Heart Disease Is More Than Cholesterol: What I'm Doing About Inflammation, Blood Sugar and Triglycerides
Heart disease is more than cholesterol. My LDL was only a little high, but my A1C of 5.8 told the real story. Here's how high blood sugar feeds inflammation, why that matters for your heart, and the simple habits I'm using to bring it down naturally.
I'd been eating sugar. Not a little sugar. I'd had some whopping sugar cravings, and I was giving in to them.
So when my A1C came back at 5.8, my first reaction wasn't panic. Honestly? I was relieved it didn't go up. I wasn't sad. I wasn't happy. I was pretty much indifferent.
But indifferent isn't the same as fine. That number was another warning, the kind you can only ignore so many times. It's the reason I decided to go back on Mounjaro.
Here are my numbers. All of them. Because I think you deserve to see what a real lab report looks like on a real 62-year-old woman, not a cleaned-up example in a textbook.
- LDL: 113 (up from 105 last year)
- HDL: 36
- Triglycerides: 135
- Total cholesterol: 176
- Non-HDL cholesterol: 140
- A1C: 5.8
If you'd glanced at that list, you probably would have landed on the LDL. Everybody does. It's the number your doctor circles, the one the commercials talk about, the one that gets you a prescription.
And yes, it crept up. But that's not the number that kept me up.
Before you read another word
If you take a statin, do not stop it because of anything you read here. Talk to your doctor. LDL matters. I'm not here to tell you it doesn't.
What I am here to tell you is that LDL is one piece of the picture. Not the whole picture. And a pill that lowers one number doesn't automatically fix what's going on underneath.
The number nobody circled
Take your triglycerides and divide by your HDL.
Mine: 135 divided by 36 equals 3.75.
Under 2 is generally considered ideal. Above 3 often points to insulin resistance, meaning your cells have stopped listening to insulin the way they should.
Now put that next to an A1C of 5.8. That's my average blood sugar over the last few months, and it's sitting in the range doctors start watching closely.
So here's the blunt truth. My heart story isn't really a cholesterol story. It's a blood sugar story wearing a cholesterol costume.
How blood sugar messes with your cholesterol
This is the part I wish somebody had drawn on a napkin for me years ago.
When your cells resist insulin, sugar hangs around in your blood longer. Your liver takes that extra fuel and packs it into fat particles called triglycerides, then ships them out into your bloodstream.
That sets off a chain reaction. Your HDL, the cleanup crew, drops. And your LDL particles change shape. They get smaller and denser, which makes it easier for them to slip into artery walls and stick.
So two women can have the exact same LDL number, and one has a pile of small, dense, troublemaking particles while the other doesn't. The standard lipid panel can't tell you which one you are.
Who'da thunk it? The number everybody watches can look almost fine while the real trouble is brewing somewhere else.
And blood sugar doesn't stop at cholesterol. It also fans the flames of inflammation, which I dig into in Cool It: Taming the Flame of Inflammation.
The tests most of us never get
I’ve spent 30+ years inside hospitals. And I had never had these three tests run on myself:
- hs-CRP measures inflammation in your body. Inflammation is part of how plaque forms and how it breaks loose.
- ApoB counts the actual number of particles that can get into your arteries, instead of just measuring how much cholesterol they're carrying.
- Lp(a) is a type of LDL particle you inherit. Diet and exercise barely touch it. You only need it tested once in your life.
I'm asking for all three at my 6-month recheck. If you've never had them, write them down and take the list to your next appointment.
Where Mounjaro fits
I'm going to be honest, because you'd find out anyway. I'm back on Mounjaro at a low dose.
If you want the whole backstory, gastroparesis and all, I wrote about it in restarting Mounjaro at a low dose.
Here's how I think about it. It quiets the food noise. That constant "one more cookie" with no stop signal gets turned way down, and that gives me a window to build habits while it's quiet.
