FAQ: cholesterol tests

Does cholesterol still matter? The answer is a resounding yes, even though recent research suggests that this waxy stuff is just one of several factors that conspire to cause heart attacks and strokes. These guidelines will help you understand more about cholesterol so you can maintain good health.

Experts say that by identifying people who need cholesterol-lowering medication, the tests save lives. If my LDL is high but so is my HDL, am I protected? Having high "good" cholesterol may offset some of the damage caused by "bad" cholesterol. By now you may know that "bad" LDL cholesterol contributes to plaque in the arteries while "good" HDL sweeps bad cholesterol out of the body.

Some doctors believe that a patient's ratio of bad to good cholesterol offers a better indication of their heart disease risk than their LDL or total cholesterol levels. Most labs determine cholesterol ratio by dividing the total cholesterol number by the HDL number. A ratio higher than five to one increases the risk of heart attacks, while 3.5 to one or lower protects the heart.

Absolutely. High cholesterol is just one threat to your heart. Studies show that one-third to one-half of all heart attacks occur in people who do not have high cholesterol. There are at least two morals to this story.

1.  Maybe the bar for "high" cholesterol should be lowered; some doctors argue that putting even more people on cholesterol-lowering drugs would prevent many heart attacks and deaths.
2. Your cholesterol numbers don't tell the whole story of your risk for heart attacks and strokes. They say nothing, for instance, about how inflamed the linings of your arteries are. Many cardiologists now believe that most heart attacks occur when inflammation causes cholesterol-filled "plaques" that form along the inner walls of arteries to break apart and form blockages that starve the heart of blood. In response, some doctors now test the blood for C-reactive protein (CRP), a marker of inflammation.

Not necessarily. This test can reveal whether your arteries are inflamed, but many doctors say that doesn't tell them much. Studies show that people with high CRP are twice as likely to have heart attacks as people with low CRP. They are also less likely to survive heart attacks, and they have more strokes as well. In fact, people with elevated CRP have a high risk of heart attacks and strokes even if they have normal cholesterol levels.

It sounds like a no-brainer, then, to have your CRP tested — but it isn't. That's because people with elevated CRP almost always have other, more obvious risk factors for heart attacks: they smoke, they're overweight and they have high blood pressure and high blood sugar.

In other words, a doctor can tell without a CRP test that the patient is at risk. What's more, a high CRP level may simply be a sign of one of these conditions or, for that matter, an indicator of entirely unrelated inflammation. Perhaps you sprained your ankle recently, for example, or you have rheumatoid arthritis.