For Heart Health: Look Beyond your Cholesterol Number
Heart disease is the #1 cause of death in the United States.
Developing cardiovascular disease depends on numerous factors, including genetics, diet, lifestyle and environment. According to the American Heart Association, atherosclerosis – hardening of the arteries – “begins in childhood and progresses into adulthood” (2010).
Heart disease often develops without any signs or symptoms until someone suffers a heart attack. In fact, approximately 50% of all deaths due to coronary heart disease occur in people without previous cardiac symptoms or diagnoses (AHA 2010).
Since you can’t rely on symptoms to detect a developing cardiovascular health problem, it’s essential to pay attention to lab markers that can provide insight into the status of your cardiovascular health.
It’s also critical to recognize that the root cause of cardiovascular problems is not a lack of medication. Accordingly, the solutions are not found only in medication.
Numerous factors underlie cardiovascular risk, many of which are diet and lifestyle factors.
A comprehensive and effective response to identified cardiovascular risk must address diet and lifestyle factors.
Despite the numerous factors that affect heart health, you may have been told simply that atherosclerosis is caused by cholesterol (a waxy, fat-like substance found throughout the body) clogging the arteries and the solution is a medication (typically a statin drug) to reduce the cholesterol level.
In other words, cardiovascular risk boils down to:
high cholesterol (especially LDL-cholesterol) = high cardiovascular disease risk, and
low cholesterol = low cardiovascular risk
Except that it’s not really that simple.
While it’s true that cholesterol is present in an atherosclerotic artery, the cholesterol is there because something else injured the artery first (Fung, 2018, p 26-27).
Cholesterol shows up when there is damage in the body and tries to repair the damage.
Cholesterol is not the root cause of the problem.
Moreover, researchers have found that a “significant proportion of patients with elevated LDL-C have neither evidence of atherosclerosis . . . at middle age nor development of [atherosclerotic cardiovascular disease] at long-term follow-up into old age” (Mortensen, 2023, p. 1054).
Nonetheless, because of the prevalent belief that cholesterol is the villain in cardiovascular disease, the LDL-cholesterol (LDL-C) is the number on the lipid panel that gets the most attention.
LDL-C is often referred to as the “bad cholesterol” and statin medications are routinely prescribed to reduce the amount of LDL-C in the blood (National Center for Chronic Disease Prevention and Health Promotion, 2024).
High cholesterol can be a symptom of a problem – and possibly a warning sign of disease development that must be taken seriously – but cholesterol is not the root cause of the problem.
The body needs cholesterol and makes it in the liver. Cholesterol’s essential roles include:
making hormones
producing vitamin D
creating cell membranes, and
making bile acids needed to digest food (Tsoupras, 2018).
There are many types of cholesterol particles. The cholesterol attached to high density lipoproteins (HDL) are protective of heart health, while cholesterol attached to low density lipoproteins (LDL) can be damaging to tissues.
Multiple dietary and non-dietary factors can lead to elevated cholesterol as well as potentially causing other symptoms, out-of-range lab markers, and health problems.
These factors are the root causes of high cholesterol:
High sugar diet (AKA the Standard American Diet)
Trans fats and excess saturated fat (fried foods and fast food)
Processed meats
Stress
Certain medications – for example, birth control pills, retinoids, corticosteroids, antivirals, anticonvulsants, medicines for high blood pressure
Thyroid dysfunction – thyroid hormones help remove extra cholesterol from the body; a low-functioning thyroid can’t do this job well
Type 2 diabetes
Menopause – when estrogen falls, LDL-C and total cholesterol increase
Being sedentary – when you sit too long, the enzyme that turns LDL into HDL drops by 95%
Liver problems
Excess alcohol
Pregnancy — can cause a temporary spike in cholesterol
Kidney problems
Genetics -- for a small number of people, genetics cause the liver to produce too much LDL cholesterol
Imbalanced gut microbiome (Yoo, Sniffen, Percy, & Palaval, 2022).
Note that high cholesterol foods are not included in this list.
Eggs are not the culprit here – not even the yolks.
For most people, dietary cholesterol in food is not the cause of high cholesterol in the blood (Kresser, 2019).
If you don’t consume the cholesterol needed to do cholesterol’s important jobs, your liver will produce it instead (Healthline, 2023).
Statin drugs can effectively reduce cholesterol levels. They do so by blocking an enzyme that the liver needs to make cholesterol.
In some people, statin drugs may be needed to protect against heart attack and stroke.
