I recently listed to your cholesterol podcast and I learned a lot. Thank you for everything you do and all of your hard work!
My question relates to a recent blood test I had completed. I know you might not be able to give specific advice, but I am having trouble interpreting these results. Most things look fairly good, except for the “ldl particle number”, “ldl small”, and “ldl medium.” Should I be concerned that these numbers are so high? Is there anything special to lower these numbers, or is it just diet and maybe a statin or other meds?
Heart issues are fairly common in my family, so I like to be proactive about these things. Thanks again
Hi there,
Glad you found the podcast helpful.
This is a somewhat unusual lipid profile, particularly because the “standard” cholesterol panel looks pretty good, your apoB and Lp(a) measurements are also great, however the total number of LDL particles remains high. This is indeed a source of concern, although why this is happening - or what should be done about it - is tricky to say without more information about you and your medical history (e.g., things like waist circumference, any history of diabetes, high blood pressure, fatty liver disease, etc.), since this kind of “discordance” between ApoB and LDL-P can be seen in situations of insulin resistance.
Our general advice on managing blood lipid problems is outlined in this article: Cholesterol - Causes, Prevention & Treatment
Thank you for the prompt reply. I thought I would provide a few more details to make sure nothing stands out as needing more attention.
- I included the first page of blood work mainly just to show you my bilirubin was high if that means anything to you. It is always elevated when I do blood work.
- I included the page with the A1C as well. It has always been within range when I do blood work.
- Blood pressure is controlled via meds. Take carvedilol (12.5 mg 2 x day) and valsartan with hydro. (160 mg, 12.5 mg). Open to changing
- No history of diabetes, 35 in. waist. Never been screened for fatty liver disease that I know of.
- I am getting these tests ran again in December.
The most likely cause of an asymptomatic, chronically elevated total bilirubin in this range is Gilbert’s syndrome (a benign condition), however it’s tough to provide much specific/detailed commentary on your specific situation via the forum. The high blood pressure may be a manifestation of some insulin resistance (or may be unrelated), although your HbA1c is reassuring against diabetes. Overall your labs look pretty good, but I am puzzled by your discordantly high LDL particularly counts, which are typically a source of concern as it relates to cardiovascular risk.
