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routinely prescribe medication to lower it, and also because heart disease remains the No. 1 cause of death in the U.S. Let there be no mistake, accurately assessing our risk of heart disease and taking appro- priate action based on that risk is of utmost importance. The question becomes: What if our screening methods are outdated and lead to interventions that do more harm than good? CHOLESTEROL IN DETAIL You may have heard low-density lipoprotein (LDL) referred to as "bad cholesterol" and high-density lipoprotein (HDL) called "good cholesterol." This terminology is inaccurate and confusing. Both LDL and HDL are actually particles called lipoproteins that contain cholesterol. The cholesterol within LDL and HDL is identical. Cholesterol is cholesterol. It's the lipoproteins that are different and deserve a closer look. Current American Heart Association (AHA) guidelines consider the risk of heart " disease to be greater in people with total cholesterol levels greater than 200 milligrams per deciliter or LDL levels greater than 100 milligrams per deciliter. The guidelines also suggest the lower your levels, the better, despite studies that suggest total levels below 160 milligrams per deciliter can actually be hazardous to our health. Levels of HDL below 50 milligrams per deciliter for women, and below 40 milligrams per deciliter for men, also can prove dangerous. High cholesterol is considered one of many risk factors for heart disease. Other risk factors include obesity, smoking, poor nutrition, sedentary lifestyle, diabetes, high blood pressure and family history of heart disease. Cholesterol gets a lot of attention from doc- tors because it's the easiest factor to control with medication. As a result, doctors are quick to recommend statins—the side effects of which can include memory loss, muscle pain and diabetes—and often fail to emphasize other factors that promote heart health, such as nutrition and exercise. Helping patients make difficult life changes requires time most doctors don't have. LISTEN TO THE LIPOPROTEINS The good news is we now have better tools to assess the risk of heart disease. One such advancement is the development of the comprehensive lipoprotein profile panel (LPP). The LPP provides much greater detail regarding the characteristics of lipoproteins and more accurate assessments of their influence on heart disease risk. It also helps focus treatment plans. Because a standard blood test provides limited information about LDL and HDL, many patients are prescribed medication based on limited information. As it turns out, lipoproteins come in different sizes and with different risks. Large LDL particles, for example, do not increase your risk of heart disease, but very small ones do. In other words, two people with the same LDL levels can have very different risks of heart disease depending on the subtypes they possess. There are also different subtypes of HDL. Remnant lipoprotein, meanwhile, is considered a building block of arterial plaque and is typically hard to detect. Enter the comprehensive LPP, which detects remnant lipoprotein. Other tests included in the comprehensive LPP identify C-reactive protein, an inflamma- tory marker, and homocysteine, an amino acid known to be damaging to blood vessel walls when elevated. Elevations in either one can be remedied with proper nutrition. Another promising test in the assessment of heart disease is the carotid intima-media thickness test (CIMT test), which involves a noninvasive ultrasound that measures the thickness of the walls of the carotid arteries. CIMT is considered an independent predic- tor of heart disease. Cardiologists are using it as a primary risk-assessment tool, and the AHA is now recommending it for people 45 and older. It's more important than ever to take advantage of recent advances in screening and knowledge. We're long past the days of determining heart disease risk based on cholesterol alone, but it's up to you to make sure your doctor realizes that. MAY / JUNE 2012 | Washington Athletic Club Magazine | 31 Accurately assessing our risk of heart disease and taking appropriate action based on that risk is of utmost importance." Paul Dompé is a naturopathic physician and an adjunct faculty member and clinical supervisor at Bastyr University. He is a primary care physician specializing in treatment of stress-related disor- ders using biofeedback, nutrition and herbal medicine. He also provides services through the Wellness Center at the WAC.