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What's in a Lipid Panel? Looking Below the Surface.

(This is not medical advice. Consult your physician for medical advice. For reference only.)


Lipid panels have come a long way. It used to just be that if your cholesterol was over 200, it was high, and if it wasn't you were good! Now, you get 5 numbers in your lipid panel, and they can tell you a lot about your metabolic health now, and even predict the future, if you know how to look!


I highly recommend that you take matters into your own hands when it comes to your lipid panel. The "normal" ranges on the computer are a "one size fits all" and that is not good enough for a variable that can can, well, vary, so widely. Moreover, the numbers may fall within the "reference range" but still give important information. They should also be interpreted in the clinical context of your other cardiovascular risk factors, which the computer can not do. While your physician is an important resource, medicine tends to be more "reactive" than "proactive", so you may get a letter that your results are "normal", which they might be, but we can dig a little deeper here.

There are three main numbers in your lipid panel, and two ratios, so five numbers that I recommend examining. Here they are:


LDL: Low density lipoprotein, AKA: "lousy" cholesterol.

HDL: High density lipoprotein, AKA "healthy" cholesterol.

Triglycerides: fatty acids to transfer adipose between fat stores and the liver

Cholesterol/HDL ratio: the ratio of total cholesterol to HDL

Triglyceride/HDL ratio: the ratio of triglycerides to HDL


Now, log into your patient portal and pull up your latest result; what should you look for with each of these?


LDL: This directly correlates with the risk of atherosclerosis and therefore heart attacks, strokes, and other vascular disease. So, as you can imagine, with LDL, the lower the better. Ideal is under 70, great is under 100, acceptable is under 130, moderately elevated is under 160, and severely elevated is over 160. Now, if you have a high risk of cardiovascular disease, then you want your LDL under 70 and should take a "statin" no matter what your LDL is, as long as you do not have a contraindication. If you are low risk for cardiovascular disease, you may not need a "statin" unless your LDL is as high as 190.