More Than ‘Good’ & ‘Bad’ Cholesterol Are You Missing Key Heart Markers?

Cholesterol and Cardiovascular Disease: A Closer Look at Advanced Markers

Cardiovascular disease (CVD) is a major health concern worldwide, and for years, cholesterol has been at the heart of the discussion. But there’s a lot more to the story than just “good” and “bad” cholesterol. While traditional markers like total cholesterol and LDL cholesterol (LDL-C) have been used to assess heart health, newer and more advanced markers - like lipoprotein(a) [Lp(a)] and the apolipoprotein B to apolipoprotein A1 (ApoB/ApoA1) ratio - provide a much clearer picture of your real risk.

So, what do you really need to know?

Cholesterol: Friend, Not Foe

First things first - cholesterol itself is NOT the enemy. In fact, your body absolutely depends on it. Cholesterol is essential for:

• Hormone production (including oestrogen, testosterone, and cortisol)

• Building and maintaining cell membranes

• Making vitamin D (which is crucial for immune function, bone health, and mood)

• Producing bile acids to help digest fats

Your body actually makes most of the cholesterol it needs because it’s that important.

LDL and HDL: More Than Just “Good” and “Bad”

You’ve probably heard LDL called “bad” cholesterol and HDL called “good” cholesterol. But it’s not quite that simple.

• LDL (Low-Density Lipoprotein): Yes, LDL carries cholesterol to the cells, and if too much sticks around, it can contribute to plaque build-up in arteries. However, LDL is not inherently bad - it’s necessary for delivering cholesterol where it’s needed. The issue arises when LDL becomes oxidized or when there’s an imbalance with other markers.

• HDL (High-Density Lipoprotein): HDL helps remove excess cholesterol and transport it to the liver for disposal. However, more is not always better, very high levels of HDL can sometimes be problematic and may even be linked to increased inflammation in certain cases.

Advanced Markers: The Real Game Changers

Since traditional cholesterol tests only give a partial picture, let’s look at some advanced markers that provide deeper insight.

Lp(a): A Hidden Risk Factor

What is Lp(a)?

Lp(a) is similar to LDL, but it has an extra protein called apolipoprotein(a), which makes it particularly harmful. High levels are strongly linked to increased risk of heart disease, stroke, and blood clots.

Why does it matter?

Unlike other cholesterol markers, Lp(a) is almost entirely determined by genetics which means diet and lifestyle won’t lower it. If you have high Lp(a), the key is to be extra mindful of other risk factors and work on reducing overall cardiovascular risk. While there are currently no widely available treatments to lower Lp(a), new drugs are in development.

ApoB and ApoA1: The Better Balance Test

What are they?

• ApoB is a protein found in LDL and other cholesterol particles that contribute to plaque build-up. Since each LDL particle contains one ApoB, this is a much more precise measure of harmful cholesterol than LDL-C alone.

• ApoA1 is the main protein in HDL and reflects how well your body can remove cholesterol.

Why does this ratio matter?

A higher ApoB/ApoA1 ratio means more artery-clogging particles and less protection which makes it a strong predictor of cardiovascular risk.

Other Important Markers: The Bigger Picture

While cholesterol and lipoproteins are key players, other markers can help assess overall cardiovascular and metabolic health:

• High-Sensitivity C-Reactive Protein (hs-CRP): A measure of inflammation in the body. Chronic inflammation is a major driver of CVD, and elevated hs-CRP levels can indicate increased cardiovascular risk.

• Haemoglobin A1c (HbA1c): A long-term measure of blood sugar control. Poor blood sugar regulation is linked to metabolic dysfunction, which increases the risk of CVD.

It's not just cholesterol - look at the whole body

Cholesterol is only really “a problem” when it’s moving through an environment that encourages damage. If blood sugar is running high or swinging up and down, and inflammation is simmering in the background, that combination increases oxidative stress and makes LDL particles more likely to become oxidised and irritating to artery walls. That is why the goal is not just a number on a cholesterol panel, but improving the terrain: steadier blood sugar (often reflected by HbA1c and post-meal spikes), lower inflammation (often tracked with hs-CRP), plus the foundations that support this like fibre-rich whole foods, movement, sleep and stress support. And if Lp(a) is high, this matters even more, because you cannot meaningfully shift Lp(a) with diet and lifestyle, so being extra on it with blood sugar, inflammation and other risk factors becomes a key part of lowering overall cardiovascular risk

Why These Markers Matter for You

Knowing these advanced markers allows for a more personalised approach to heart health. If your Lp(a) is high, for example, you’ll want to be extra proactive about managing other factors like inflammation, blood sugar, and blood pressure. Similarly, a high ApoB/ApoA1 ratio can highlight hidden risks even if your LDL and HDL look “normal.”

What You Can Do

If you’re serious about protecting your heart, consider getting tested for these advanced markers. As part of my wellness programs, I can arrange for these tests to be included in your health assessment.

If you're a current client, feel free to reach out to get tested. And if you're new here, let’s chat. I offer a free 20-minute health review call where we can discuss your concerns and explore how these markers can help guide your journey to better health.

Your heart health is in your hands. Let’s take a proactive approach together. Book your call today.

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I'm Gemma Westfold, BANT registered Nutritional Therapist.