In the past few years, new cholesterol tests have become available that are more sensitive and individualized. They go by a number of names; the most common is lipoprotein subfraction testing. Right now, doctors usually order these tests for people who have a strong family history of heart disease. But they provide much better information than standard blood test for LDL, HDL, and total cholesterol. We'd like to see all our patients have them.
Subfraction tests are much more sensitive than the standard blood cholesterol test. They measure as many as 20 different factors, instead of just four. Most importantly, these tests measure the size and pattern of cholesterol particles. In recent years, experts have learned that the number and size of cholesterol particles makes an enormous difference in assessing heart attack risk.
Finding out particle size can indicate how easy it will be to affect cholesterol levels with lifestyle changes, or whether you also need medication. Bigger cholesterol particles are better; they don't cause as many problems.
If you have small molecules of cholesterol, it's harder for the body to eliminate them. People with small-molecule cholesterol are three to four times as likely to have a heart attack. So, knowing you have small molecules of cholesterol, known as "pattern B," doctors would probably choose to be more aggressive with statin treatment.