Imagine two people with nearly identical cholesterol results.
One has no family history of early cardiovascular disease. The other has a parent who experienced a heart attack at 52 and has inherited a high level of lipoprotein(a), or Lp(a).
Their standard cholesterol panels may look very similar.
Their cardiovascular risk may not be.
As a naturopathic doctor, this is what interests me most about cardiovascular health. The numbers matter, but so does the story behind them. A standard cholesterol panel is an important starting point, but it doesn’t always provide the complete picture of someone’s cardiovascular risk.
Understanding your heart health means looking at cholesterol alongside family history, blood pressure, metabolic health, lifestyle, previous card
By Dr. Rachelle Viinberg, OLY, BSc, ND
What Does a Cholesterol Test Actually Tell Us?
A routine lipid panel typically includes total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.
LDL cholesterol is particularly important because LDL-containing particles contribute to the development of atherosclerotic plaque. Lowering LDL cholesterol in appropriate patients reduces the risk of cardiovascular events.
But I would never interpret an LDL result without asking other questions.
What is your blood pressure? Do you smoke? Do you have diabetes? Has a close relative experienced a heart attack or stroke at a young age? Have you already had a cardiovascular event?
The same LDL result can lead to a very different clinical conversation depending on the answers to those questions.
That’s why cardiovascular prevention isn’t simply about deciding whether cholesterol is “good” or “bad.”
It’s about understanding risk.
ApoB: How Many Particles Are Carrying That Cholesterol?
One way to understand ApoB is to think about the difference between the cholesterol being transported and the particles transporting it.
LDL cholesterol tells us about the amount of cholesterol being carried within LDL particles. Apolipoprotein B, or ApoB, provides information about the number of atherogenic particles capable of contributing to plaque formation.
Usually LDL cholesterol and ApoB tell a similar story.
Sometimes they don’t.
This discordance can be particularly relevant when triglycerides are elevated or metabolic health is a concern. In those circumstances, ApoB can sometimes add useful information to cardiovascular risk assessment rather than replacing the standard lipid panel. Canadian guidelines specifically recognize ApoB and non-HDL cholesterol as valuable measures of atherogenic lipoprotein burden.
This is one reason I prefer to look at blood work as a pattern rather than focusing on a single number.
Your cardiovascular markers are part of your broader metabolic health, alongside glucose regulation, blood pressure, inflammation, lifestyle and family history.
Lp(a): A Risk Factor Your Usual Cholesterol Panel Doesn’t Show
Lipoprotein(a), usually shortened to Lp(a), is a largely inherited cardiovascular risk factor.
It isn’t included in a standard lipid panel, and you cannot determine your Lp(a) level from your LDL cholesterol or ApoB result.
This is particularly important for people who have a strong family history of premature cardiovascular disease.
Someone may eat well, exercise regularly and have fairly reassuring conventional cholesterol results but still have a significantly elevated Lp(a) because genetics largely determine the level.
The Canadian Cardiovascular Society recommends measuring Lp(a) once in a person’s lifetime as part of initial lipid screening. Because Lp(a) is highly heritable and generally remains relatively stable throughout life, repeated testing is usually unnecessary for cardiovascular risk assessment.
A high Lp(a) result doesn’t mean that a heart attack or stroke is inevitable.
It gives us another piece of information that can help you and your healthcare team determine how closely your other modifiable cardiovascular risk factors should be managed.
That’s an important distinction.
The purpose of identifying risk isn’t to create fear. It’s to make prevention more individualized.
The Rest of the Cardiovascular Picture Matters
Heart health involves much more than lipids.
When I review someone’s blood work, I want to understand those numbers alongside family history, blood pressure, smoking status, physical activity, nutrition and metabolic health.
Glucose and HbA1c can help identify diabetes or prediabetes. Triglycerides and, in some circumstances, fasting insulin may provide additional context about metabolic health.