For others, using a statin is essentially attacking a symptom of dysfunction while ignoring the root cause of the dysfunction.
If statins drive cholesterol levels too low this can disrupt
the structure of the body’s cells
the production of hormones – including sex hormones (estrogen and testosterone), insulin and thyroid hormones
the body’s ability to produce vitamin D – a nutrient essential for immune health, and
the creation of bile acids needed to digest fats.
Statins also deplete the body’s stores of Coenzyme Q10 – a potent antioxidant that protects cells against oxidative stress.
Statins can cause side effects in some people including:
muscle pain and damage
increased blood sugar levels leading to type 2 diabetes
digestive problems
neurological problems including memory loss or confusion, and
liver damage (Mayo Clinic, 2025).
Focusing only on a standard lipid panel to assess heart health can lead to the use of medications to reduce cholesterol numbers without addressing the underlying causes of the elevated cholesterol.
Moreover, reliance only on a standard lipid panel can fail to identify risk factors in people whose cholesterol numbers are within the normal lab reference ranges.
Approximately 50% of people who suffer heart attacks have "normal" LDL levels (Sachdeva, et al, 2009).
Given the many underlying factors that could be causing an increase in cholesterol levels, along with the potential side effects of statins, a more effective approach is to understand the root causes of your elevated cholesterol and address those factors.
Identifying root causes and thoroughly evaluating cardiovascular risk involves testing beyond the standard lipid panel.
Additional testing is readily available and can provide more nuanced information about cardiovascular health risks AND the underlying factors – including blood sugar dysregulation, thyroid imbalance, and inflammation – that could be the root cause driving that risk.
The following are tests to consider discussing with your doctor before agreeing to use a statin:
Standard Lipid Panel
High-density lipoprotein (HDL)
Low-density lipoprotein (LDL)
Total cholesterol
Triglycerides
This is the standard test run at an annual physical. Elevated LDL and triglycerides indicate an increased risk of atherosclerosis, while high HDL levels are considered protective against heart disease.
Advanced Lipid Panel
LDL particle number (LDL-P)
Lipoprotein(a)
LDL and HDL particle size
Apolipoprotein A-1
Apolipoprotein B
“Small and dense LDL-P is a significant predictor of cardiovascular risk and may be more accurate in this prediction than the standard LDL cholesterol measurements” (Institute for Functional Medicine, 2024).
Apolipoproteins are the protein components of HDL and LDL that play critical roles in metabolism and function. Research indicates that apolipoprotein measurements deliver even more precise predictions of both cardiovascular disease and mortality than HDL and LDL.
“If your LDL is high and your ApoB is low, your risk of heart disease is low.”
“If your LDL is normal or low and your ApoB is high, your risk of heart disease is high” (Hyman, 2024).
Inflammatory Markers
C-reactive protein
High-sensitivity C-Reactive Protein
Homocysteine
Inflammation is a known risk factor for cardiovascular diseases.
C-reactive protein (CRP) detects systemic inflammation while High-sensitivity C-reactive protein (HsCRP) is a more sensitive CRP test that detects inflammation associated with the heart.
Homocysteine is an amino acid associated with cardiovascular (and neurological) health. High levels can lead to inflammation which damages blood vessels and can lead to atherosclerosis and a higher risk of blood clots, stroke and heart attack.
Blood Sugar Markers
Fasting glucose
Fasting insulin
Hemoglobin A1c
Uric acid
Blood sugar dysregulation and insulin resistance, in particular, are closely connected to heart disease (Damaskos, 2020). Dietary and lifestyle factors that lead to elevated blood sugar levels can also be a root cause of high cholesterol.
Comprehensive Thyroid Panel
TSH
T4
T3
Free T3
Free T4
Reverse T3
Thyroid Antibodies
Thyroid dysfunction can lead to elevated cholesterol levels. From a preventative perspective, testing TSH alone is insufficient to assess thyroid function because other markers will be dysregulated before TSH levels fall outside a standard lab reference range.
Coronary Artery Calcium Scan
Johns Hopkins’ Medicine refers to the Coronary Artery Calcium Scan as “The Heart Test You May Need—but Likely Haven’t Heard Of” (Lima, n.d.).
This simple test measures calcification of arteries and is more predictive of your risk of heart disease in the future than your cholesterol number.
Calcium scans are useful for “people ages 40 to 75 whose 10-year risk of heart disease or stroke ranges from 7.5% to 20%.“ This “intermediate-risk group” does not include people who are at very low risk of heart disease nor those who have had a serious cardiovascular event. (Harvard, 2019). See the ASCVD Risk Estimator to calculate your risk for a cardiovascular event.
