Cholesterol is a vital part of body function. It's responsible for regulating our cells, metabolism, hormone production, and many more physiological processes. Like many good things in life, this essential substance becomes an issue in excess. Excessive levels can lead to cardiovascular disease (CVD), which is the number one cause of death in the U.S. Early detection can prevent the onset of disease by providing guidance on lifestyle modifications and other integrative approaches to manage the risk. Therefore, regular lab testing for patients at risk for high cholesterol and other CVD is beneficial for effective cholesterol management. This article aims to provide an overview of high cholesterol and highlight the top labs for comprehensive testing.

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What is High Cholesterol?

Before discussing what high cholesterol is, we first need to discuss what cholesterol is. Cholesterol is a type of fat called lipids and carries out many integral physiological roles. Some of these roles include cell membrane function and health, production of sex hormone production such as estrogen and testosterone, stress hormones such as cortisol, vitamin D, and many other metabolic processes. 

Cholesterol is produced from our liver or consumed through foods like meat and eggs. It is transported throughout our body in two primary forms, Low-density lipoprotein (LDL) and High-density lipoprotein (HDL). LDL is considered the "bad" type as it carries cholesterol to body tissues and can become oxidized and cause cardiovascular issues. HDL is considered the "good" type as it takes the cholesterol from the cells and puts it back into the liver to be processed or metabolized. High cholesterol occurs when excessive cholesterol levels are circulating, also called hyperlipidemia or hypercholesterolemia.

Total cholesterol levels should be under 200, LDL under 100, and HDL higher than 60 on lab assessments. A person is considered at risk if the total cholesterol and LDL are higher than those values or the HDL is lower. Dangerous levels are considered, with total cholesterol at 240 or higher, LDL at 160 or higher, and HDL under 40 for males and under 50 for females. Cholesterol levels at abnormal ranges that are poorly managed can increase the risk of atherosclerosis leading to CVD, such as coronary artery disease (CAD), blocked blood flow to your heart, heart attacks, strokes, and other circulatory disorders.

What Causes High Cholesterol?

There are two leading causes of high cholesterol. They are acquired and hereditary (genetic). Lifestyle behaviors are a significant contributing factor to high cholesterol. These behaviors include unhealthy diets that are higher in trans fats, processed foods, and low in vegetables, smoking and lack of exercise. All can cause elevated levels of LDL. 

Familial hypercholesterolemia is the most common genetic condition that can cause excessive levels of LDL. The genetic disorder has genetic mutations such as the PCSK9 gene or apolipoprotein B (ApoB) that cause issues with cholesterol metabolism by affecting the LDL receptor. These genetic variations can decrease the clearance of LDL, leading to increased levels of this cholesterol. 

There are also secondary causes, causes from another condition or situation, such as hypothyroidism, kidney and liver disorders, diabetes, and certain medications like diuretics. A thorough medical intake, including medical history, physical exam, and regular testing, can detect risks early on, so lifestyle modifications or treatments can be created to improve cholesterol levels and reduce the associated risks.

High Cholesterol Symptoms

There aren't any symptoms of high cholesterol itself. Symptoms occur when elevated cholesterol levels, particularly LDL, oxidize and cause plaque build-up leading to atherosclerosis or other CVD conditions. Some common symptoms include:

●  Chest pain

●  Fatigue

●  Shortness of breath

●  Swelling

●  Irregular heartbeats

What Are The Benefits of Regular Lab Testing for Patients with High Cholesterol?

High cholesterol levels can typically be modified through integrative approaches such as lifestyle adjustments and nutrition. These increased levels will usually respond to multiple interventions.

Regular lab testing can help patients who are at risk for CVD associated with high cholesterol levels properly screen and monitor their levels. This screening and monitoring can allow for the effective management of elevated levels. Many people can successfully manage these levels through lifestyle modifications such as dietary changes, supplements, and regular exercise. 

Medications may sometimes be needed, as in the case of familial hypercholesterolemia. Monitoring these levels will provide insights into the effectiveness of treatment so adjustments can be made.

Top Labs To Run Bi-Annually On Patients With High Cholesterol

Assessing cardiovascular risk pertaining to cholesterol can be complex. Practitioners often use the following functional medicine labs to monitor cholesterol levels for their patients at risk for high cholesterol. These labs include:

Comprehensive Lipid Panel

This comprehensive cholesterol screening panel is commonly used by functional medicine practitioners for their patients to monitor their cholesterol levels and the associated risks. This test is done by analyzing serum and provides insights into 15 markers to evaluate the patient's risk of CVD. These markers include the basic lipid markers such as HDL, total cholesterol, and LDL. Additionally, it also includes markers that provide a deeper insight into CVD risk, such as Lp(a), VLDL, Apo A1, Apo B, sdLDL, and others. For instance, ApoB levels have been shown to be more predictive of a heart attack than all other lipid metrics, and elevations in sdLDL have a higher atherogenic potential than that of other LDL subfractions, making these markers more specific for assessing CVD risk. Regular monitoring of these levels can guide interventions and adjustments on any protocols to improve these levels and reduce the overall risk.

Cholesterol Balance Test

This cholesterol test provides insights into the underlying factors involved in a patient's higher cholesterol levels. It measures markers of cholesterol production at the cellular level and gastrointestinal absorption. These markers included (lathosterol and desmosterol) and absorption markers (beta-sitosterol, campesterol, and cholestanol) for circulating plasma cholesterol, which can indicate the effectiveness of LDL-lowering treatments. These markers are important because genetic variations can cause people to make more intracellular cholesterol or absorb more cholesterol from the gut. This lab test is completed through a blood sample. It can help identify the root cause for elevated cholesterol levels allowing providers to prescribe the most effective treatment strategy. Regular monitoring can help with any necessary adjustments to those treatments.

Oxidized LDL (OxLDL)

OxLDL is oxidized LDL and is a single marker test done by a blood sample. Elevated levels can trigger inflammation in the vascular system and CVD, such as atherosclerosis, CAD, and heart attacks. Higher levels have also been associated with metabolic issues, insulin resistance, and untreated hypothyroidism. This test should a measured bi-annually for patients with high cholesterol or other risks of CVD. Results can provide practitioners with information on the effectiveness of treatments and guidance on managing these risk factors.

Additional Labs to Check 

Although these labs do not need to be completed regularly, they should still be done for patients with high cholesterol. Metabolic screening should be conducted to rule out medical conditions that can cause secondary high cholesterol levels, such as a comprehensive metabolic panel (CMP) to assess for kidney function, hemoglobin A1c (HbA1c) to assess for diabetes, and thyroid panel to assess for hypothyroidism. 

A coronary artery calcium (CAC) scan provides images of the heart and plaque deposits in the blood vessels. It can help analyze the risk of CVD, specifically for people with high cholesterol, to help identify appropriate interventions. Other assessments that should be considered include an ASCVD (atherosclerotic cardiovascular disease) calculator used to estimate a patient's baseline risk for ASCVD and monitor progress.

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Summary

One in every five deaths is due to CVD. Early detection can help in preventing the onset of CVD. With high cholesterol being considered a key modifiable risk factor in CVD, it is essential to provide options to assess these levels so various approaches to preventing, managing, and treating high cholesterol can be utilized. Elevated levels can be present without people knowing, making it critical for people to get checked on a regular basis. 

A functional medicine approach to address high cholesterol involves regular testing through specialty labs. The results of these labs can provide individualized lifestyle modifications, such as dietary changes to improve cholesterol levels, as catching these measurements early gives people a chance to make the necessary changes needed for healthy levels.