Home Am I at Risk? Other Types of Blood Fat (Lipids)

Other Types of Blood Fat (Lipids)

What is non-HDL cholesterol?

Non-HDL cholesterol is calculated by subtracting the HDL (good) cholesterol from the total cholesterol. You don’t need a separate test for it. Measuring non-HDL cholesterol is particularly helpful in people with high triglycerides. Non-HDL cholesterol is better at predicting who will develop heart disease or have a heart attack than LDL (bad) cholesterol because it includes all of the bad types of cholesterol and lipids. There are no official cutoffs for non-HDL cholesterol; the American Heart Association suggests that women aim for a level below 130 mg/dL.24

What is Lp(a) and should I be tested for it?

Another type of lipid or fat that seems to increase a woman’s risk for heart disease is Lp(a), pronounced “lipoprotein little a” or “Lp little a.” Lp(a) is made up of LDL linked to a protein called apolipoprotein (a). Women with high levels of Lp(a) are more likely to develop fatty plaque blockages in their arteries and have a higher risk of having a heart attack compared with women with lower levels.32-34

There is no standard test for Lp(a) and no established definition of a high or low level. Research studies suggest that less than 30 mg/dL is ideal. Women with levels above 30 mg/dL had twice the risk of suffering a heart attack or other heart problems than women with lower levels in one study.35 Cutoffs may vary by race because levels of Lp(a) are naturally higher in African Americans than in whites.

Your healthcare provider may order an Lp(a) test if you have heart disease but none of the traditional risk factors (such as smoking, diabetes, or high total cholesterol), or if you have a family history of heart disease. Your Lp(a) level is largely set by genetics.36 There are no medications specifically for lowering Lp(a) and diet and exercise don’t seem to affect it. Nicotinic acid or niacin, a medication mostly used for raising HDL (good) cholesterol, lowers Lp(a). It has yet to be shown that lowering Lp(a) will lower your risk for heart disease.

What is apo-B and should I be tested for it?

Apo-B stands for apolipoprotein B, the protein part of LDL. High levels of apo-B may be a stronger risk factor for heart disease than previously thought.37, 38 Apo-B is not routinely tested for because calculating non-HDL (which doesn’t require a separate test) gives you similar information. If your LDL (bad) cholesterol is high, then your apo-B level will be high too, so there is no point in testing for it. If you have very high triglycerides, it is difficult to accurately measure your bad cholesterol level and an apo-B test may be helpful in this case. Your healthcare provider may put you on a stricter diet or a different dose of medication depending on your apo-B test results. Your healthcare provider may test for apo-B if you have a personal or family history of heart disease, especially if you have high triglyceride levels.

There is no official definition of a high or low level of apo-B. Studies suggest that under 130 mg/dL is a good target for men and women with 1 or no risk factors; those with 2 or more risk factors should aim for a level below 110 mg/dL, and people already diagnosed with heart disease or diabetes should aim even lower (under 90 mg/dL).39 Most cholesterol drugs that lower LDL (bad) cholesterol, such as statins (e.g., Lipitor) also lower apo-B. A heart-healthy diet and exercise can also lower apo-B levels. It has yet to be shown that lowering apo-B will lower your risk for heart disease.


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