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A Heart Risk Factor Even Doctors Know Little About

To millions of Americans, Bob Harper was the picture of health, a celebrity fitness trainer who whipped people into shape each week on the hit TV show “The Biggest Loser.”

But last February, Mr. Harper, 52, suffered a massive heart attack at a New York City gym and went into cardiac arrest. He was saved by a bystander who administered CPR and a team of paramedics who rushed him to a hospital, where he spent two days in a coma.

When he awoke, Mr. Harper was baffled, as were his doctors. His annual medical checkups had indicated he was in excellent health. How could this have happened to someone seemingly so healthy?

The culprit, in turned out, was a fatty particle…

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Featured

  Is it time to retire cholesterol tests?

The next time you go in for a medical checkup, your doctor will probably make a mistake that could endanger your life, contends cardiologist Allan Sniderman of McGill University in Montreal, Canada. Most physicians order what he considers the wrong test to gauge heart disease risk: a standard cholesterol readout, which may indicate levels of low-density lipoprotein (LDL) or non-high density lipoprotein (non-HDL) cholesterol. What they should request instead, Sniderman argues, is an inexpensive assay for a blood protein known as apolipoprotein B (apoB).

  Blood Lipids and Cardiovascular Risk: Everything You Need to Know

My goal with this blog post is to bring clarity into this landscape not by just adding another voice, but by taking you by the hand and reviewing all of the different pieces of evidence, and all of the various claims on both sides of the argument. My goal is that by the end of the blog post, you will have much more clarity on the science of this important topic of how blood lipids are related to cardiovascular disease, how important lipids such as LDL-cholesterol are relative to other risk factors, which lab tests to have done, and how to interpret them.

 Assessing your risk of cardiovascular disease (Lipid Series – Part 2)

There is so much noise online about the tests that matter, the ones that don’t, and which biomarkers to look out for. In this episode, Dr Dayspring clearly outlines the three lipid tests that you should take to best assess your risk of atherosclerotic cardiovascular disease – and importantly, the ones you don’t need.

 Measuring cardiovascular disease risk and the importance of apoB

Millions of Americans schedule an annual physical health examination. During their visit, many can expect to get their blood drawn for a standard lipid panel, which ultimately provides the patient with a readout of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TGs). What virtually nobody among them will get is an apolipoprotein B (apoB) test. Yet this is considered the ideal, if not essential, measurement to assess lipoprotein-related atherosclerotic cardiovascular disease (ASCVD) risk

 The Blood Tests That Can Flag Your Hidden Heart Disease Risk

Two blood tests you probably haven’t heard of might predict your risk of heart disease better than standard tests do. The first measures a protein called apolipoprotein B, or apoB for short, that contributes to artery-blocking plaque. The other test, for lipoprotein(a), measures a type of bad cholesterol. High levels of each have been linked to increased risk of heart disease.A growing number of specialists and primary care doctors say these tests can help give you a more precise and earlier indication of possible heart problems than more common tests for things like LDL, the best-known bad cholesterol marker. In some cases, these lesser-known tests identify at-risk people whose standard lipid tests look normal. Proponents say the tests should supplement, not replace, your standard lipid panel, which is generally recommended every one to six years for adults. Other doctors are wary of ordering the tests, citing a lack of consensus on what constitutes normal levels and whether and how to treat them—not to mention the extra cost. U.S. medical organization guidelines don’t universally recommend them.

Articles of Interest

Apolipoprotein B (apoB)

Several studies have shown that apoB may be a better predictor of cardiovascular disease risk than LDL-C.

Lipoprotein(a)

Those with a family history of early heart disease not only need to get tested for the usual risk factors of high cholesterol, high blood pressure, diabetes and smoking but also must make sure they know if their Lp(a) is high and get their children tested as well.

VLDL – The Role of Triglyceride-Rich Lipoproteins and Remnant Cholesterol

Lipoproteins are important biochemical substances whose main purpose is to carry lipids from one tissue to another. VLDL is produced by liver cells and is an important carrier of triglycerides (TGs) and to a lesser extent cholesterol. Once in the circulation, VLDL is broken down in capillary beds by an enzyme called lipoprotein lipase, releasing lipids, mainly TGs, for energy utilization by cells or storage in adipose tissue.

