HSOS #35: Cholesterol Testing Beyond LDL: What Women Need to Know

Cholesterol numbers start acting suspicious, curiosity kicks in, and the investigation begins. This episode pulls back the curtain on the labs that reveal what standard cholesterol panels miss, including particle counts, inflammation markers, insulin levels, and genetic risk factors. Along the way, a zero calcium score, some surprising lab insights, and a few lifestyle truths show how much more there is to the heart health story for women over 40.

Let’s talk.

Welcome to Her Season of Strength—where women over 40 reclaim their bodies, their energy, and their voices, without apologies. I'm Kim Duffy—registered dietitian, personal trainer, mom, and your biggest hype woman when it comes to aging like you mean it.

This show isn’t about chasing skinny or counting wrinkles. It’s about building real strength—physical, emotional, and hormonal. Each week, I’ll share straight-talking nutrition tips, sustainable fitness strategies, and conversations that help you feel powerful in your skin once again.

Menopause is not an ending, it is only the beginning. This is your season of strength.

What I Cover in This Episode:

• The moment my “healthy lifestyle” numbers didn’t add up
• The test result that changed the whole conversation
• Why the usual cholesterol panel might be missing something
• The hidden clues inside your cholesterol particles
• The surprising role inflammation plays in heart health
• A metabolic number that quietly predicts risk
• What your body might be saying about insulin
• The difference between “fluffy” and “troublemaker” cholesterol
• Why some risks are written in our genes
• Grab the the simple guide that helps you ask better questions at your next doctor visit

Links & resources for this episode:

Fit After 50+ Program: 8-Week Nutrition Coaching & Strength Program for menopausal women.  Join the interest list today for the best discounts, bonuses and updates about the next program coming Fall of 2026!

Free cheat sheet: "20 Tips to Crushing Menopause"

Join my free weekly newsletter list and get a new high protein recipe sent to your inbox every Thursday. 

Find me on social media: Instagram I Facebook I Tiktok

Transcript

[00:00:00] Hi there, and welcome to Her Season of Strength, where women over 40 reclaim their bodies, their energy, and their voices, without apologies. I'm Kim Duffy, registered dietitian, personal trainer, mom, and your biggest hype woman. When it comes to aging like you mean it, this show isn't about chasing skinny or counting wrinkles.

[00:00:20] It's about building real strength, physical, emotional, and hormonal. Each week, I'll share straight talking, nutrition tips, sustainable fitness strategies. And conversations that help you feel powerful in your skin. Once again, menopause isn't an ending. It's only the beginning. This is your season of strength.

[00:00:39] Hello, and welcome back to her season of Strength. I am so happy you're here and if you. Listen to my last episode, number 34. It was a part one. You heard me kinda share a little bit about my personal story when it comes to my cholesterol numbers and cardiovascular [00:01:00] risk. And as I was seeing.

[00:01:02] I was talking about how my cholesterol numbers have started trending in the wrong direction over the past year. And I was, as a person who just loves to figure out how things work in the body and why I was trying to figure out how I'm seeing those numbers go in such a wrong direction.

[00:01:18] Is it related to menopause and hormonal changes? Because I know I've got some bad genetics, but I also work very hard at doing everything I can to decrease my risk factors and to make those numbers good. And I'm exercising most days. I do a lot of strength training. I eat a very high fiber diet.

[00:01:36] I do not smoke. I try to maintain a healthy weight, and my blood pressure's awesome. But my cholesterol numbers still crept up. So I talked to my doctor and she recommended a coronary calcium scan. Which actually looks for, plaque formation in the arteries of heart. So are we actually seeing the thing that we become most worried about when it comes to cardiovascular disease?

[00:01:59] [00:02:00] And that result came back at zero, which was incredibly reassuring. But that whole experience made me realize something that I think is really important for women to understand that standard cholesterol labs don't always tell the whole story. And if we're gonna take control of our heart health, especially after 40.

[00:02:18] We talked about last time just about how one in five women are dying because of cardiovascular disease and we just, I don't think we realize it. We need to look at the bigger picture. So let's, first I wanna start with just the problem with standard cholesterol test. Most doctors are gonna routinely check for things, and that's gonna be your total cholesterol, your LDL cholesterol.

[00:02:44] Your HDL cholesterol and your triglycerides and those numbers are incredibly healthy, helpful. Sorry. And I am not. I'm a dietician. I am not a doctor. I am not trying to say, oh, you're, I know more than your doctor by any means. I'm just trying to open this up because I [00:03:00] want it to be, I want you to feel knowledgeable enough to be able to go and ask your doctor these questions.

[00:03:07] These numbers are only part of the picture. You can have normal cholesterol and you can still develop that dangerous plaque in your arteries. You can have high cholesterol and never develop heart disease. So the question becomes, what else should we be looking at today? I wanna walk you through several labs that give a much clearer picture of our cardiovascular risk, especially for women over 40.

[00:03:31] And I also wanna talk a little bit about. Optimal levels and lifestyle strategies that can actually influence each one. Natural not medications, not loading up on supplements, right? The first marker is something called A-O-B-A-P-O, capital B. It stands for APO lipoprotein B. And it's actually becoming one of the most important markers that cardiologists look [00:04:00] at today, and here's why.

[00:04:01] When we measure our LDL cholesterol, we're actually, we're measuring how much cholesterol is inside of certain particles, but ApoB tells us how many particles are actually circulating in our blood. And this matters because every particle that carries cholesterol into the artery wall contains one Apo B protein.

[00:04:25] So Apo B tells us how many potential plaque forming particles are in circulation in our bloodstream. So let me give you a little analogy. Imagine cholesterol particles are delivery trucks. LDL tells us how much cargo is inside of those trucks. But Apo B it tells us how many trucks are actually on the road.

[00:04:48] So the more trucks that are on the road, the higher the chance that some of them are gonna end up stuck in the artery wall in forming plaque. So what are some optimal APOB levels? Generally [00:05:00] optimal would be below 80, even better, is gonna be below 70. And some cardiologists aim for below 60 in those higher risk patients.

[00:05:12] So here are some lifestyle factors that improve Apo B. The encouraging thing is that Apo B actually responds really well to lifestyle. Things that help to lower it are gonna include increasing soluble fiber, which are gonna be things like oats, beans, chia seeds, also resistance training. Decreasing our processed or refined carbohydrates.

[00:05:40] So those are gonna be the ones that aren't, don't contain fiber, maintaining a healthy body composition, getting in those good Omega-3 fatty acids from like fatty fish like salmon and halibut, and improving our metabolic health. And this [00:06:00] is a marker where lifestyle really does make a difference. The next marker is called lipoprotein A or LP (a).

[00:06:12] And this one is fascinating because it's mostly genetic. It's basically an LDL particle with an extra protein attached to it, and that extra protein makes it stickier to artery walls, more inflammatory and more likely to contribute to clotting. About one in four people have elevated LP-A and many people have never had it tested.

[00:06:40] Optimal levels are gonna be below 30. Elevated risk typically begins above 50. And here's the tricky part. Lifestyle does not dramatically lower LPA because it's largely genetic. But knowing your numbers helps doctors to determine how aggressive that [00:07:00] prevention should be, right? So if someone has elevated LPA, doctors often focus more on lowering A POB, decreasing inflammation and improving metabolic health.

[00:07:11] So again, information just gives us power, right? It gives us knowledge so that we know the best plan for moving forward. The next marker, number three. Is called H-S-C-R-P, and that's high sensitivity. C reactive protein. Okay. It's directly related to inflammation because heart disease is not just about cholesterol numbers, right?

[00:07:38] It's also about inflammation in our arteries. You hear me talk about inflammation all the time because we know that higher inflammation in our body is going to be higher risk of all chronic illnesses, including diabetes and cancers including cardiovascular disease, including even just. Joint issues and [00:08:00] autoimmune.

[00:08:01] So inflammation can damage the lining of our arteries, and it makes it easier for that cholesterol particle to get trapped there. Our optimal levels are under one, moderate risk is gonna be between one and three, and higher risk is above three. So if someone has an elevated CRP, it often reflects things like chronic stress.

