Start your discussion with your doctor with a review of your cholesterol test values for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) and their specific goals.

More advanced information to discuss with your healthcare provider includes:

• If you have elevated TG (150-200 mg/dL), ask your doctor to discuss TG as a marker for increased risk for coronary heart disease (CHD).

  Specifically, should you consider a comprehensive cholesterol test (VAP) or Apo B, NMR profile, Berkeley HeartLab panel to more accurately stratify your risk related to high triglycerides.
  
  Triglycerides per say do not usually cause atherosclerosis (small dense VLDL₃ is directly atherogenic). Instead, it is their association with other cholesterol carrying lipoproteins that increase your risk. Specifically, high triglycerides are associated with emerging risk factors, atherogenic remnant lipoproteins [intermediate-density lipoprotein (IDL) and small very-low density lipoprotein [(VLDL₃)] and LDL particles that are small and high in number (reflected by high Apo B or high LDL particle concentration (LDL-P).
  



• If you have low-HDL-C and elevated TG (150-200 mg/dL), ask your doctor about possible Metabolic Syndrome, also known as Insulin Resistance Syndrome, which can progress to diabetes.

  Specifically, should you consider a comprehensive cholesterol test (VAP), hemoglobin A1C, fasting glucose (blood sugar) test or post-prandial glucose (blood sugar after a meal) or Berkeley HeartLab panel to more accurately stratify both cardiovascular risk and risk for diabetes. The NCEP guidelines state that the Metabolic Syndrome enhances the risk for CHD at any given LDL-concentration level.



• If your TG are >200 mg/dL, ask your doctor to discuss your non-HDL cholesterol (Total Cholesterol minus HDL-C)) value and goal.

  Specifically, consider a comprehensive cholesterol test (VAP) or Apo B, NMR profile or Berkeley HeartLab panel to more accurately stratify your risk.
  
  When TG are high, LDL-C alone inadequately defines the risk associated with atherogenic lipoproteins. Non-HDL cholesterol more accurately represents the concentrations of all atherogenic lipoproteins (LDL + IDL + VLDL + Lp(a) cholesterol).
  
  Importantly, NCEP guidelines recognize non-HDL cholesterol as a secondary target of therapy for persons with high triglycerides (200-499 mg/dL) in addition to LDL-C.



• If your TG are >200 mg/dL or your LDL-C is <100 mg/dL, ask your doctor about benefits of getting a directly measured LDL-C value.

  Specifically, you should consider a direct LDL test or VAP cholesterol test for a more accurate LDL-C measurement.
  
  In the routine lipid panel, the LDL is calculated and may be inaccurate. Conventional LDL-C measurements are estimated from the Friedewald formula that calculates LDL based on TG levels. Unfortunately, the formula is progressively inaccurate as TG values rise above 150 mg/dL and when actual LDL-C values are <100 mg/dL.



• If you have a positive family history for heart disease or diabetes, ask your doctor about measuring National Cholesterol Education Program (NCEP) emerging lipid risk factors associated with premature coronary heart disease (CHD).

  Specifically, consider a comprehensive VAP cholesterol test or Berkeley HeartLab panel.
  Emerging risk factors include Lp(a), small LDL particles (pattern B) and HDL subspecies (HDL2) and remnant lipoproteins IDL and small VLDL. Their presence presents the option to raise your risk to a higher level and modulate therapy.



• If you are on a cholesterol-lowering drug and not at goal, ask your healthcare provider if you are a candidate for combination therapy.

  Even with maximal use of statins under ideal conditions, many patients fail to achieve their LDL-C goal. When statins alone do not lower LDL cholesterol to a satisfactory level, combination therapy can lower LDL cholesterol levels an additional 10 to 50 percent (through the use of multiple agents).