What can I measure that predicts risk of heart disease?

The (very) short answer is this:

Doctors typically measure the following in a standard cholesterol test:

• LDL-C – the concentration of LDL (“bad”) cholesterol in your blood
• HDL-C – the concentration of HDL (“good”) cholesterol in your blood
• TG – the level of triglycerides (“bad”) in your blood

Combining HDL-C and TG into a ratio (i.e., TG/HDL-C) is probably the single best predictor of cardiac risk you can derive from a standard cholesterol test.  The lower the ratio, the lower your chances of having an “adverse cardiac event,” as the medical community describes it (e.g., a heart attack). Despite what doctors tell you, LDL-C is pretty much useless for predicting your risk of heart disease. In fact, it’s not even part of the risk assessment for metabolic syndrome, which everyone agrees is the central link to heart disease (and virtually all other chronic diseases we’re afflicted with).

The real story is that the number, size, and density of cholesterol particles in your blood (LDL-P and HDL-P) are far better predictors of heart disease risk. A quick summary:

1. Large, buoyant LDL particles are good
2. Small, dense LDL are bad
3. Small HDL particles are less protective
4. Large HDL particles are more protective

The best way to measure your heart disease risk through LDL cholesterol is to measure the number of LDL particles in your blood, or LDL-P, which you never get checked unless you have a fancy test called a lipid nuclear magnetic resonance test – or NMR test for short. There are two surrogate ways to test this:

1. You can look at particle size.  As a general rule (this is NOT always the case, however), the larger the LDL particles, for a given LDL-C, the fewer the particles (which is what we want).
2. You can look at the concentration of something called apoprotein B, or ApoB for short. Every LDL particle has approximately one ApoB, so knowing how much ApoB you have gives you a very accurate measurement of the number of LDL particles you have.

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