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 look into more detailed cholesterol testing to better determine which treatments might be best for you.
“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. Dr. Weinstock will be answering questions about lipids and statins during the May 21st Health eTalk. To find out more or to ask a question, click here: www.cooperhealth.org/etalk.
“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.
Another indicator of your overall risk of heart disease is your non-HDL cholesterol count. This measurement is obtained by subtracting your HDL “good cholesterol” from your total cholesterol. So, if your total cholesterol count is 190 and your HDL cholesterol count is 40, your non-HDL cholesterol is 150.
Knowing your level of non-HDL cholesterol tells you all the bad cholesterol circulating in your blood—not just your LDL cholesterol but your VLDL (very low density lipoprotein) cholesterol and your IDL (intermediate-density lipoprotein) cholesterol, which also affect your cardiovascular health.
The recommended level for non-HDL is no more than 130 for disease prevention, and no more than 100 for people with established coronary artery disease or those at very high risk, such as diabetics or those with evidence of atherosclerosis (hardening of the arteries or clogged arteries).
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),” Dr. Weinstock noted.
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. If you’d like to learn more about this topic, be sure to read the complete transcript from the Health eTalk Dr. Weinstock hosted on May 21 where he answered questions about lipids live on cooperhealth.org.
About Perry J. Weinstock, M.D.
Dr. Perry J. Weinstock is one of only a few hundred physicians nationwide certified by the American Board of Clinical Lipidology, where his status as Diplomate recognizes his successful completion of advanced education and rigorous examination in the field of clinical lipidology. Dr. Weinstock serves on the Board of the American Heart Association, and is an officer on the Board of Directors of the Northeast Lipid Association. He also is a member of the editorial board of the Journal of Clinical Lipidology.