Seeing normal cholesterol numbers on a blood test report often brings a sigh of relief, with many assuming their heart attack risk is minimal. However, this common belief can be dangerously misleading, according to medical experts.
The Hidden Dangers of a Normal Lipid Profile
In a recent social media post, Dr. Priyanka Sehrawat, a general physician and neurologist, addressed this widespread misconception. She emphasised that relying solely on standard cholesterol readings like LDL (bad cholesterol) and triglycerides provides an incomplete picture of cardiovascular health. "Even if your cholesterol levels are normal, your risk of a heart attack can still be high," she stated. The expert pointed out that other, often overlooked, predictors are essential for a more accurate risk assessment.
Two Critical Markers Your Routine Test May Ignore
Dr. Sehrawat highlighted two specific biomarkers that can reveal hidden risks: ApoB and Lipoprotein(a).
Apolipoprotein B (ApoB) measures the actual number of cholesterol-carrying particles in the bloodstream. All atherogenic particles, including LDL and VLDL, contain ApoB. "When these particles are present in high numbers, they tend to stick to the walls of blood vessels, leading to plaque formation and increasing the risk of clotting," explained Dr. Sehrawat. Elevated ApoB is also frequently linked to underlying metabolic dysfunction.
Lipoprotein(a) is largely a genetic risk factor. Dr. Sehrawat advised that individuals with a family history of early heart attacks should specifically get this level checked. She summarised her warning by stating that both markers are vital for evaluating heart attack risk, even when conventional cholesterol values fall within the normal range.
Why Standard Tests Fall Short: Expert Insight
Echoing this perspective, Dr. CM Nagesh, Honorary Secretary at the Indian College of Cardiology and Founder of Cardea Super Speciality Hospital, elaborated on the science. He explained that routine cholesterol tests measure the amount of cholesterol but not the number of harmful particles. "ApoB directly counts the number of atherogenic particles... which can penetrate the arterial wall and trigger plaque formation. This makes ApoB a more accurate indicator of true cardiovascular risk," he told indianexpress.com.
Regarding Lipoprotein(a), Dr. Nagesh noted it is a genetically determined particle that promotes both plaque buildup and abnormal clotting. "Even when total cholesterol is normal, elevated Lipoprotein(a) can significantly increase heart attack and stroke risk," he added. Together, these tests can uncover dangers that a standard lipid profile might completely miss.
Who Should Get Tested for These Advanced Markers?
Dr. Nagesh recommends considering these tests for specific high-risk groups:
- Individuals with a family history of premature heart disease or unexplained heart attacks in relatives.
- People who have experienced early cardiac events despite having normal cholesterol levels.
- Those with conditions like diabetes, metabolic syndrome, obesity, chronic inflammation, or autoimmune diseases, as routine tests often underestimate their risk.
- Patients with a prior history of heart attack or angioplasty.
- Younger adults who appear healthy but have strong genetic risk factors.
"In such cases, these tests help guide more precise and preventive treatment strategies," concluded the expert. The key takeaway is clear: a normal cholesterol report is not a free pass for heart health. Consulting a healthcare practitioner for a comprehensive risk assessment, including these advanced markers when indicated, is a crucial step in prevention.
