Lipid Profiles and Heart Disease
Most of us are familiar with the idea that high levels of cholesterol in the blood are associated with a higher risk of heart disease. Yet the majority of those who suffer a heart attack have cholesterol levels within the “normal” range. Why? There are many developing theories, but one thing that’s become clear is that the truth is far more complex than was once assumed.
In order to accurately understand both the risk of a cardiac event, including heart attack or stroke, and the progression of cardiovascular disease, it’s important to understand the interactivity of the various types of fats in your blood and how much of each kind you have. We determine the right mix of tests for each individual and, once we have the results, craft a specific plan to help you improve these numbers, retesting as needed to monitor our progress.
The oxidation of LDL cholesterol occurs in the earliest stages of atherosclerosis. High levels of this marker can indicate a higher risk of metabolic syndrome and coronary artery disease. In one study of middle aged men, high levels of OxLDL correlated with four times the risk of developing coronary artery disease.
LDL cholesterol is not usually measured directly. Instead, levels of HDL cholesterol, triglycerides and total cholesterol are analyzed and placed into a formula to provide a good estimate of LDL levels. But in those with high triglyceride levels, this formula becomes less accurate. In addition, LDL particle size seems to have a strong correlation with the risk of developing heart disease. Small particle sizes may put patients at a far greater risk: they indicate a higher risk for heart attack, insulin resistance and metabolic syndrome as well as increased danger from other cardiac risk factors such as high total cholesterol or high CRP.
The only way to determine particle size is by direct measurement. Using nuclear magnetic resonance (NMR) spectroscopy to measure the number and size of these particles negates the effects of triglyceride levels and can produce a much clearer picture of the real risk of cardiovascular disease.
Small, Dense LDL (sd LDL)
In addition to measuring LDL particle size, particle density can indicate higher risk for coronary heart disease. Small, dense particles are associated with three times the risk of heart attack and may contribute to an accelerated progression of disease. These particles may also accompany high triglycerides, reduced HDL cholesterol, insulin resistance and obesity. Understanding the nature of your LDL and HDL cholesterol is as important — if not more so — than understanding how much cholesterol you have.
N-terminal pro b-type natriuretic peptide (NT-proBNP)
When the heart is under duress and working hard to pump blood, BNP is released into the blood. Sometimes, certain conditions can mimic the symptoms of heart disease. This test is done to ensure that a diagnosis of some level of heart failure is warranted. Normal results can indicate the presence of some other problem. It can also indicate an increased risk of future or recurring cardiac events.
Lipids are carried through the blood stream once they are combined with a protein produced by the APOE gene. Some people carry a variant of this gene that interferes with this process, giving them an increased risk of atherosclerosis. They seem to deposit fat into the artery walls more easily and tend to have higher levels of blood cholesterol and triglycerides.
This is is gene has a role in a highly complex chain of events converting homocysteine to methionine. People with a mutation in this gene can develop abnormal blood clotting and may have a higher risk for heart disease, stroke, high blood pressure and preeclampsia. This test maybe ordered to discover whether or not high homocysteine levels are related to genetic causes.