4 Important Nonstandard Cholesterol Tests
The standard cholesterol test of checking the total cholesterol, HDL, and LDL levels don't actually tell us much.
Cholesterol is largely hereditary and isn't affected by lifestyle factors such as diet and exercise.
Health, as determined by cholesterol, isn't largely determined by the total amount of cholesterol in the body, but by other factors as well such as the particle size, the state of the cholesterol (whether oxidized or not), and whether a person has certain risk factors such as elevated levels of lipoprotein A (lipo A).
Which nonstandard cholesterol tests are more useful?
APO B
APO B is a total measure of all LDL cholesterol, including LDL-C, VLDL, ILDL, and lipoprotein-A.
In other words, an APO B tests counts all of your LDL cholesterol and gives the result as a single number. The particles in your blood that cause heart disease are called lipoproteins, and they come in many sizes and densities. The density of the lipoprotein is the main factor that determines whether it’s atherogenic (i.e., causes heart disease). VLDL (very low density lipoprotein), LDL (low density lipoprotein), and IDL (intermediate density lipoprotein) are three different particle types that cause heart disease. HDL (high density lipoprotein) doesn’t cause heart disease, and may even protect against it. VLDL, LDL, and IDL particles each contain exactly one ApoB molecule. So each ApoB molecule is counted to count each LDL particle (LDL, VLDL, and IDL). So the APOB test gives us the total cholesterol number in particle number of LDL cholesterol amount rather than the mass that the standard LDL-C does, and it takes into account all LDL cholesterol including VLDL, IDL, and Lipoprotein-A rather than just LDL-C.
Lipo Fractionation
Lipo Fractionation gives a breakdown of the LDL in your body and gives the amount of each type of LDL cholesterol that you have.
It tells the amount of total LDL particles that you have (LDL Particle Number (LDL-P)) which measures the total number of LDL particles, with a high LDL-P is typically associated with a higher cardiovascular risk, LDL Particle Size, in which the report will often classify your LDL particles as Pattern A (larger, more buoyant, and generally less atherogenic/dangerous) or Pattern B (smaller, denser, and more easily oxidized, indicating higher risk), HDL Particle Number (HDL-P) which measures the total number of protective "good" cholesterol particles, VLDL Particle Number where high counts are often seen with high triglycerides, insulin resistance, or metabolic syndrome, and lipoprotein(a) [Lp(a)] which is a genetically determined type of LDL that carries a higher risk for cardiovascular disease.
OxLDL Test
The OxLDL test checks to determine the amount of LDL cholesterol that has been damaged by free radicals in the bloodstream.
This oxidation triggers vascular inflammation and is consumed by immune cells, turning them into foam cells that form dangerous arterial plaque.
High levels of OxLDL indicate elevated oxidative stress and an increased risk of coronary artery disease.
Lp-PLA2 Test
The Lp-PLA2 test is a specific inflammatory enzyme and biomarker used to evaluate vascular inflammation and the risk of soft, vulnerable atherosclerotic plaque in arteries. Elevated levels are strongly correlated with a higher risk of heart attacks and strokes.
Lp-PLA2 is an enzyme that breaks down oxidized LDL cholesterol, generating inflammatory byproducts that cause plaque to form and become unstable (soft/vulnerable) and prone to rupture. This rupturing is what can cause a cardiovascular event, such as atherosclerotic plaque that can lead to a coronary blockage.
This test usually would not be done unless the OxLDL is abnormal. Being that Lp-PLA2 is only elevated when there is oxidized plaque, it would only be carried out if OxLDL is elevated and would not be done if OxLDL levels are normal.
You may think it may be smart to just do a Lp-PLA2 test, since it would show there is oxidation with accompanied break down of the oxidized cholesterol, but this isn't true. Sometimes Lp-PLA2 can be elevated for other reasons other than oxidized LDL, such as heavy smoking or systemic inflammation. Also, the production and release of these markers fluctuate depending on the stability of atheosclerotic plaques. Therefore, OxLDL should be conducted first to find out that if the patient has high oxidation of LDL.
These cholesterol tests, done individually or as a whole, will give you a much better look at your health, particularly in regard to your cholesterol and cardiovascular profile than simply a standard cholesterol test.
APO B tests count all of your LDL cholesterol, even your Liprotein A (LpA).
Lipo Fractionation tells you the breakdown of the type of cholesterol pattern that you have, either large and buoyant or smaller and denser.
OxLDL tells you the oxidation status of your cholesterol.
If OxLDL is abnormal, you can then do a Lp-PLA2 test if warranted to evaluate the risk of soft, vulnerable atherosclerotic plaque in your arteries.