But I won't be on it forever. It's a bridge, not the destination. The habits are what I get to keep when I step off.
The habits I'm building
More protein. It protects the muscle I've got, and muscle is where a huge amount of your blood sugar gets used. When I finally added up how much I was eating, I was nowhere close to what I needed.
No snacking. Every snack is another insulin bump. Fewer bumps give my body a chance to actually burn through what's already there.
Strength training, the easy way. Air squats and wall push-ups while the coffee brews. That's it. Nobody's handing me a gym membership medal, but it's something I actually do every morning.
Smart shopping. I build our grocery pickup order myself, and my husband picks it up. If it's not in the order, it's not in the house. Problem solved before it starts.
These are the habits most likely to bring triglycerides down and nudge HDL up. And they help blood sugar at the same time. One set of habits, three numbers moving in the right direction. That's the kind of math I like.
What happens next
My recheck is in 6 months. I'll be back with every number, the new tests included, and I'll tell you straight what moved and what didn't.
No spin. If it doesn't work, you'll hear that too.
Frequently Asked Questions
What is a good triglyceride to HDL ratio?
A triglyceride-to-HDL ratio under 2 is generally considered ideal when both are measured in mg/dL. A ratio above 3 is often linked to insulin resistance and a higher number of small, dense LDL particles. To find yours, divide your triglyceride number by your HDL number from a standard lipid panel.
Can you have heart disease with normal cholesterol?
Yes. Many people who have heart attacks have LDL levels in the normal range. Other factors raise risk too, including insulin resistance, high triglycerides, low HDL, inflammation, high blood pressure, smoking, and inherited Lp(a). A standard cholesterol panel does not measure all of these, which is why extra testing can help.
What does an A1C of 5.8 mean?
A1C shows your average blood sugar over roughly the past three months. A result from 5.7 to 6.4 falls in the prediabetes range. At this level, blood sugar is higher than ideal, and changes in eating, activity, and muscle building can often help bring it down over time.
What is hs-CRP and why does it matter for heart health?
High-sensitivity C-reactive protein, or hs-CRP, is a blood test that measures low-level inflammation. Inflammation plays a role in how plaque builds up in arteries and how it can rupture. A result under 1 mg/L is considered lower risk, while a result above 3 mg/L is considered higher risk.
What is ApoB and is it better than LDL?
ApoB is a protein found on every particle that can carry cholesterol into artery walls, so measuring it counts the number of those particles. LDL measures how much cholesterol is inside them. Two people with the same LDL can have very different ApoB levels, which is why many clinicians see ApoB as a sharper risk marker.
What is Lp(a) and how often should it be tested?
Lipoprotein(a), or Lp(a), is a type of LDL particle whose level is mostly set by your genes. A high level raises heart disease risk, and diet and exercise have little effect on it. Because it stays fairly stable throughout life, most people only need it tested once.
How can I lower triglycerides naturally?
Triglycerides often respond well to cutting back on sugar, refined carbohydrates, and alcohol, eating enough protein, avoiding frequent snacking, and building muscle through strength training. Regular movement helps muscles use blood sugar, which means less extra fuel for the liver to turn into triglycerides. Results usually show up on labs within a few months.
Your Turn
Pull up your last lab report. Divide your triglycerides by your HDL and see where you land. Then grab my free Body Signal Starter so you can start noticing what your body is telling you between lab draws, not just on the day your blood gets drawn.
Members get the step-by-step: how to find the one heart number on your own labs that almost nobody checks, what else to look for if it's high, and the 8 habits I'm using to cool inflammation and bring it down.
Every path to healing counts. Take what fits, and let your body have the final say,
Jamie
Members section
This is the part you can do tonight at your kitchen table with your last lab report and a calculator. No appointment needed.
Step 1: Find your two numbers
Pull up your most recent lipid panel (the cholesterol test). It's usually in your patient portal under lab results. You're looking for two lines:
