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For the last 20 years, the focus in assessing our risk for coronary and vascular disease has been LDL cholesterol. This is traditionally known as "bad" cholesterol, because it causes blockages in our coronary arteries. HDL is the "good" cholesterol and offers protection against the damage that LDL causes. However, cholesterol results that we obtain from a traditional lipid profile don't necessarily tell us our true risk.

The Presbyterian Center for Preventive Cardiology offers advanced lipid testing to help find the hidden risks that show us the concentration and sizes of the LDL and HDL particles. Some particles are small and dense, while others are large and fluffy. For both types of cholesterol, the smaller and denser your particles, the higher the risk. The smaller, denser LDL ("bad") particles are four times as likely to produce blockages in our arteries, whereas large, fluffy HDL ("good") particles appear to provide protection against coronary and vascular disease.

Once we analyze an advanced lipid profile, we can pinpoint people who have high levels of the "bad" LDL cholesterol particles that are small and dense in addition to low levels of "good" HDL cholesterol and elevated triglycerides (another blood fat). This combination of unhealthy lipid levels means you are at an increased risk for coronary disease and also indicates that you could have what is called Metabolic Syndrome. This condition is caused by a combination of abnormalities that also includes high blood pressure, insulin resistance and, often, abdominal obesity. Certain people have a genetic predisposition for developing Metabolic Syndrome, and half of all patients with coronary disease have the condition. Women with Metabolic Syndrome have a higher risk of developing coronary disease than men with the same condition.

The good news is that the risk of coronary and vascular disease can be reduced! Proper diet and exercise, along with aggressive medical management, will maximize your chances to reduce your risk.