[00:08:24] It can also be acute. So it can also, like if you have somebody going in the hospital with an infection or something going on that can, or a virus or, if your body is actively it, the immune system is being activated because of something going on that can cause that. But that is a short term, right?

[00:08:41] It's when this number is elevated. Chronically over a long period of time. So chronic stress, it's gonna be caused by things like poor sleep, metabolic dysfunction, excess fat around our organs and in our abdomen, that visceral fat. And [00:09:00] then a high consumption of those ultra processed foods, lifestyle strategies that we can.

[00:09:06] Incorporate that are gonna lower inflammation. And this is where lifestyle becomes super powerful. Strength training, you're gonna be hearing the same me say the same things over and over. Things that are gonna improve this. But strength training is huge. Getting in those good Omega-3 fatty acids, high fiber diet, and we're gonna get fiber from plants, right?

[00:09:28] Stress management getting better quality and quantity of sleep. And reducing intake of those ultra processed foods. And this marker often improves when someone focuses on that overall lifestyle, health, not just one factor, but just your overall body, right? So it's not gonna make a difference if you take one supplement, you know that's not gonna decrease your overall inflammation if you're continuing to smoke or live a sedentary [00:10:00] lifestyle or.

[00:10:01] Eat a diet that's maybe higher in, in those processed ultra processed foods. It's gonna just be that overall. So now let's move on and we're gonna talk about marker four and that's your triglyceride to HDL radio ratio. And this is something that you can actually calculate from just a standard lipid panel.

[00:10:19] It's one of my favorite quick markers 'cause it tells us a lot about metabolic health. This ratio can really reveal early signs of insulin resistance, which is a major driver of cardiovascular disease, is when we don't have as good of control over those blood sugars. Typically, when it comes to triglycerides specifically, we want them to be under a hundred for optimally.

[00:10:44] And when it comes to our HDL, which is that good cholesterol, we want that above 50. Yeah. And then when we divide them, so we're gonna divide that HDL into the triglycerides. We want that ratio to be [00:11:00] under two and lower ratios are gonna typically indicate healthier metabolism. So we're gonna see that lower ratio when the triglyceride is lower and our HDL is higher.

[00:11:15] Okay, so things that can improve this ratio is decreasing sugar and refined carbohydrates, which those can raise our triglycerides. Increasing our protein intake strength training. Again, improving sleep and limiting alcohol. Okay higher alcohol levels. We can see that cause higher triglyceride numbers.

[00:11:39] So when someone improves that metabolic health, which metabolism is directly related to, our muscle and how much muscle we have, and that strength training is that one way we're gonna build that muscle. So when we see that people are incorporating these lifestyle factors in this ratio, it often improves pretty quickly, which [00:12:00] is awesome.

[00:12:01] You can even see that in a three month time. The next factor I wanna talk about is fasting insulin. And this is also related to your blood sugar control because if we have see high levels. Of insulin, fasting insulin in our bloodstream. It's just gonna indicate that we are not as reactive, we're not reacting to that insulin and bringing those blood sugars down.

[00:12:26] So we'll tend to see higher blood sugars at the same time. It just, tells us how hard is our body working to control blood sugar When our insulin stays higher for years, it's gonna damage blood vessels and it can accelerate that plaque formation. So our optimal levels of fasting insulin is typically between two and six, but many lab ranges will say up to 20 is normal.

[00:12:51] And that's where things can get confusing because sometimes something can be normal but not optimal. And I'm trying to talk [00:13:00] about optimal levels here. Lifestyle strategies that can improve our insulin. That's gonna be balancing those meals and making sure we're getting it in protein and fiber, especially when we're consuming carbohydrate.

[00:13:13] 'cause protein and fiber are gonna help to balance and slow that blood sugar spike and fall resistance training helps us to be more sensitive to insulin. Walking after meals, which will help us to digest food a little better and also help to bring those insulin levels down, avoiding constantly eating all day during the day.

[00:13:34] Trying to have some breaks of eating between your meals. Because otherwise, our body is constantly sending insulin in our blood sugar's going up. We need insulin to bring it down. And then also maintaining that good muscle mass 'cause that's gonna help us to stay more sensitive to insulin.