Despite its proven utility, insurance often won't cover the calcium scan test. Call around to radiology facilities and ask for the self-pay price -- it can range from $99 to $400+.
The Bottom Line
There’s a lot more to heart health than your cholesterol number and there are better tests than the standard lipid panel to understand the true picture of your cardiovascular risk.
Regardless of the test results, achieving optimal cardiovascular health requires addressing the diet and lifestyle factors that are causing dysfunction in your body.
A healthy heart depends on a healthy body.
In my work as a Nutritional Therapy and Restorative Wellness Practitioner, I’m not in the business of diagnosing disease.
Instead, I provide my clients access to comprehensive lab work that helps identify the actual root causes of health concerns. I guide and support my clients in addressing those root causes by adopting a nutrient-dense whole foods diet and making needed lifestyle changes.
If you’d like to learn what nutritional therapy work looks like, and whether it could be the answer you’re looking for, schedule a complimentary discovery call.
REFERENCES
American Heart Association. (2010). 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults. Circulation (122:25): e584-e636. https://doi.org/10.1161/CIR.0b013e3182051b4
Cloyd, J. (2025). What Do Homocysteine Test Results Tell Us? https://www.rupahealth.com/post/what-do-homocysteine-test-results-tell-us
Damaskos, C., Garmpis, N., Kollia, P., Mitsiopoulos, G., Barlampa, D., Drosos, A., Patsouras, A., Gravvanis, N., Antoniou, V., Litos, A., & Diamantis, E. (2020). Assessing Cardiovascular Risk in Patients with Diabetes: An Update. Current Cardiology Reviews, 16(4):266-274. https://doi.org/10.2174/1573403X15666191111123622
Fung, J. (2018). The Diabetes Code. Greystone Books.
Harvard Health Publishing. (2019). Do you need a calcium scan? https://www.health.harvard.edu/heart-health/do-you-need-a-calcium-scan
Healthline. (2023). Why Dietary Cholesterol Does Not Matter (For Most People). https://www.healthline.com/nutrition/dietary-cholesterol-does-not-matter#bottom-line
Hyman, M. (2024). Why LDL is Not Enough: The Tests Your Doctor is Missing to Assess Your Risk of Heart Disease | Know Your Numbers. https://drhyman.com/blogs/content/podcast-ep856
Institute for Functional Medicine. (2024). Advanced Lipid Testing: A Deeper Insight to Cardiometabolic Health. https://www.ifm.org/articles/advanced-lipid-testing-cardio-health
Lima, J. (n.d.). The Heart Test You May Need—but Likely Haven’t Heard Of. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-heart-test-you-may-need-but-likely-havent-heard-of
Kresser, C. (2019). The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy. https://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/
Mayo Clinic. (2025). Statin side effects: Weigh the benefits and risks. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
Mortensen, M.B., Dzaye, O., Bøtker, H.E., Jensen, J.M., Maeng, M. , Bentzon, J. F., Kanstrup, H., Sørensen, H.T., Leipsic, J., Blankstein, R., Nasir, K., Blaha, M. J., & Nørgaard, B. L. (2023). Low-Density Lipoprotein Cholesterol Is Predominantly Associated With Atherosclerotic Cardiovascular Disease Events in Patients With Evidence of Coronary Atherosclerosis: The Western Denmark Heart Registry. Circulation, 147:14, 1053-1063. https://doi.org/10.1161/CIRCULATIONAHA.122.061010
National Center for Chronic Disease Prevention and Health Promotion. (2024). https://www.healthcentral.com/drug/most-common-medications
Sachdeva, A., Cannon, C.P., Deedwania, P.C., Labresh, K.A., Smith, S.C., Dai, D., Hernandez, A., Fonarow, G. (2009). Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With the Guidelines. American Heart Journal, 157(1), 111–117.e2. https://do.org/10.1016/j.ahj.2008.08.010
Tsoupras, A., Lordan, R. Zabetakis, I. (2018). Inflammation, not Cholesterol, Is a Cause of Chronic Disease. Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986484/
Yoo, J.Y., Sniffen, S., Percy, K.C., Pallaval, V.B., Chidipi, B. (2022). Gut Dysbiosis and Immune System in Atherosclerotic Cardiovascular Disease (ACVD). Microorganisms, 10(1), 108. https://doi: 10.3390/microorganisms10010108.