Inflammatory markers can sometimes add information as well, although they need to be interpreted carefully. High-sensitivity C-reactive protein, for example, is a nonspecific marker of inflammation. An elevated result cannot tell us by itself what is causing inflammation or whether plaque exists within an artery.
This is an important part of responsible testing.
The goal isn’t to order every possible test.
Thoughtful laboratory testing can help us move from simply collecting numbers to understanding how those numbers fit into your overall cardiovascular and metabolic picture.
Book your Discovery Call today
This complimentary call is an opportunity to discuss your health concerns, learn more about Dr. Viinberg’s approach, and determine whether naturopathic care may be a good fit for you.
Prevention Looks Different for Different People
There is another important distinction in cardiovascular medicine: primary versus secondary prevention.
Primary prevention means reducing the likelihood of a first cardiovascular event in someone who hasn’t previously experienced one.
Secondary prevention means reducing the risk of another event in someone who already has established cardiovascular disease, such as a previous heart attack or stroke.
Those are very different clinical situations.
Someone who has already experienced cardiovascular disease generally requires much more intensive risk reduction than someone at relatively low risk who is trying to prevent a first event. Canadian cardiovascular guidelines explicitly distinguish these populations when recommending lipid-lowering treatment and risk management.
This is also why comparing your cholesterol numbers with a friend, spouse or someone on social media isn’t particularly useful.
Their medical history isn’t yours.
Their genetics aren’t yours.
And their cardiovascular risk isn’t necessarily yours.
Where Metabolic Health Fits In
Cardiovascular health and metabolic health are closely connected.
Blood pressure, glucose regulation, insulin resistance, triglycerides, abdominal fat distribution, physical activity and nutrition can all contribute to long-term cardiovascular risk.
This becomes particularly relevant in midlife, when people may begin noticing changes in cholesterol, glucose or body composition even though their lifestyle hasn’t dramatically changed.
Rather than treating each of these findings as an isolated problem, looking at them together can help us understand the broader metabolic pattern.
That is often where prevention becomes much more personalized.
Lifestyle Still Matters—Even When Genetics Are Involved
Learning that you have a genetic cardiovascular risk factor can feel discouraging.
But inherited risk doesn’t make lifestyle irrelevant.
In fact, knowing that an inherited risk factor is present can make managing the factors you can influence even more important.
Regular physical activity, a heart-supportive dietary pattern, maintaining healthy blood pressure, avoiding smoking, supporting metabolic health and appropriately treating elevated lipids all remain important parts of cardiovascular prevention. The Canadian Cardiovascular Society continues to describe health behaviour modification, including exercise and a heart-healthy diet, as a cornerstone of cardiovascular disease prevention.
Genetics may influence your starting point.
They don’t tell the entire story.
The Bottom Line
A “normal” or reassuring cholesterol panel is valuable information.
But it isn’t the same thing as a complete cardiovascular risk assessment.
LDL cholesterol matters.
ApoB can provide additional information about atherogenic particle burden.
Lp(a) can uncover an inherited risk factor that isn’t visible on a routine cholesterol panel.
And all of those numbers need to be considered alongside family history, blood pressure, glucose regulation, smoking, physical activity, previous cardiovascular disease and the rest of your health history.
The goal isn’t to find more things to worry about.
It’s to understand your risk well enough to make a prevention plan that actually fits you.
Do We Understand Your Risk Well Enough to Make a Plan That Fits You?
If you have a family history of cardiovascular disease, questions about your cholesterol results, or an interest in preventing a future cardiovascular event, we can review what’s already known and identify what may be useful to discuss with your healthcare team.
At Dr. Kristy Lewis & Associates, our approach combines individualized assessment, appropriate laboratory testing and sustainable lifestyle strategies while working alongside your family doctor and specialists when appropriate.
Book your Discovery Call today
This complimentary call is an opportunity to discuss your health concerns, learn more about Dr. Viinberg’s approach, and determine whether naturopathic care may be a good fit for you.