It’s actually possible to be a ticking time bomb with severe coronary heart disease while also having a “normal” cholesterol (lipid) profile.

This is why you shouldn’t assume you’re automatically out of the woods just because your cholesterol numbers came back terrific.

Not every heart attack sufferer had bad cholesterol numbers.

Perhaps you’ve heard that about one-half of people who suffer a heart attack have “normal” cholesterol. This brings to mind the interior of coronary arteries looking pretty good. And how can this be?

“Cholesterol is only one risk factor for CAD,” says Pilar Stevens-Cohen, MD, FACC, Department of Cardiology, South Nassau Communities Hospital.

CAD stands for coronary artery disease (a.k.a. heart disease).

“We recognize that it is only part of the picture,” she continues. “Diabetes [prevention of], smoking cessation, blood pressure management are all key factors in secondary prevention.”

Cholesterol Defined

“It’s a moving target,” says Dr. Stevens-Cohen. “When I was training, the bad cholesterol target was under 100.

“Now we say less than 70. Do we know how low to go? We also now recognize that LDL is only part of the equation.”

LDL is the “bad” cholesterol: high density lipoproteins.

“Newer tests, NMR [nuclear magnetic resonance spectroscopy], evaluating particle size [of LDLs], may be more helpful in managing patients than actual LDL levels.

“A person can seemingly have a good cholesterol panel, but when you do specialized testing, you see that their particle size is shifted and you should be managing them more aggressively.”

The bigger the LDL particles, the more desirable. A person can have normal cholesterol numbers, but if the particles are very small…this can mean heart disease — which can ultimately lead to an attack.

Another reason a person with normal cholesterol could have a heart attack is due to atrial fibrillation, an arrhythmia that can cause blood clots to form in the heart.

Dr. Stevens-Cohen is board certified in cardiology, nuclear cardiology, echocardiography and internal medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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