When it comes to cholesterol levels, most people are paying attention to the wrong numbers, according to a Baton Rouge cholesterol specialist.

Total cholesterol, a number whose target is 200 or below, is mostly the combination of LDL — often called “bad cholesterol” — and the HDL — the “good cholesterol.”

While easy to understand, the total cholesterol number isn’t very informative.

“That can be off base. Forget the total cholesterol. Don’t focus on the total cholesterol,” said Dr. Robert St. Amant, a cholesterol specialist at Baton Rouge General’s Womack Heart Center.

Cholesterol levels are complicated, St. Amant said. A healthy level for one person may not be appropriate for another.

When a doctor runs a cholesterol test — called a lipid panel — these three numbers are important for most people: the HDL and LDL cholesterol numbers and the triglyceride level.

  • The “bad cholesterol level” known as LDL, the low-density lipoprotein, should be below 100 for most people, but “there is a lot of variation in that,” St. Amant said. Heart attack survivors with other risk factors — such as smoking, diabetes and uncontrolled blood pressure — need to maintain an LDL lower than 70, he said.
  • HDL, the “good cholesterol” can help remove the bad cholesterol from the blood. It needs to be above 40 in men and above 50 in women.
  • Triglycerides, which are a type of fat found in the blood, should ideally be below 100 for women and below 150 for men, St. Amant said.

But there is another test that people at risk for heart disease should get — the LDL particle test.

Cholesterol doesn’t travel through the blood by itself. It has to be transported in the blood by “vehicles” called lipoproteins.

These are particles that are filled with cholesterol and triglycerides and have proteins on the surface. The low-density type of lipoprotein (LDL) is what causes the most damage by hardening arteries.

In the past, doctors focused on testing for LDL cholesterol levels in the blood. But that doesn’t always tell the whole story like the LDL particle number test does, St. Amant said. The LDL particle test can tell how many of these particles are in the blood.

“It’s fine to talk about the numbers with respect to risk,” he said, “but 50 percent of the people are going to have normal looking cholesterol and have significant risk based on the carrying vehicles.”

Generally the LDL particle number should be consistent with the LDL cholesterol in the lipid panel. But if it is higher, it means the patient has a higher risk of heart disease.

The LDL particle test is not always ordered by doctors along with the lipid panel, St. Amant said, but it can be an extremely important test.

“If we’re just treating according to the LDL cholesterol, we’re going to miss a whole lot of people who are at risk,” St. Amant said.