Cholesterol itself is not a ‘good’ or ‘bad’ substance. It is necessary for cell membranes, steroid hormones, and bile acids. The issue is which particles carry cholesterol in the blood and how much exposure the blood vessel walls have to atherogenic particles over the years.
What should really be assessed?
LDL cholesterol remains one of the key measurements; however, it does not show the whole picture on its own. Especially when elevated triglycerides, diabetes, or metabolic risk is present, ApoB may provide additional information about the number of atherogenic particles. Lp(a), meanwhile, is an independent risk marker that is largely genetically determined, and the 2026 ACC/AHA guideline recommends measuring it at least once in adults.
The good news: risk can be managed
Cardiovascular risk is not just a single laboratory value. Blood pressure, smoking, glucose metabolism, family history, kidney health, physical activity, and, if needed, a coronary calcium score are assessed together. Nutrition, physical activity, weight management, and tobacco-free living are fundamental approaches; in the appropriate risk group, medication is a powerful tool that reduces the risk of heart attack and stroke.
A practical approach
- Do not look at a standard lipid panel solely in terms of ‘high HDL, low LDL’.
- If there is a family history of early cardiovascular disease, discuss an Lp(a) assessment and, if needed, an ApoB assessment.
- If risk is high, do not get stuck in the ‘natural methods or medication?’ dilemma; lifestyle measures and evidence-based treatments can be used together.
Our approach at our Bodrum clinic: the goal is not to correct a single cholesterol number, but to understand the person’s overall cardiometabolic risk and develop a feasible and sustainable plan.
