Your Clinical Questions
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      2. Your Clinical Questions

      What would be the cause for exceedingly high LDL, low Triglycerides, and optimal HDL?

      Actual Results:

      • Total Cholesterol 368 mg/dl
      • HDL 64 mg/dl
      • Triglycerides 63 mg/dl
      • LDL 296 mg/dl
      • Non-HDL 304 mg/dl
      • Triglycerides continue to fall while LDL and non-HDL continue to rise over time.

      Although ODX does not provide individual clinical or diagnostic guidance, the following information should be helpful.

      ANSWER:

      Total Cholesterol 368 Elevated cholesterol levels (Total, LDL, and non-HDL) with low triglycerides may indicate genetic alterations in cholesterol metabolism and the absence of blood glucose metabolism if glucose and insulin are within optimal range. 

      Further evaluation of the client’s cardiometabolic health and genetic factors would be needed to provide a more comprehensive view of the case.

      Cholesterol levels above the standard range, including total, non-HDL, and LDL, suggest that genetic factors may be at play and familial hypercholesterolemia should be explored further.

      Since triglycerides are low, advanced blood glucose dysregulation is less likely. However, evaluation of fasting glucose, insulin, and other blood glucose regulation biomarkers would be prudent.

      There are genetic and acquired causes of hypercholesterolemia. The classical genetic disorder is familial hypercholesterolemia due to mutations in the LDL-receptor gene resulting in LDL-C greater than 190 mg/dl in heterozygotes and greater than 450 mg/dl in homozygotes. This defect in the LDL receptor accounts for at least 85% of familial hypercholesterolemia (Ibrahim 2023 ncbi.nlm.nih.gov/books/NBK459188/).

      Please see the ODX Research blog entries below:

      Elevated cholesterol may be due to familial hypercholesterolemia. A total cholesterol above 350 mg/dL (9 mmol/L) or an LDL-C above 190 mg/dL (4.9 mmol/L) may be indicative of this genetic disorder (Pejic 2014).

      A fasting TC above 230 mg/dL (6 mmol/L) may be reflective of higher LDL-C of at least 160 mg/dL (4.1 mmol/L) and/or non-HDL cholesterol of at least 190 mg/dL (4.9 mmol/L), warranting further evaluation (Nantsupawat 2019). https://www.optimaldx.com/research-blog/lipid-biomarkers-total-cholesterol

      An LDL-C above 160 mg/dL (4.1 mmol/L) is associated with primary hypercholesterolemia (Arnett 2019). https://www.optimaldx.com/research-blog/lipid-biomarkers-ldl-cholesterol

      As the thyroid gland regulates cholesterol and lipid metabolism, cholesterol levels are influenced by thyroid function. Thyroid dysfunction can be reflected in total cholesterol levels. Hypothyroidism is associated with elevated cholesterol (Jung 2017). Total cholesterol, LDL cholesterol, and non-HDL cholesterol have a positive statistical association with TSH, increasing consistently as TSH increases, especially in individuals with thyroid autoantibodies (Biondi 2008). In those with autoantibodies, TC above 290 mg/dL was reduced with the administration of thyroxine (Michalopoulou 1998). https://www.optimaldx.com/research-blog/lipid-biomarkers-total-cholesterol

      A TSH above 4 uU/mL can increase heart disease risk, while hypercholesterolemia with a TSH of 2-4 uU/mL responds favorably to thyroid hormone replacement (Raymond 2021). https://www.optimaldx.com/research-blog/thyroid-biomarkers-tsh

      Additional biomarkers should be evaluated to help clarify the entire cardiometabolic picture, including: