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Advanced Cholesterol Testing:

Normal Levels Can Deceive!

High cholesterol plays a large role in the development of atherosclerosis, or hardening and narrowing of the arteries, which in turn raises the risk of heart attack and stroke. When an artery is narrowed by atherosclerosis it becomes blocked and stroke symptoms can develop gradually in minutes to hours, or (in rare cases) days.

Physicians understand that controlling your cholesterol will reduce the likelihood of stroke. But many people who experience a heart attack or stroke didn’t receive fair warning from their routine cholesterol test.

More than half of all heart attack patients have "normal" cholesterol levels. That’s one reason why physicians are increasingly using advanced cholesterol testing. It allows them to more accurately identify their patients’ true risk of heart disease, leading to better treatment decisions and lifestyle changes that can decrease the risk of a stroke or heart attack.

A Closer Look at Cholesterol

The basic cholesterol test measures the "good" HDL cholesterol (high density lipoproteins), the "bad" LDL cholesterol (low density lipoproteins), triglycerides and total cholesterol. In very low-risk groups, this is often sufficient. However, for higher-risk groups the standard cholesterol test gives an incomplete picture of risk. An advanced cholesterol test offers the most comprehensive view of heart attack and stroke risk and includes many components of blood cholesterol, including:

  • Total LDL Cholesterol: LDL is the "bad" cholesterol and the primary cause of heart disease. It is the primary cholesterol target in heart disease risk management.
  • HDL Cholesterol: HDL is the protective or "good" cholesterol. Low levels of HDL are related to increased risk for coronary heart disease. Low HDL is an independent risk factor for heart disease.
  • VLDL Cholesterol: VLDL is the main carrier for triglycerides and, if elevated, can be an independent risk factor for heart disease.
  • Total Cholesterol: Total cholesterol is the amount of cholesterol circulating throughout your body.
  • Triglycerides: Triglycerides are energy-rich molecules needed for normal functions throughout the body. Elevated levels are associated with diabetes and cardiovascular disease.
  • Non-HDL Cholesterol: Non-HDL cholesterol is LDL + VLDL cholesterol. It has been shown to be a better predictor of heart disease risk than LDL alone.
  • Total apoB100: Total apoB100 combines all of the "bad" risk factors into a single value.
  • Lp(a): The "heart attack" cholesterol, Lp(a), is a strongly inherited risk factor for heart disease. Patients with this problem need even more lipid lowering management.
  • Real LDL Cholesterol (LDL-R): The Real LDL Cholesterol that circulates in your body. It is a component of Total LDL Cholesterol: Total LDL = Lp(a) + IDL + Real LDL.
  • LDL Cholesterol (size pattern): LDL exists in a range of sizes from small, dense "Pattern B" to large, buoyant "Pattern A." The smaller LDL cholesterol sizes are associated with an increased risk for heart disease. Small, dense LDL is prevalent in patients with insulin resistance or diabetes.
  • Metabolic Syndrome: Metabolic Syndrome is characterized by the combination of several metabolic risk factors, including 1) elevated Triglycerides, 2) low HDL, and 3) small, dense Pattern B LDL that increase the overall risk for heart disease.
  • IDL Cholesterol: IDL is elevated in patients with pre-diabetes, such as those with metabolic syndrome and in patients with a high carbohydrate diet.
  • HDL2 / HDL3 Cholesterol: HDL cholesterol sub-fractions are also used for risk prediction. HDL2 is large and buoyant and the most protective form of HDL cholesterol. Low HDL2 is a risk factor for heart disease in patients with normal LDL levels. HDL3 is small and dense and the least protective form of HDL.
  • Total apoAI: Total apoAI combines all of the "good" particles that are heart protective into a single value.
  • apoB100/apoAI Ratio: The apoB/apoAI ratio is a measure of heart disease risk and in some studies has been shown to be the best predictor of risk. In general, the lower apoB/apoAI value, the lower your risk for heart disease.
  • VLDL3 Cholesterol: VLDL3 is the most dense VLDL sub-fraction and a greater risk factor for heart disease than both VLDL1 and VLDL2.

Additional Value to Advanced Cholesterol Testing

Advanced cholesterol tests provide a personalized picture of your heart disease risk and allows for your doctor to customize treatment recommendations. Such tests identify and quantify all components of "bad cholesterol" while providing additional insight into the nature of good cholesterol. Hidden risk factors are often discovered in people with otherwise "normal" cholesterol. A very dangerous inherited particle called Lp(a) is often elevated in people with a family history of premature cardiovascular disease.

Ask Your Doctor

Advanced cholesterol tests provide additional information you and your doctor can use to manage your cardiovascular risk. Certain advanced tests also help to identify metabolic syndrome, which leads to diabetes, stroke and heart disease.

People who have experienced a stroke or heart disease or have risk factors (diabetes, hypertension, obesity, family history) and those taking cholesterol-lowering medication are candidates for comprehensive cholesterol tests. Most of these advanced tests are available nationwide and covered by insurance providers, including Medicare and Medicaid. Ask your doctor about getting a more detailed look at your risk with an advanced cholesterol profile.

By: James Ehrlich, M.D., Preventive heart disease expert, medical consultant for Atherotech, manufacturer of the VAP (Vertical Auto Profile) Advanced Cholesterol Test

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"More than half of all heart attack patients have seemingly 'normal' cholesterol levels."

Quick Facts

  • High cholesterol raises your risk of stroke and leads to atherosclerosis, or hardening and narrowing of the arteries.
  • The "traditional" routine cholesterol test gives an incomplete picture of heart disease risk.
  • More than half of all heart attack patients have normal cholesterol levels.
  • Your physician may order an advanced cholesterol test instead of a routine lipid panel to better manage your risk of stroke, heart attack, Metabolic Syndrome and diabetes.
  • Advanced cholesterol tests provide a personalized picture of your heart disease risk and offer the most comprehensive view of stroke risk.
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