The Great Cholesterol Con


“As for me, except for an occasional heart attack, I feel as young as I ever did.” – Robert Benchley

There is no question that blood cholesterol is involved in the accumulation of plaque in the arteries. This narrows the arteries and restricts blood flow and can lead to heart attacks and strokes. Yet the conventional approach misses the most important point: It’s the plaque that’s dangerous, not cholesterol itself. What’s more, your body actually needs cholesterol in order to make all steroid hormones.

So, in order to keep your heart healthy, what you really need to know is the tendency you have for your cholesterol to create plaques. And that is what VAP, a new diagnostic tool, helps do.

If the VAP test is used wisely, you can find out if your cholesterol is actually dangerous or if you fall into the larger group, where your cholesterol is harmless. This is possible because VAP introduces some new categories of cholesterol measurement that are far more predictive of heart disease than the traditional tests. Among the most important are Lp(a), LDL pattern size, Metabolic Syndrome, and lipid remnants.

1. Lp(a). The size of cholesterol-carrying particles is more important than the amount of cholesterol in your blood. That’s because some cholesterol particles will stay soluble in your blood (and so remain harmless) while others tend to cause cholesterol plaques, which narrow your arteries. The most dangerous of this last kind is a lipoprotein called Lp(a).

In particular, the research shows that smaller lipoprotein particles are dense and heavy, making them more likely to turn into plaque. The larger particles, by contrast, are lighter — so they are less likely to cause buildup on blood-vessel walls.

2. LDL. The same is true with LDL, the “bad cholesterol” you’ve heard so much about. With LDL, the smaller particles are again far more dangerous. In fact, they raise the risk of heart disease by 400%. High triglyceride levels and medications like beta-blockers and diuretics can cause LDL particles to become small, dense, and dangerous.

3. Metabolic Syndrome. This is a condition that causes high triglyceride levels, decreased HDL levels, and small, dense LDL particles. Since Metabolic Syndrome is a kind of “pre-diabetic” state, the sooner you catch the abnormality, the better. The trouble is, most traditional blood-sugar tests may not identify it until after you’ve developed heart disease. That’s one reason there is a virtual epidemic of this syndrome — most doctors miss the diagnosis.

4. Remnant lipids. The breakdown of very-low-density lipids produces these remnants. They contain mostly triglycerides and are directly “atherogenic,” meaning they cause plaquing.  We now know that remnants are an independent risk factor for developing heart disease. Traditional cholesterol tests do not check for remnant levels — but VAP does.

Traditional cholesterol tests often overlook risks when cholesterol levels appear normal. Overall, in fact, the old tests pick up only about 45% of cholesterol abnormalities. On the other side of the coin, traditional tests also often cause unnecessary worry (and treatment) by issuing false alarms. By contrast, VAP’s manufacturer, Atherotech, has compiled data suggesting that the new tests show 90% of cholesterol abnormalities.

When you weigh the evidence, the verdict is clear. To properly measure your heart health, you have to do more than measure total cholesterol levels.

So be sure to have your cardiovascular risk measured accurately. That means measuring for levels of C-reactive proteins and homocysteine in your blood. And it means getting a VAP test. It costs about the same as routine tests, and most insurance covers the cost. Discuss it with your doctor. He can order it from Atherotech, and you can learn more about the VAP test through the company’s website:

(Editorial Note: Dr. Al Sears is the editor of Health Confidential for Men, a publication devoted to men’s health.)