If you’re over 50 and you’ve been told your cholesterol is high, you may be wondering what it actually means for your health.
Most people know about LDL and HDL cholesterol, but today’s cholesterol testing often includes additional markers like ApoB, Lipoprotein(a), and inflammation levels. These numbers can help us better understand your risk for heart attack and stroke and create a treatment plan that’s right for you.
LDL: The Cholesterol Most People Know About
LDL is often called “bad cholesterol.”
When LDL levels stay elevated over time, cholesterol can build up inside your arteries. This buildup can narrow blood vessels and increase the risk of heart attack and stroke.
The higher your LDL, the more attention we pay to lowering it, especially if you have other risk factors.
HDL: The Helpful Cholesterol
HDL is often called “good cholesterol.”
Its job is to help remove excess cholesterol from the bloodstream and support healthy arteries. Higher HDL levels are generally considered beneficial, although we look at the full picture rather than relying on one number alone.
The New Cholesterol Markers We Pay Attention To
Over the last several years, we’ve learned that traditional cholesterol numbers don’t always tell the whole story.
ApoB
ApoB helps measure the number of cholesterol particles that can contribute to plaque buildup.
In some patients, LDL may not look terribly high, but ApoB is elevated. When that happens, the risk for heart disease can be higher than expected.
The good news is that ApoB usually responds to the same treatments we use for LDL cholesterol.
Lipoprotein(a) or Lp(a)
Lp(a) is a cholesterol particle that is largely inherited.
People with elevated Lp(a) may have a higher risk of heart attack, stroke, and plaque buildup, even when other cholesterol numbers look reasonable.
Because it often runs in families, it’s an important test for people with a family history of heart disease.
hs-CRP
This blood test measures inflammation in the body.
Inflammation plays a role in heart disease, and elevated levels may signal additional cardiovascular risk.
A Real Patient Example
Recently, I saw a 54-year-old woman who wanted to be proactive about her heart health because several family members had experienced heart attacks and strokes.
Her LDL was mildly elevated, and her ApoB was also higher than I would like to see. Even though some of her other numbers looked reassuring, her family history and overall risk profile told us she would likely benefit from treatment.
We started a low dose of rosuvastatin, one of the most commonly prescribed cholesterol medications.
Just four weeks later, her LDL had dropped by more than 40%, and her ApoB improved as well.
What If You Can’t Take a Statin?
Many patients worry about statin side effects.
While statins are often our first choice because they work well and are affordable, not everyone tolerates them.
If side effects occur, there are other options available, including:
• Ezetimibe (Zetia)
• Injectable medications such as Repatha, Praluent, and Leqvio
• Mediterranean-style nutrition plans
• Exercise programs
• Other cholesterol-lowering strategies
The goal is to find a plan that works for you, not force a medication that doesn’t.
Can Diet and Exercise Lower Cholesterol?
Yes.
For many people, healthy lifestyle changes can make a meaningful difference.
I typically recommend a Mediterranean-style eating plan that focuses on:
• Vegetables and fruits
• Beans and plant-based proteins
• Healthy fats like olive oil
• High-quality omega-3 foods
• Minimally processed foods
At the same time, I encourage regular exercise, including walking, cycling, swimming, or other activities that keep you moving consistently.
Many patients can lower their cholesterol significantly through lifestyle changes, although higher-risk patients often need medication as well.
Why Your Cholesterol Goal May Be Different Than Someone Else’s
One of the most common questions I hear is:
“What should my cholesterol be?”
The answer depends on your individual risk.
Factors we consider include:
• Family history
• High blood pressure
• Diabetes
• Smoking history
• Cholesterol levels
• Evidence of plaque buildup
That’s why two people with similar cholesterol numbers may receive very different treatment recommendations.
Looking Beyond Blood Work
In some patients, additional testing helps us understand risk more clearly.
A coronary calcium scan can look for plaque in the heart’s arteries before symptoms develop.
A CIMT ultrasound can evaluate the arteries in the neck for early signs of cholesterol buildup.
When these tests show plaque, we often become more aggressive about lowering cholesterol to help prevent future problems.
The Bottom Line
Managing cholesterol isn’t about chasing one number.
It’s about understanding your overall risk and creating a plan that fits your health history, family history, and goals.
Whether that plan includes lifestyle changes, medication, or both, there are more treatment options available today than ever before.
The earlier you identify risk factors and take action, the better your chances of preventing a heart attack or stroke before it happens.
Ready to Learn Your True Heart Risk?
If you’re over 50 and concerned about your cholesterol, don’t focus only on your total cholesterol number. A complete evaluation can help uncover hidden risks and identify the best path forward.
Schedule an appointment with Dr. Krock to review your cholesterol numbers, assess your heart disease risk, and create a personalized prevention plan.
WATCH THE FULL VIDEO:
