EP54: Cholesterol Tests: The Good, The Bad, And The Ugly

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Introduction: Dr. Warwick Bishop is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode, he provides a comprehensive breakdown of cholesterol tests, explaining what each component measures and why understanding these numbers matters for assessing cardiovascular risk. Key Takeaways: Fasting for 8 hours before a cholesterol test is optimal; fasting longer than 12-14 hours can skew results as the body makes metabolic adjustments. Total cholesterol measures all cholesterol in the blood and should ideally be around 5-5.5 millimoles per litre. Triglycerides are free fats in the bloodstream and should be below 2 millimoles per litre; elevated levels may indicate recent eating, diabetes risk, or excess weight. HDL cholesterol is "good cholesterol" that removes cholesterol from tissues and returns it to the liver; levels should ideally exceed 1 millimole per litre. LDL cholesterol is "bad cholesterol" because extensive research shows that lowering it in high-risk patients leads to better health outcomes. The cholesterol ratio (HDL to total cholesterol) should be less than 4, as lower ratios indicate a more favorable lipid profile. Primary prevention guidelines recommend LDL cholesterol targets below 2 millimoles per litre, while secondary prevention (after a cardiac event) targets below 1.8 millimoles per litre. Emerging research suggests even lower LDL targets below 1 millimole per litre may benefit high-risk patients with no adverse effects. Dr. Bishop prefers fasting cholesterol tests because they allow simultaneous measurement of glucose and insulin levels to calculate insulin resistance using the HOMA calculation. Cholesterol numbers alone don't tell the complete story; blood pressure, blood glucose, insulin levels, and lifestyle factors are equally important for cardiovascular health assessment.