Is This You?

Heart disease runs in your family and you want to get ahead of it. Or you were told your cholesterol is "a little high" and handed a prescription, or a pamphlet about diet, without much explanation. Or everything on your panel looks normal and you still have a feeling there's more to know.

All of those are good reasons to look closer. And I know it can be scary to think about, but there is a lot we can do.

The Markers I Look At

Your standard panel reports LDL, HDL, and triglycerides. That's a start. I use advanced cardiovascular testing to go further:

• ApoB and LDL particle count. ApoB is a protein that coats the particles carrying harmful cholesterol, so it gives us a more precise count of your risk than LDL alone.
• Inflammation markers like hs-CRP and myeloperoxidase, because inflammation in your blood vessels is a big part of how plaque develops.
• Homocysteine, a marker of stress on your blood vessels.
• Metabolic markers such as fasting insulin and hemoglobin A1c, since insulin resistance and heart disease are closely tied.

For some patients, I'll also recommend a coronary calcium score, a scan that shows whether plaque has already started to build up.

What Could Be Driving It

Genetics and Cholesterol Particles

There's only so much you can do with diet for cholesterol. A big component is genetic. That's not bad news. It tells us which tools are going to work for you.

Inflammation

Chronic inflammation can come from your gut, your diet, excess weight, poor sleep, or an underlying condition. When your inflammation markers are high, we go looking for the source.

Insulin Resistance

High insulin and unstable blood sugar damage blood vessels over time, oftentimes years before anyone calls it diabetes.

Thyroid and Hormones

An underactive thyroid can raise your cholesterol, and optimizing it can improve your numbers. Hormone changes in midlife shift heart risk for both women and men.

How We Work on It Together

Having this data allows us to create more precise interventions. Your plan might include a Mediterranean-style way of eating built around foods like extra virgin olive oil, exercise that fits your life, targeted supplements, and, in some cases, medication.

I practice integrative medicine, which means I use what works. For the right patient, a small dose of a cholesterol medication is a really good tool, and I'll prescribe it. For another patient, nutrition and lifestyle are enough. We decide together, and then we retest so you can see whether the plan is working.

Otto came to me with a severely elevated calcium score and several specialists who each owned one piece of him. You can read how we looked at all of it together in his story.