Understanding Lipids, Cholesterol, and Cardiometabolic Health
Why Lipids Matter for Heart and Metabolic Health
Cholesterol and other blood lipids play essential roles in hormone production, cell membrane structure, and energy metabolism. However, when imbalanced—especially in combination with inflammation, oxidative stress, or insulin resistance—they can contribute to the development of atherosclerosis and cardiometabolic disease.
A standard lipid panel gives valuable insights, but by itself, it doesn’t tell the full story of cardiovascular risk. Understanding what each marker means—and what influences them—can help tailor more precise, individualized prevention and treatment strategies.
Interpreting a Standard Lipid Panel
Total Cholesterol
Sum of all cholesterol types in the blood
Optimal range: < 5.2 mmol/L
Interpretation: Elevated levels may indicate risk, but interpretation depends on ratios and particle types.
HDL Cholesterol
High-density lipoproteins that help clear cholesterol from arteries
Optimal range: > 1.3 mmol/L (women) and > 1.0 mmol/L (men)
Interpretation: Higher is protective. Low HDL increases cardiometabolic risk.
LDL Cholesterol
Low-density lipoproteins that carry cholesterol to tissues
Optimal range: < 3.0 mmol/L (optimal), < 2.0 mmol/L (in high risk populations)
Interpretation: Elevated LDL is a key risk factor, especially when oxidized or small-dense.
Triglycerides (TG)
Circulating fats in the blood
Optimal range: < 1.7 mmol/L
Interpretation: Elevated TG are linked to insulin resistance and fatty liver.
Non-HDL Cholesterol
All atherogenic particles
Optimal range: < 3.5 mmol/L
Interpretation: More predictive of risk than LDL alone.
Total Cholesterol/HDL Ratio
Measure of insulin resistance and particle size
Optimal range: TC/HDL < 4
Interpretation: Lower ratios indicate better metabolic health.
Triglycerides/HDL Ratio
Measure of insulin resistance and particle size
Optimal range: TG/HDL < 2
Interpretation: Lower ratios indicate better metabolic health.
What Causes High LDL or Low HDL?
Factors Increasing LDL-C:
A diet high in saturated and trans fats
Genetic factors (e.g., familial hypercholesterolemia, APOE4 variant)
Hypothyroidism
Chronic inflammation or oxidative stress
High refined carbohydrate intake leading to small, dense LDL
Low physical activity or high stress levels
Factors Lowering HDL-C:
Insulin resistance and elevated triglycerides
Smoking and alcohol overuse
Sedentary lifestyle
Chronic inflammation
Low estrogen levels (e.g., post-menopause)
Lifestyle, inflammation, thyroid function, and metabolic health all play critical roles—so addressing lipid imbalances requires a whole-person approach.
Why Cholesterol Alone Doesn’t Tell the Whole Story
A standard cholesterol panel can still miss subclinical cardiometabolic risk. Many individuals with “normal” LDL and HDL levels may still have:
Atherogenic particle imbalance (e.g., high ApoB)
Endothelial dysfunction (poor nitric oxide signalling)
Chronic low-grade inflammation
Insulin resistance or early metabolic syndrome
That’s why more advanced testing provides a clearer picture of cardiometabolic health beyond cholesterol.
Cardiometabolic Risk-Enhancing Factors
These additional variables can significantly modify your true cardiovascular risk:
APOE3/4 or APOE4 genotype – higher LDL particle number, impaired lipid clearance, and increased Alzheimer’s risk
Family history of premature CVD or metabolic syndrome
Metabolic syndrome (increased waist circumference, high triglycerides, low HDL, increased fasting glucose, and high blood pressure)
Inflammation markers (e.g., hs-CRP > 1 mg/L)
Elevated homocysteine – endothelial injury and oxidative stress
Elevated Lp(a) – genetic lipoprotein linked to early atherosclerosis
Insulin resistance – fasting insulin > 56 pmol/L or TG/HDL > 2
Poor nitric oxide bioavailability – impaired vascular relaxation
Chronic stress, poor sleep, or low physical activity
These markers offer a much deeper understanding of how lipids interact with metabolism and inflammation to drive disease risk.
