For most people, total cholesterol is the headline number to watch on their blood test reports, but does that single figure truly reveal your risk of heart disease? While it offers a broad overview, experts say it doesn’t tell the full story. Cardiovascular risk is driven by specific types of cholesterol particles and lipoproteins – some of which are far more predictive of plaque build-up and future heart events than total cholesterol alone. Understanding these deeper markers can provide a clearer, more accurate picture of your heart health.
Dr Dmitry Yaranov, a cardiologist and heart-transplant specialist with expertise in advanced heart failure and mechanical circulatory support, emphasises that simply checking your total cholesterol is not enough to assess true cardiovascular risk.
He highlights that a deeper look at specific lipid markers provides a far more accurate picture of heart health – and shares the cholesterol measures that matter most. In an Instagram video shared on February 12, the cardiologist highlights, “Most people focus on total cholesterol. That’s not the number that matters. Here’s what you should actually know about your lipid panel.”
1. LDL-C
LDL-C (low-density lipoprotein cholesterol), often referred to as the “bad” cholesterol, is a type of lipoprotein that transports cholesterol through the bloodstream. While cholesterol itself is essential for various bodily functions, Dr Yaranov notes that elevated levels of LDL-C can lead to plaque build-up in the arteries, significantly increasing the risk of cardiovascular disease. He explains, “LDL-C drives plaque. Lowering LDL reduces cardiovascular risk. This is causal.”
2. ApoB
Apolipoprotein B (ApoB) is the main structural protein found on all atherogenic, plaque-forming lipoprotein particles, including LDL, VLDL, IDL and Lp(a). Its level reflects the total number of harmful cholesterol particles circulating in the blood. Dr Yaranov highlights that ApoB is an even more powerful risk marker than LDL-C alone, as elevated levels directly drive the development of atherosclerosis and increase cardiovascular risk. He explains, “ApoB counts the number of atherogenic particles (LDL, VLDL, IDL, Lp(a)). More ApoB equals more plaque-driving particles. If LDL and ApoB disagree, ApoB wins.”
3. Non-HDL
According to the Cleveland Clinic, non-HDL cholesterol is a value on your lipid panel that represents all the “bad” cholesterol circulating in your bloodstream. A high non-HDL level signals a greater risk of heart disease, as it captures the cholesterol carried by LDL, VLDL and other atherogenic particles known to contribute to plaque build-up in the arteries. The cardiologist notes that non-HDL cholesterol can serve as an alternative to ApoB when ApoB levels are not directly measured. He states, “Non-HDL is a practical backup for ApoB if it’s not measured.”
4. Triglycerides
Triglycerides are the most common type of fat circulating in the bloodstream, serving as an important source of energy for the body. While normal levels are essential for metabolic function, elevated triglycerides can signal an excess of atherogenic lipoprotein particles and an increased risk of cardiovascular disease. Dr Yaranov recommends getting your ApoB levels tested if triglycerides are high, for a clearer picture of heart disease risk. He notes, “High levels often signal excess atherogenic particles. If elevated, check ApoB.”
5. Lp(a)
According to the American Heart Association, lipoprotein(a), or Lp(a), is a genetically inherited form of LDL cholesterol that serves as a significant and independent risk factor for heart disease, stroke and aortic stenosis. The cardiologist highlights that nearly 20 per cent of people may have elevated Lp(a) levels without realising it – and that it can substantially increase cardiovascular risk even when standard LDL cholesterol levels appear normal. He stresses, “Lp(a) is genetically inherited. Approximately 20 percent of people have elevated levels. Increases risk even if LDL looks “normal.” Measure it at least once in your lifetime.”
6. HDL
High-density lipoprotein (HDL) is often labelled the “good” cholesterol because it helps clear excess cholesterol from the bloodstream. According to the Mayo Clinic, HDL carries cholesterol away from tissues and arteries back to the liver, where it can be processed and excreted. However, Dr Yaranov stresses that while beneficial, a high HDL number does not protect you from heart disease risk since it does not negate high LDL levels. He explains, “Raising HDL does not reduce cardiovascular events. High HDL does not cancel high LDL.”
Heart disease prevention math
The cardiologist sums up modern cardiovascular prevention into one clear, actionable principle: “lower ApoB, lower LDL, and know your Lp(a)”. By reducing the number of atherogenic particles in the bloodstream and understanding your inherited risk, you can take far more precise control of your long-term heart health.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. It is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.
