Having finally found a UK source for an LDL particle size test I got my results back today. There were other marker results in the test and it was a mixture of mainly good news but some not so good. The results were as follows Total Cholesterol 5.64 LDL Cholesterol 3.08 HDL 2.17 Triglycerides 0.87 LDL paricle count 1,131 HDL partcile count 30.2 LDL Size 21.1 (means large pattern A) LP(a) 0.82 CRP 0.52 LpPLA2 210 Fibrinogen 9.1 Homocysteine 23.5 The good news is that the LDL size was big and fluffy and not small and dense. Most other markers were all in acceptable range for the marker with the exception of Total LDL (for those who still think this marker is predictive), LpPLA (too high) and Homocysteine (too high). Homocysteine was very much on the high side with the acceptable range being 3.7 to 10.4. The jury seems to be out a little on this factor, some people seem unconvinced that it is a responsible factor for heart disease whilst others are. It is produced from methionine and has a genetic influence. Kidney problems can also elevate this factor so the way forward would seem to be centred around keeping ones kidneys flushed with water and reducing high methionine foods such as meat (not really applicable in my case) and Brazil nuts (applicable in my case). PLA2 is an enzyme detected in the blood when someone has plaque build up in the arteries. This one might prove a little harder to crack.
There are some useful comments below on the use of Vit B6, B12 and Folate for lowering Homocysteine and a useful link here
The more digging I do the more I become aware that the lipid test you get from your local GP is totally inadequate. Even the little information they offer is misinterpreted by most GP’s. The focus tends to be on LDL and keeping it low. It may surprise you that no research has been able to show a relationship between LDL levels as your doctor test shows and heart events. The size of LDL particles is relevant but this test is not offered. It may also surprise you to know that insurance companies in the USA do not even look at LDL levels when assessing your risk. They realise, better than our GP’s, that LDL levels are not relevant. A better indicator from the basic Lipid panel is Total Cholesterol / HDL ratio and it is this ratio that insurance companies focus on. The ideal ratio is below 3.5 for men, 3 would be even better.
So what test’s do offer a better indication.
1. Fibrinogen levels – Fibrinogen causes clotting and high levels are considered bad. A trial called Eurostroke divided participants into 4 categories based on Fibrinogen levels. There was a 50% rise in strokes for each increase in category. Arterial plaque has been found to contain Fibrinogen suggesting it plays a significant part in its formation. Desirable levels are less than 500 mg/dl
2. CRP – C Reactive Protein is a test your GP here in the UK will include. It is raised by inflamation within the body and with inflamation now considered the root cause of heart disease, high levels of CRP are certainly not desirable. One word of caution though general body inflamation can spike CRP, so if for example you have arthiritis or flu this may spike your CRP levels. Desirable levels < 0.5 mg/L
3. Microalbumin/Creatinine urine ratio (MACR) – Research from the Framlingham study showed that elevated ratios of Microalbumin to Creatinine had a 20% higher rate of CV events. Ideal ratios are lower than 7.5 for Women and lower than 4 for men.
4. LpPLA2 – This test measure the level of an enzyme Phospholipase attached to LDL. This level will be elevated when the arterial wall is inflamed. A danger sign that plaque could rupture and cause a heart attack. Levels less than 200 ng/ml were considered desirable according to a Mayo heart study.
5. ApoB / APO A1 ratio – These values show up on a Blue Horizon comprehensive test here in the UK. Research has shown the following indicators.
Men Low risk 0.4 – 0.69 Moderate risk 0.7 – 0.89 High risk 0.9 – 1.10
Women Low 0.3 – 0.59 Moderate 0.6 – 0.79 High 0.8 – 1.0
The ApoB/ApoA1 ratio (divide your ApoB value by your ApoA1 value) has been shown in numerous studies to be a better predictor of future heart attack events than both LDL alone and even the Total cholesterol / HDL ratio. Despite many doctors and researchers stating that this should be included in a standard lipid panel of results, you still have to go private to obtain it.
Maybe one day all these or at least more than one will be available at your local GP
So far I have been rather sceptical about the gene connection to heart disease simply because some populations have little HD and yet acquire it readily when they emigrate to places like the USA. This suggests that any supposed genetic protection is not doing them much good when they hit America. A part of me suspects that finding gene connections with simple genetic tests is a wonderful way for drug companies to get people onto drugs even earlier in life, after all plenty of people are going to run scared when they find out that despite being in seemingly good health at the age of 20 they are nevertheless in the high risk gene camp.
The latest research suggests that there are 6 of these gene camps associated with the APOE gene. Each one is a pair of factors, E2E2, E2E3, E2E4, E3E3, E3E4 and E4E4. From the point of view of cardio risk the worse category is E4E4 followed by E3E4. E2E2 is considered low risk with E3E3 being the average reading.
The current thinking is that E4 carriers are far more prone to have raised LDL levels and thus increased risk of Heart Disease. There is even a suggestion that the correct diet for each of these categories needs to be different with E4 carriers needing a low fat diet with high carb’s whilst the E2 carriers fairing best from a high fat low carb diet.
My personal category is E3E4 which might explain my previous blog theme where I mentioned that eating eggs and liver for a week seemed to spike my Cholesterol, whereas for many people cholesterol laden food does not have too much of an effect on their cholesterol levels.
There is an overview of this topic at the following link
There is also a book covering the area at
The category you are in could also have an effect on whether you gain a positive LDL response to alcohol or not. Some research has suggested that E2 carriers get positive LDL reactions to drinking alcohol whilst E4 carriers do not. So if you are downing the red wine in search of the French paradox and you are an E4 carrier, think again.