You are trim, fit and active. You eat right, don’t smoke and rarely “stress out.” You are told your blood pressure and your cholesterol are normal.
Still, if heart disease runs in your family, or if you’ve had any type of heart or vascular problem in the past, you might want to take a closer look at your cholesterol to make sure routine screening isn’t missing other potentially life- threatening cholesterol disorders.“When it comes to assessing risks for cardiovascular disease, it’s important to know that routine lipid (cholesterol) testing doesn’t always tell the complete story,” said Perry J. Weinstock, M.D., a cardiologist and board-certified lipidologist, who heads the division of cardiovascular disease at Cooper University Hospital.
“For people with a personal or immediate-family history of heart disease, the cholesterol results obtained from traditional lipid testing do not necessarily tell us their true risk. These are the people whose genetic make-up might predispose them to heart disease, and these are the people who could benefit from advanced lipid testing,” Dr. Weinstock said.
Unlike traditional lipid testing, which calculates the level of “bad” LDL (low density lipoprotein) cholesterol in the blood, advanced lipid testing is a laboratory technique that provides direct, detailed information about specific cholesterol particles. It is through the analysis of these particles that doctors can detect abnormalities that may contribute to the development of heart and vascular disease. The tell-tale components of these particles involve their size and density, which is not revealed by routine lipid testing.
For example, a routine test might show normal levels of LDL cholesterol in the blood, but advanced testing shows that the cholesterol particles are small and dense, and potentially more harmful.
Dr. Weinstock explains:
“Some cholesterol particles are small and dense while others are large and buoyant. A small, dense LDL particle may confer a higher risk for atherosclerosis (hardening of the arteries or clogged arteries). The small, dense LDL particles more easily settle between the cells in the arterial wall than do the large, buoyant LDL particles, allowing for greater interaction with the blood vessel, and more deposition of cholesterol.
“Another potentially artery-clogging lipoprotein is known as Lp(a). Lp(a) is a small, dense variant of LDL that, at least in some families, may predispose to early atherosclerosis. The total cholesterol and LDL cholesterol numbers on a standard Fasting Lipid Profile blood test do not give us any information about Lp(a).”
Arteries carry oxygen-rich blood to the heart and throughout the body. Atherosclerosis is a narrowing of the arteries caused by the build-up of plaque and fatty deposits (cholesterol) on the inner surface of the arterial wall. “Often times, people experience no symptoms of this narrowing until the blood flow to their brain or heart is completely blocked, resulting in a stroke or heart attack,” Dr. Weinstock said.
“Clearly,” Dr. Weinstock added, “early identification of such risk factors is the key to prevention. Advanced lipid testing allows us to pinpoint these otherwise hidden risk factors and, ultimately, prescribe individualized therapies to modify the condition and reduce the risk of future coronary and vascular events.”
Of course, the cholesterol abnormalities discussed here represent only a few of the many various and complex lipid disorders capable of detection through advanced lipid testing. “Even the “good” HDL cholesterol has different subclasses, each with different levels of risks or benefits assigned to them,” Dr. Weinstock said.
While the results of traditional lipid testing are important—a baseline, routine cholesterol test is recommended at age 20 for all adults, more advanced lipid testing may be appropriate for people with a personal history of heart disease and people whose parents, siblings or children have or have had heart disease.
“By knowing what to do with the results obtained from advanced lipid testing,” Dr. Weinstock said, “advanced cardiac centers like the Cooper Heart Institute can tailor life-saving treatment plans for these individuals who are most at risk.”
Talk to your doctor about advanced lipid testing and a board-certified lipidologist who can personalize a treatment plan.
Dr. Perry J. Weinstock is one of only a few hundred physicians nationwide certified by the American Board of Clinical Lipidology (ABCL). He also is an ABCL Diplomate, a status recognizing his successful completion of advanced education and rigorous examination in the field of clinical lipidology. Dr. Weinstock serves on the Board of Directors of the Northeast Lipid Association, and on the editorial board of the Journal of Clinical Lipidology. He has been repeatedly selected as a TOP DOC by numerous publications.