HDL, LDL, WTF: Cholesterol?

No, this is not the new “must know” texting lingo; it’s the response I get from many of my patients who struggle with hyperlipidemia. Dealing with an abnormally high concentration of fats or lipids in the blood can be frightening and perplexing — just what do those numbers mean and why do they matter? Well, let’s start with the basics

Triglycerides

Yes, cholesterol is important, but there's another fat—triglycerides—you need to keep tabs on - Arthur Agatston

What is the difference between LDL and VLDL?

LDL and VLDL are both "lipoprotein packages" in your blood. Both are considered "bad" types of cholesterol. They differ in what each package carries. LDL cholesterol carries mostly cholesterol, some protein, and minimal triglycerides throughout your circulation. LDL should be less than 130 mg/dl, and ideally less than 100 mg/dl. VLDL cholesterol contains minimal protein and mainly transports triglycerides. VLDL should be less than 40 mg/dL.

Cholesterol Conundrum

Changing HDL and LDL levels does not always alter heart disease or stroke risk.

Making sense of cholesterol tests

The pros and cons of total cholesterol, HDL, LDL, and triglyceride testing.

The Sneakiest Heart Risk

Yes, cholesterol is important, but there's another fat—triglycerides—you need to keep tabs on. Here's how to get it under control.

Why LDL is Not Enough: The Tests Your Doctor is Missing to Assess Your Risk of Heart Disease | Know Your Numbers

Why LDL is Not Enough: The Tests Your Doctor is Missing to Assess Your Risk of Heart Disease | Know Your Numbers

"Advanced" cholesterol testing: Is it for you?

For most people, there is no advantage to tests that measure cholesterol and triglyceride particle size.

Ask Well: Should You Fast Before a Cholesterol Test?

Current cholesterol testing guidelines in the United States stipulate that fasting before a cholesterol test is “preferred.” But repeated studies have found no clinically significant differences between results from cholesterol tests done on a full stomach and those done after fasting.

Beyond "bad" cholesterol: A closer look at your blood lipids

For assessing heart disease risk, a standard cholesterol test doesn't always tell the whole story. Some people with "normal" LDL cholesterol levels might benefit from a test that measures apolipoprotein B (apoB). This test, which measures the number of LDL particles as well as other particles that can contribute to clogged arteries, may be a better indicator of heart disease risk than just an LDL cholesterol value.

Cholesterol levels predict if under-45s will ever have heart disease

A person’s cholesterol levels before the age of 45 can predict their lifetime risk of developing cardiovascular disease. The finding has prompted debate about whether younger people should be recommended preventative measures, such as taking statins.

End the War on Fat

The foundation for the "fat is bad" mantra comes from the following logic: Since saturated fat is known to increase blood levels of "bad" LDL cholesterol, and people with high LDL cholesterol are more likely to develop heart disease, saturated fat must increase heart disease risk. If A equals B and B equals C, then A must equal C. Well, no. With this extrapolation, scientists and policymakers made a grave miscalculation.

Getting Your Cholesterol Checked? Why You Don't Have To Fast

The next time you have blood drawn to check your cholesterol level, you may have a smile on your face. The reason? You don't have to fast overnight and skip breakfast before your blood draw.

Lipids and Coronary Heart Disease

Cardiovascular disease, or coronary heart disease, is the most common cause of morbidity and mortality in the developed world; over the course of this century it will assume this dubious distinction in the developing world as well. Many factors contribute to heart disease, including age, gender, family history, hypertension, and diabetes: hyperlipidemia figures especially prominently as such a risk factor.

Resources

National Lipid Association

To enhance the practice of lipid management in clinical medicine.

Patient

Hyperlipidaemia is quite common and is known to be a risk factor for cardiovascular disease such as heart attacks and strokes. The UK population is known to have the highest average cholesterol levels in the world. Two out of every three people in the UK will have higher than recommended cholesterol levels.