Why “High Cholesterol” Is Often Misunderstood

For decades, “high cholesterol” has been treated as a diagnosis rather than a data point. If LDL cholesterol (LDL-C) crosses a predefined threshold, the conversation often jumps straight to medication, usually a statin.

What’s wrong with that?

LDL-C alone does not accurately represent cardiovascular risk in many individuals. And you may be taking a medication that is unnecessary for your health.

This blog explains:

• Why a basic lipid panel can be misleading.

• Why statins should not always be first-line therapy.

• Why advanced testing like an NMR lipid profile offers a more accurate, diagnostic view of risk.

The Main Problem: LDL-C Is An Incomplete Marker

A standard lipid panel measures:

• Total cholesterol

• LDL-C (cholesterol mass inside LDL particles)

• HDL-C

• Triglycerides

What it does not measure:

• How many LDL particles are circulating

• Whether those particles are small and dense or large and buoyant

• How long they remain in circulation

• Whether they are being driven by insulin resistance or inflammation

LDL-C tells you how much cholesterol is being carried, not how many particles are doing the carrying.

That distinction matters because atherosclerosis is a particle-driven process, not a cholesterol-mass problem.

Atherosclerosis Is a Particle Disease

Plaque formation occurs when apoB-containing particles (LDL, VLDL remnants) penetrate the arterial wall and remain there long enough to trigger inflammation.

Risk is driven by:

• Particle number

• Particle size

• Particle residence time

• Endothelial health

• Systemic inflammation

You can have:

• High LDL-C with low particle number → lower risk

• Normal LDL-C with high particle number → higher risk

This phenomenon, called LDL discordance, is well documented and extremely common, especially in metabolically unhealthy individuals.

How People Get Misdiagnosed

Consider a common scenario:

• LDL-C: 165 mg/dL

• Triglycerides: 65 mg/dL

• HDL-C: 68 mg/dL

• A1c, insulin, CRP: normal

On a basic lipid panel, this patient is labeled “high cholesterol” and often advised to start a statin.

However, an NMR lipid profile may show:

• Low LDL particle number

• Large, buoyant LDL particles

• Minimal small dense LDL

• Strong HDL particle count

Actual biological risk: low
Medication necessity: questionable, but probably not needed.

This patient did not have a cholesterol disease; they had efficient cholesterol transport.

Why Statins Are Often Used Too Early

Statins work by:

• Inhibiting hepatic cholesterol synthesis

• Increasing LDL receptor activity

• Improving LDL particle clearance

What they do not do:

• Fix insulin resistance

• Reduce VLDL overproduction

• Address hepatic fat accumulation

• Correct lifestyle-driven dyslipidemia

In modern populations, most dyslipidemia is metabolic, not genetic. Treating the downstream cholesterol number without addressing the upstream metabolic dysfunction is incomplete care.

This is why statins should be contextual tools, not automatic first-line therapy.

The NMR Lipid Profile: A More Diagnostic Test

An NMR (nuclear magnetic resonance) lipid profile provides deeper, clinically actionable data:

• LDL particle number (LDL-P)

• LDL particle size

• Small dense LDL burden

• VLDL and HDL particle counts

• Early insulin-resistance patterns

This allows clinicians to:

• Identify hidden cardiovascular risk earlier

• Avoid unnecessary medication

• Personalize nutrition, lifestyle, and treatment plans

• Track real improvement beyond LDL-C alone

In short, the NMR answers the question:

“Is this person actually at risk or just outside a reference range?”

In Summary

• A standard lipid panel is a screening tool, not a diagnostic endpoint

• High LDL-C ≠ high cardiovascular risk

• Statins lower cholesterol numbers, not always disease risk

• The NMR lipid profile provides a clearer, more precise risk picture

If you’ve been told you have “high cholesterol” but have never had particle testing, your risk assessment is incomplete.

If you are still making decisions based on LDL alone, that is outdated and incomplete medicine.

If you want:

• A deeper look at your cardiovascular risk

• Advanced testing that actually explains why your cholesterol looks the way it does

• A strategy that prioritizes root cause before prescriptions

Request an advanced lipid evaluation and stop guessing about your heart health.

Average health is common. Optimized health is intentional

-Dr. Zach Taylor