most charitable thing I can say about routine lipid testing (called a "fasting lipid profile") is that it isn't completely useless.

The fasting lipid profile, as the name implies, is checked after several hours of not eating or drinking anything with calories in it, preferably drinking nothing but plain water for 8-12 hours. As people typically go for that long between dinner and breakfast, the most convenient time to have your blood drawn for this is usually in the morning before you eat your first meal of the day (before you "break" your "fast" - breakfast).

This test measures 4 substances in the blood: total cholesterol, triglycerides, high-density lipoprotein (HDL), and very low density lipoproteins (VLDL). Based on these four measurements, the lab calculates a fifth: low density lipoprotein (LDL). Some of these terms should be at least vaguely familiar to you, as they have become more commonly used in the mass media over the past 20 years. Whether or not they've been used correctly is a matter of debate.

The research evidence is fairly clear: the two parts of the fasting lipid profile which are the most useful for predicting whether or not you will die from a heart attack are your HDL and triglycerides. The higher your HDL is (to a point), the better. The lower your triglycerides are (again, to a point), the better. The standard of care, as advised by the National Cholesterol Education Program (a small part of the NIH), is to use the lipid profile to manage your risk of heart disease based primarily on LDL. According to them, the lower your LDL, the better. I disagree, for most patients. If your LDL is very high, I won't ignore it. But it isn't the first number I'm going to look for.

It'll be the third, after HDL and triglycerides.