This month we will diverge from the performance side of why we put in hours of training, and focus on a more subconscious and less publicized goal of triathlon training—our health and longevity.  As we well know, one primary cardiovascular (CV) risk factor is high cholesterol.  We need cholesterol in our body to be healthy, but an excess can eventually be lethal.  Don’t hours of training pretty much guarantee CV health?  In many cases yes, but in some cases no.  Let’s tackle this one…
 
Elucidating lipid health has come a long way.   From the late 60’s-70’s, the slide rule of cholesterol measurement was the total cholesterol.  “What’s your number?”  It did help to pick out a number of people at higher risk for heart disease, but people with low cholesterol still had heart attacks—even some athletes. 
 
Through the 80’s the pocket calculator of cholesterol measurement was the total plus the HDL & LDL—the “good” and “bad” cholesterols (high and low density lipoproteins).  A lesser-publicized type of bad cholesterol, the VLDL (very low…), can be calculated by subtracting the HDL & LDL from the total.  It turned out that some people who had a high total (uh oh) actually had a high HDL and a low LDL (whew!).
 
The PC with Intel inside has been developed over the past 10 years as researchers have determined that these cholesterol components can all be broken down still further into “subfractions”.  The bottom line is that particle size is everything.
 
Regular LDL particles come in 2 sizes—large fluffies and small dense ones.  Researchers found that the large particles (LDL₂) just bounce along the walls of the arteries, while the small ones (LDL₃) catch in crevices in the walls and cause fatty deposits that can eventually cause the big one.  If you have predominantly large particles you are classified as the less risky “pattern A”, while a majority of small particles gives you an ominous 3-10 times riskier “pattern B”.  Keep taking your fish oil with the omega-3 fats—it helps promote pattern A.  Interestingly, a study found that 1/3 of the people who were pattern A when fed a 48% fat diet converted to pattern B when fed a 24%fat diet…. and when the remaining pattern A people were fed a 10% fat diet, 1/3 of them converted to pattern B¹.  So what gives?  This flies in the face of everything we had been taught about eating a “healthy” low fat diet (remember, not all fats are bad).
 
It doesn’t stop here… the standard LDL number actually lumps together 3 different types of lipoproteins, each with its own set of issues.   Lp(a) (called “L-P little a”, per unit volume has 10x the propensity to cause a build-up than regular LDL) and IDL (intermediate density lipoprotein, 5x the propensity) are strongly genetic.  Your standard LDL level could be normal, but the relative levels of these two variables could be high and risky (and unaffected by statin drugs).  The third type is R-LDL (“real” LDL, the type discussed above) and composes the largest quantity.  Concerning the VLDL, having too many small dense particles (VLDL₃) also puts you at even higher risk.
 
The flipside—a high HDL protects against CV disease, and a study of runners showed an increase in HDL up to 40-49 miles/wk.  However, you could have an insufficient amount of the more protective large fluffy HDL particles (HDL₂) and leave you at higher risk than it might appear from the standard lipid panel.
 
So what can we do?  If you have any cardiac risk factors your insurance will cover a “VAP” test (theVAPtest.com) ordered by your family doctor.  If you are too “apparently healthy” for you insurance to cover it, the out-of-pocket cost is amazingly reasonable.  At ELITE we now include the VAP test as a part of our standard executive physical.
 
So while you are sweating through your hours of training, this comprehensive lipid test can help give the peace of mind that your CV system is as healthy as you would like to think it is… and if not (uh oh), your doctor can now provide effective treatments to improve it (whew!).
 

References
 
1.  Dreon, DM, Fernstrom HA et al., Low-density lipoprotein subclass patterns and lipoprotein response to a reduced-fat diet in men. FASEB J. 1994 Jan;8(1):121-6.
 
2.      Williams, PT, Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners. The National Runners' Health Study. Arch Intern Med. 1997 Jan 27:157(2): 191-8.
 
Dr. Dan Moser, Ph D, is the director of research and clinical services at ELITE Health & Wellness (http://www.elitewellness.com).  Coming from a background in track and field, he has  more than 10 years of experience testing professional and recreational athletes, including triathletes, runners, cyclists, in-line skaters, and hockey players.
 
Jeff Devlin is an endurance coach and former professional triathlete, who offers practical insights into the application of the latest science. Jeff holds five national championship titles and two 3rd place finishes at the Hawaii Ironman. He runs his own international coaching business, Human Performance Engineering (http://www.jeffdevlin.com).