[00:13:51] 'cause muscle is, it's one of the most powerful tools for improving our insulin sensitivity. This is why, you know you hear me talking all the time [00:14:00] about the importance of strength training for women after 40, and this is just one of them. 'cause we know once we hit menopause, we become less sensitive to insulin.

[00:14:08] Now the next two markers, and these are the final two markers that, that I'm gonna talk about today, actually have to do with your LDL and specifically particle size and number. I should have had this after. Your APOB test. But I'm throwing it in here because I don't wanna forget it. These are super important and they can give us more information about our cardiovascular risk.

[00:14:31] And so this first LDL particle number, this me test measures the total number of LDL particles that are actually circulating in your bloodstream. So you might be thinking, wait a second, didn't we just talk about, something similar with A POB? And yes, they are closely related, both A POB and LDLP measures the number of cholesterol particles that could potentially enter our artery walls.

[00:14:56] But your LDLP. [00:15:00] Particle number specifically focuses on the LDL particles themselves, and why does this matter? Because research has actually shown that the number of particles in circulation, it often predicts heart disease risk more accurately than the amount of cholesterol in those particles. And the, that those particles are carrying.

[00:15:20] So some, someone could have a normal LDL cholesterol level, but still have a high number of LDL particles, which is increases the likelihood that their plaque may develop. So optimal levels of the LDLP is generally below 1000 nmol per liter. Higher risk is usually seen above 1300. And some specific lifestyle strategies that can help to improve the LDL particle number.

[00:15:49] And many of them are just the exact same things that improve our metabolic health. And that's gonna be improving our insulin sensitivity. Increasing our physical activity [00:16:00] overall, and that can include, cardio that can include just movement in general, strength training, maintaining that healthy body composition, which is, me making, helping to maintain or stop loss of muscle, helping to decrease body fat and just maintaining a healthy weight overall.

[00:16:17] Decreasing those refined carbs and sugars and increasing fiber intake. Like I said, you're gonna be hearing the same lifestyle factors over and over. And then the final marker that I wanna talk about is called LDL Particle Size N Pattern. And it's something that most people have never heard their doctor talk about, but it can be super helpful when interpreting those cholesterol numbers.

[00:16:41] LDL particle size just indicates, not all of the LDL particles are the same. Some of them are actually large and fluffy, and others are small and dense. And the small and dense ones, those are the ones that are more likely to penetrate our arterial [00:17:00] walls to stick to the lining and to contribute to black formation.

[00:17:04] So when labs look at LDL patterns, they often categorize them into two groups, pattern a. Which means that they are larger and less dense, and this pattern is generally associated with lower cardiovascular risk. Pattern B just means that they're smaller and denser, and those are associated with higher risk.

[00:17:26] And here's something that's super interesting, the small dense particles that are often associated with insulin resistance. And metabolic dysfunction, which we see more frequently during perimenopause and menopause. So this is one reason why metabolic health becomes so important as we age, right? And lifestyle factors that are going to influence this particle size.

[00:17:52] And one positive is that the, the good news is that we can do things, we can make lifestyle changes that will affect this [00:18:00] like. The same thing as you're going to, we talked about before, decreasing those refined carbs in sugar, increasing fiber intake, strength training, improving insulin sensitivity, maintaining those healthy triglyceride levels, improving sleep and stress management.

[00:18:19] So when triglycerides go down and our good cholesterol, our HDL goes up, we're gonna see those LDL particles. They're often gonna shift toward shift towards that healthier, larger pattern. All right. I know this is a lot of information and I know you're like, I'm never gonna remember all this, but just wait a second and I'll, I'm gonna give you a little bit of a cheat sheet.

[00:18:41] So when you look, at your cholesterol numbers, you can start to see there's multiple layers here. So much information. We can look at how much cholesterol is present. We can look at how many particles are circulating in our bloodstream. We can look at the size and the density of those particles.

[00:18:56] We can look at how much inflammation we have going on, [00:19:00] and we can look at our metabolic health, like our insulin, our triglycerides, our blood sugars. And when we combine those labs with the imaging tests like your coronary calcium scan like I had, we start to get a much clearer picture of our cardiovascular risk.

