The Numbers are In, and I'm Not Happy

No, the title to this post does not refer to my opinion on the recent Democratic primary results.  It's about my health.

Specifically, my cholesterol.  I got around to schlepping myself to the doctor a couple weeks ago for a physical, and because of a family history of cholesterol/heart disease, he suggested a new, non-standard cholesterol panel run by the Berkeley HeartLab.  Rather than just spout off your cholesterol numbers (HDL, LDL, and Trigliceride counts), this panel goes further and separates each of the types of cholesterol up into the concentrations of the various size particles that compose up each type of cholesterol.  The reason these concentrations are important is that you can have normal cholesterol count numbers and still be at an elevated risk for heart disease if you've got the wrong kinds of good/bad cholesterol.

(If you're not interested in why this is the case, you can skip the next three paragraphs and go straight to reading about why I'm not happy with my results.)

LDL entry into the artery wall

In the bad cholesterol (LDL), you've got basically two categories of particles - those that are large & buoyant, and those that are small & dense.  New research shows that it is these small & dense particles that cause the major heart-disease problems: they are small enough to pass out of the bloodstream and into the artery wall, where they build up and create plaque within the wall of the artery.  When this buildup becomes too great, the wall of the artery can rupture, releasing the plaque to form a clog and cause heart attacks and other medical problems. 

Distribution of the Types of Cholesterol

Although the larger-sized LDL can (and do) enter the artery walls, they do so at a much slower rate.  As you can see, it is advantageous to not only minimize your overall LDL count, but also limit the number of smaller-sized LDL particles, if you can.

In the good cholesterol (HDL), the particles are responsible for removing cholesterol from your blood.  The larger the size of the particle the better it is at removing cholesterol.  The only problem is the smaller HDL particles can actually be converted into the smaller versions of the LDL particles, making matters worse.

So, in summary, to be healthy, not only do you want your HDL cholesterol to be high and your LDL cholesterol to be low, you want to minimize the number of smaller sized particles of each of these types of cholesterol while increasing the number of larger-sized HDL cholesterol particles, if possible.

And where do I stand?  My cholesterol count is in the normal range, overall, but I've got all the wrong types.  My HDL2b is low (7% instead of the desired 20%+).  My LDLIIIa+b is way too high (47.5% instead of the desired < 15%).

If I was older, I think you could call me a walking heart attack.

As it is though, my doctor said that because I'm young, I'm probably safe (for the moment).  But it would be best to get on the ball to try to change these numbers as soon as possible.  While diet and exercise along may be effective in changing some of these numbers, it won't do all the results I need for this and other variables that attribute to advanced cardiovascular risk.

So after talking to my doctor for a while about it, I'm going to be starting a couple of medicines to help out:

- Crestor, a statin that will reduce LDL and raise HDL, 3x a week
- Niaspan, a niacin supplement that will also help with these and reduce other CAD factors, every day

And along with these, I'm going to be making changes to my diet, primarily in the reduction of fats and alcohol (ugh).  NOT going to be fun.  We'll see how I'm doing in 2 months, and again in 4-6 months.  I'm hoping to see some major improvement.  If so, I might be able to cut back on some of the medication and just maintain with diet and exercise.  But my long-term health is more important than the inconvenience of taking medications or not being able to eat/drink what I like, so for now I'll grin and bear it.