Natural Health Services

Cardiovascular Disease Risk Assessment


Arkansas Nutrition and Natural Healing

Dr. Roger Trubey, Dr.PH, MPH, and Doctor of Integrative Medicine 362 Unger Trail, Mountain Home, Arkansas 72653

Call 501-538-4944

Cholesterol testing has historically been used as the standard indicator for cardiovascular disease classified as HDL (good) or LDL (bad). However, it is actually the lipoprotein particles that carry the cholesterol throughout the body, not necessarily the cholesterol within them, that are responsible for key steps in plaque production and the resulting development of cardiovascular disease.

You see, cholesterol is a waxy fat-like substance and as such, does not mix well in a water-soluble medium like blood.  So it must be carried through the blood in these lipoprotein particles.  And your cardiovascular risk increases with a higher number of Low density lipoprotein (LDL) particles, regardless of how much cholesterol each of the lipoprotein particles contain.  This is why data from the National Heart, Blood and Lung Institute have shown that approximately one-half of all heart attack victims have “normal” cholesterol.  Some data suggest that it could be as high as 75% of heart attack victims have normal cholesterol.If you look at the people of France, they have one of the highest average cholesterol levels (about 250) in Europe.  But they also have one of the lowest incidence of heart disease.   A ten-year study of the people on the Greek island of Crete failed to register a single heart attack despite an average cholesterol well over 200.  Numbers like these would prompt doctors all over the US to put these individuals on a statin drug.Some of this newer information coming in during the last five years or so has forced medicine to turn away from an obsession with the cholesterol perspective and toward the understanding that it is the inflammation of arterial tissue that leads to heart disease and most strokes.   Cholesterol plays a role, but in no way a leading role. You find cholesterol at the scene of arterial inflammation and destruction, to be sure; it is a participant in the crime, so to speak, but not the perpetrator.   LDL Cholesterol is often called the bad cholesterol, yet it plays a very important and necessary role in the body.  Without cholesterol itself you would die and in fact, people with the lowest cholesterol as they age, are at the highest risk of death.

But let’s go back to that so-called bad cholesterol, LDL cholesterol.  LDL cholesterol is only bad if it is oxidized.  And there are literally hundreds of toxic chemicals, heavy metals, infectious organisms and the like that will initiate an oxidation response and cause LDL to oxidize and become part of the plaque and atherosclerotic process.  So what would protect the LDL cholesterol from becoming oxidized in the first place?  Antioxidants!  Vitamin E, Vitamin C, Co-enzyme Q10, Alpha Lipoic Acid and the like!  So is the “bad guy” here the cholesterol or the oxidizing chemicals and the lack of adequate antioxidants?

Measuring the lipoprotein subgroups is the only way to evaluate these new risk factors, which is crucial for the accurate assessment of one’s cardiovascular disease risk, and that is according to the National Cholesterol Education Program (NCEP).  So what are these new emerging risk factors NCEP has identified?

  •  Small, dense LDLparticles: these atherogenic particles are easily oxidized and penetrate the arterial endothelium to form plaque
  •  Lp(a) particles: this small, dense LDL particle is involved in thrombosis and promotes the rupture of plaque.
  •  RLP (Remnant Lipoprotein) particles: is very atherogenic, has a similar composition and density of plaque, is believed to be a building block of plaque and does not need to be oxidized like other LDL particles
  •  HDL2b particles: positively correlates with heart health because it is an indicator of how well excess lipids are removed

Other critical measurements to better evaluate your risk include:

  •  C-Reactive Protein-ss – an inflammation marker
  •  Homocysteine  – an amino acid linked to higher risk of coronary heart disease and peripheral vascular disease
  •  Fasting insulin level – a high fasting insulin is a sign of insulin resistance and the start of type II diabetes or metabolic syndrome

Why is it important to know lipoprotein numbers?  Because cardiovascular disease risk increases with a higher LDL particle count! With a higher non-HDL lipoprotein count the probability of particle penetration of the arterial wall rises, regardless of the total amount of cholesterol contained in each particle. On average, the typical particle contains 50 percent cholesterol.

Now here is what is troubling.  More than 20 percent of the population has cholesterol-depleted LDL, a condition in which a patient’s cholesterol may be “normal” but their lipoprotein particle number, and hence their actual risk, could be much higher than expected. This is especially common in persons whose triglycerides are high or HDL is low. In the population with a cholesterol-depleted LDL, there can be up to a 40 percent error in risk assessment.  Notice who has the real risk in the picture below and realize that your risk increases with an increasing number of small particles as well as the total number of particles.Description: The size/density and number particles determines your risk


Here are some thought provoking findings from Mark Hyman, MD to ponder before considering the use of statin drugs.   You can read the entire article, Why Cholesterol May Not Be the Cause of Heart at:

• If you lower bad cholesterol (LDL) but have a low HDL (good cholesterol) there is no benefit to statins. (i)• If you lower bad cholesterol (LDL) but don’t reduce inflammation (marked by a test called C-reactive protein), there is no benefit to statins. (ii)• If you are a healthy woman with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death. (iii)• If you are a man or a woman over 69 years old with high cholesterol, there is no proof that taking statins reduces your risk of heart attack or death. (iv)• Aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drug alone, but led to more plaque build up in the arties and no fewer heart attacks. (v)• 75% of people who have heart attacks have normal cholesterol
• Older patients with lower cholesterol have higher risks of death than those with higher cholesterol. (vi)• Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.• Recent evidence suggests that it is more likely statins ability to lower inflammation that accounts for any of its benefits, not their ability to lower cholesterol.

So for whom do the statin drugs work for anyway? They work for people who have already had heart attacks to prevent more heart attacks or death. And they work slightly for middle-aged men who have many risk factors for heart disease like high blood pressure, obesity, or diabetes.  Sadly, statins were not enough to save the life of NBC News anchor Tim Russert.  Perhaps if he had known all the risk factors things might have turned out different for him.

Know your risk by knowing the full information.  Get a Lipoprotein Particle Profile™ and let’s evaluate your true risk and what lifestyle changes you can make along with diet and supplement support to improve your odds against heart attack.  You will be glad you did.