Advanced Cardiometabolic Testing & Interpretation
ApoB (Apolipoprotein B)
Number of atherogenic particles (LDL, VLDL)
Better predictor of heart disease than LDL-C
Optimal range: < 0.8 g/L optimal; > 1.0 elevated risk
ApoA1 (Apolipoprotein A1)
Main protein in HDL particles
Reflects reverse cholesterol transport
Optimal range: > 1.4 g/L protective
ApoB/ApoA1 ratio
Balance of atherogenic vs anti-atherogenic particles
Optimal range: < 0.6 optimal; > 0.8 higher risk
Lp(a)
Inherited lipoprotein resembling LDL
Increases plaque and clot risk
Optimal range: < 50 mg/dL (<125 nmol/L) preferred
Homocysteine
An amino acid formed as a byproduct of protein metabolism, a process dependent on B vitamins. Present in the blood.
Homocysteine is considered a pro-oxidant and can damage the endothelium of blood vessels, increasing the risk of plaque formation and atherosclerosis.
Optimal range: levels < 10 µmol/L are considered normal, but optimal is between 5-7 µmol/L
hs-CRP
High-sensitivity C-reactive protein (hs-CRP) is a blood marker of systemic and low-grade inflammation. The liver produces it in response to interleukin-6 (IL-6) and other pro-inflammatory cytokines.
Optimal range: < 1.0 mg/L low risk
Fasting Insulin
Elevated fasting insulin reflects the body’s attempt to maintain normal glucose despite reduced insulin sensitivity — an early sign of compensatory hyperinsulinemia.
Chronically elevated insulin promotes lipogenesis, endothelial dysfunction, and low-grade inflammation.
Associated with high triglycerides, low HDL, and small, dense LDL particles — all atherogenic.
Optimal range: < 48 pmol/L
HOMA-IR
An estimate of insulin resistance based on fasting insulin and glucose.
Higher HOMA-IR values are correlated with increased TG/HDL ratio, elevated ApoB and LDL-P, elevated hs-CRP, and increased visceral adiposity
Optimal range: 1 - 1.9, a HOMA-IR score above 2 indicates insulin resistance
Salivary Nitric Oxide
Reflects endothelial function
Low NO indicates poor vascular relaxation and oxidative stress
How Naturopathic Medicine Can Help
Naturopathic doctors take a comprehensive, root-cause approach to improving lipid balance and cardiometabolic health.
1. Address Underlying Drivers
Optimize thyroid function, gut health, and detox pathways
Identify and reduce inflammatory triggers (diet, infections, toxins)
Manage insulin resistance through nutrition, exercise, and supplements
2. Therapeutic Nutrition
Mediterranean or anti-inflammatory diet: rich in fiber, omega-3s, and polyphenols
Reduce refined carbs, saturated fats and trans fats; emphasize monounsaturated and polyunsaturated fats
Support bile flow and liver metabolism of cholesterol with foods like beets, artichoke, and leafy greens
3. Botanical & Nutrient Support
Omega-3 fatty acids – may lower triglycerides, improve HDL
Berberine – may improve LDL, insulin sensitivity, and glycemic control
CoQ10 – antioxidant support, depleted by statin use
Plant sterols & soluble fiber – may reduce cholesterol absorption
Niacin & red yeast rice – may improve lipid ratios
4. Lifestyle Medicine
Regular aerobic and resistance training improves HDL and lowers TG
Stress reduction and sleep optimization reduce cortisol-driven lipid elevations
Weight management helps restore insulin sensitivity and lipid balance
Disclaimer: This information is for educational purposes only and is not intended to provide or replace medical advice, diagnosis, or treatment. Always consult your qualified healthcare provider for individualized recommendations.