[00:19:16] And if you're out for a walk or you're multitasking like so many people are when they're listening to podcasts, you're likely not writing any of this down. So if you want a simple guide to the labs we talked about today. I created a downloadable heart health guide that you can take with you to your doctor to start that discussion and talk about some of these labs and if they'd be beneficial for you.

[00:19:36] And to be proactive, to be able to actually, take an active position in your heart health. And I'm gonna link that in the show notes. I'd love it if you'd share it with a friend, if they would find this helpful. If any, you have any friends who are struggling with their heart health or their numbers and they're worried about 'em please share it because as women, we really need [00:20:00] to be talking about this as much as we're talking about our breast health and getting our mammograms and.

[00:20:06] And being proactive with our follow ups, with our doctors, right? Because heart disease, we need to be talking about it more often. It's killing one in five of us. And so it's important that we need to raise awareness. We need to be more aware of this, but there, and also understanding that there are things that we can do.

[00:20:26] And just to recap, to talk about a lot of these numbers, I told you how my numbers were going out of whack. And I was seeing, my HDL or my good cholesterol for some reason dropped significantly in the six month period, and my LDL numbers were high and my total cholesterol number increased.

[00:20:49] I was fortunate that my me metabolic. Numbers were good. I have good blood sugar control, I have low insulin levels. My triglyceride to HDL ratio is [00:21:00] good. But some of the other ones, and my, also my inflammation was low, but some of the other ones were high and they were really concerning me.

[00:21:06] When you, when, when I went and had the CT calcium scoring, it was zero like a doctor could have looked at a lot of my numbers. Even just if they were looking at my total cholesterol and looking at my LDL probably would've put me on a statin and said, oh, you know what? You definitely need to go on a statin.

[00:21:22] You're high risk cardiovascular disease. And we wanted decrease risk of plaque formation. But looking at all those things. And also I had Pattern A, which is the good large fluffy LDL particles, right? So that could be what's helping me to not see that plaque formation. So anyway, so we just have to make sure that we are looking at the full picture, right?

[00:21:46] And not just focusing on just a few numbers, and especially not just those basic numbers. And so before we wanna we wrap up today, I just wanna talk a little bit about what we talked about. 'cause I know we covered a lot of information. So when most of us get our cholesterol checked, [00:22:00] we're usually only looking at total cholesterol, L-D-L-L-H-D-L and triglycerides.

[00:22:05] And while those numbers are helpful, they really only give us just a part of that picture. So if we want a clearer understanding of. Of our total cardiovascular risk, especially as women over 40, there are several additional markers that can provide much more insight. So remember we talked about A POB, which tells us how many plaque forming cholesterol particles are circulating in our bloodstream.

[00:22:26] Remember, they're like the trucks we looked at, LDL particle number, which gives us another way of measuring the number of LDL particles that could potentially enter the artery wall. Then we looked at LDL Particle size and pattern, and that helps us just to understand whether those actual particles are the larger fluff or less risky type, or the smaller denser particles that are more strongly linked to plaque formation.

[00:22:51] We also talked about lipoprotein A, which is that genetic marker that can significantly increase our cardiovascular risk for some [00:23:00] people. Mine, mine was elevated, right? I told you my mom's. Got high cholesterol in her side of the family. We looked at our HS CRP, which is just that measure of inflammation in the body and helps us just to understand how much inflammation may be affecting our arteries.

[00:23:18] We talked about that triglyceride to HDL ratio, which gives us clues about our metabolic health and our insulin resistance if we have any. And finally we talked about fasting insulin, which just helps us to identify early metabolic changes that might not necessarily be showing up on that one point in time basic glucose test.

[00:23:39] And when we combine all of that information with imaging like the coronary calcium scan we can get just a much more complete understanding of what's actually happening in our bodies. Because heart health isn't about one number, it's just about looking at that whole picture. All right, and like I said, I will link that.

[00:23:59] [00:24:00] Quick and easy handout in the show notes, please click on that and take a look at it. You'll have to let me know if it was helpful or if you like it. And please the, her Season of Strength podcast. If this is something you'd like to come back to. I love all the follows. I love the feedback I get from this program.

[00:24:17] And just remember, this is about progress over perfection. We're in this for the long haul and this is your season of strength. Have a great day.