Cholesterol Results 2014

So I finally bucked up and got my cholesterol tested in November and the results were surprising.  First of all, my cholesterol – after a year of reasonably careful eating and a lot more exercise, but no Metamucil or Fish Oil pills – actually moved in the right direction.

Details in a second.

Not only that, my new cardiologist (again, more in a sec on why I needed to finally see a cardiologist) actually called my cholesterol results “enviable.”

Enviable, people.

This shocked me. Especially because I gave up on the fish oil pills which apparently now, in a total turnaround from past belief, don’t help much with cholesterol. (It’s frustratingly difficult to keep up with what’s recommended –  and what is no long considered effective – for managing cholesterol without statins.)

That said, in the face of a genetic predisposition toward high cholesterol, I’ve managed through diet and exercise to avoid cholesterol medication.  Though truth be told, that’s more likely due to the American Heart Association’s 2013 revised Guidelines For Managing Blood Cholesterol than anything I’ve done… if the Guidelines hadn’t been revised, I’d probably still be having the statin conversation with my doctor.

In any case, here are my exciting (ha ha) cholesterol results.

My overall cholesterol is UP and now measures 246 – which used to be considered high but is apparently now not so big a deal.  Not a big deal, I guess, because my LDL (bad) cholesterol keeps falling (“goal” is less than 130 and mine is now 123) and my HDL (good) cholesterol keeps rising (“goal” is higher than 46 and mine shot up to 95).

NOTE: I put “goal” in quotes because these goals are no longer really in line with the new Guidelines; I find it fascinating that they are still reported as “goal” when the only goal according to the new guidelines is LDL (bad) cholesterol over 190 along with other heart disease risk factors that have nothing to do with cholesterol results.  Bizarre that this is still ‘outdated’ a year later.  Or maybe not bizarre, just sad.

In any case, I’m excited about the results.  Here’s a chart for those who prefer graphs.  If that’s not you, skip to cardiologist discussion 2 paragraphs below!

KLS Chol Trend Thru 2014

You’ll see the red line of total cholesterol is still high and rising – but no one seems worried about that, since the green line of LDL (bad) cholesterol is falling along with the purple triglyceride line … and because the blue line of HDL (good) cholesterol is rising.

Things certainly do change – I’m so glad I never started on a statin back in 2010-2011 when my numbers looked like a statin was in order.

Now, on to cardiologist.  My cholesterol results were surprising – and nicely so. But at same blood test I found I am positive for a blood clotting disorder, so that was a major bummer.  It’s not treated – and not dangerous unless you take hormones (which of course I was) so that had to stop immediately.

And then it turns out my blood pressure has risen quite dramatically.

Likely the stress of this past year – along with wondering and worrying about the blood clotting disorder.  Hence my doctor-referred trip to the cardiologist.

So my new cardiologist and primary care doctor are sorting out how to deal with my (hopefully short-lived) blood pressure issue … and on the plus side, I really liked the new cardiologist.  And when we discussed cardiac risk and my cholesterol trends and family history, he also thought that getting a handle on what my cardiac risk really looks like is a good idea.  So I had two more blood tests – and YAY – these are the very tests I’ve written about thinking made sense for me in Cholesterol Tests Your Doctor Hasn’t Told You About.  Finally!

So I had blood tests for both C Reactive Protein (CRP is a measure of inflammation in the body and high levels have been associated with heart disease) and also a full lipid analysis that will measure LDL density, ApoB and more.  I am really relieved to finally be getting a handle on cardiac risk.  Lastly, am debating about getting a Coronary Calcium test done – it’s a CT test so there’s radiation involved (and Aetna denied coverage) so I’ll likely wait until the blood test results come back to decide.

So on plus side, my cholesterol tests are now ‘enviable’ but am waiting for the blood test results to come back and really help hone in on cardiac disease risk. Oh, and trying to figure out how to get my blood pressure back to normal.

So I’ll end 2014 with a question for you: how’s your cholesterol? And, um, blood pressure? If you don’t know, please resolve in 2015 to have them checked.

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New Cholesterol Guidelines – An App For That

The American Heart Association and the America College of Cardiology released completely new, totally different guidelines for the treatment of high blood cholesterol back in November 2013.

As explained in my post, The NEW Guidelines For Cholesterol-Lowering Statin Meds, in broad strokes the new guidelines state that if you are in one of the following four groups you have elevated heart disease risk and should take statins:

  1. those who already have cardiovascular disease
  2. anyone with LDL (bad) cholesterol of 190 mg/dL or higher
  3. anyone between 40 and 75 years of age who has Type 2 diabetes
  4. people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher.

To determine your personal 10-year risk of cardiac disease, the new guidelines included an online calculator * … and now that a few months have passed, there’s even AN APP FOR THAT (links to the app are on the online calculator webpage – or search ‘ASCVD Risk” in iTunes store). I downloaded the app for my iPhone and it’s quite handy as it saves your data and also provides articles about key topics like ‘diet and physical activity recommendations,’ and ‘common cardiovascular terms,’ and the like – right in the app.
* NOTE – if the link does not work, check for an updated link on my RESOURCES page.

One of the more interesting topics I found inside the app (in the Patients’ Blood Cholesterol Management Recommendations tab) discussed additional blood tests. After reviewing with your doctor your ‘lifetime risk estimate’ based on the inputs in the calculator/app, the article stated there were three additional tests your doctor may want to order:  Coronary Artery Calcium (CAC), High-Sensitivity C-Reactive Protein (CRP) and Ankle-Branchial Index (ABI).

The Coronary Artery Calcium test was one my doctor had talked with me about a few years ago. She asked me to find out whether anyone in my family (all of whom take a statin to manage high cholesterol) had had a Coronary Artery Calcium test done, and if so, what the results were. I failed at that. Apparently, I need to email all my cousins and aunts and uncles.  Today.

As I wrote about in Cholesterol Tests Your Doctor Hasn’t Told You About, the C-Reactive Protein test is a test (along with apo-B) that I would really like done to truly understand my cardiac risk. CRP is a measure of inflammation in the body and high levels have been associated with heart disease.  But my doctor declined to order either test for me back a year or two ago – said with my just-over-220 total cholesterol levels, I didn’t need these tests.

The Ankle-Branchial Index I’ve never heard of before. According to the ASCVD Risk app, ABI measures “the ratio of the blood pressure in the ankle compared to blood pressure in the arm, which can predict peripheral artery disease (PAD).”

So I will have to ask my doctor again about Coronary Artery Calcium, CRP, apo-B and ABI testing. I feel sure she won’t agree to this testing because my newly calculated lifetime risk is far below the 7.5% risk that indicates statin medication is needed.

That said, these tests are at least mentioned within the new guidelines, while others, like Non-HDL cholesterol are now no longer viewed as vital to determining cardiac disease risk and treatment plans. So even though my risk is low under the new guidelines and I am no longer in the group that should be taking statins, I want to ask about whether these tests might provide further insight into cardiac risk.

If you haven’t read about the new guidelines or found the new online calculator intimidating, download the new app.* Knowing your cardiac risk before you talk to your doctor will give you more confidence to ask questions about your risk of cardiac disease at your next appointment.

* You can’t use the calculator/app if you already have cardiac disease or take statins. If that’s you, best bet is to talk with your doctor about what the new guidelines mean for you and/or if a change in your statin medication is warranted.

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Cholesterol Tests Your Doctor Hasn’t Told You About

A standard cholesterol lipid panel  provides four measures: Total Cholesterol, LDL Cholesterol, HDL Cholesterol and Triglycerides.  But did you know that there are two other blood tests — and one ratio that’s easy to calculate — that can better predict your risk of heart disease?  Which means that even with high cholesterol, you might not need a statin medication if these tests show low cardiac disease risk.

Or you might think you don’t need a statin … and in fact do.

And yet, your doctor probably has not told you about these tests.  So let me.

Apolipoprotein B – or as it’s commonly referred to, ApoB, is a simple blood test that measures the number and size of LDL (bad) cholesterol. Why this test is useful is well explained by Johns Hopkins Health Alerts:

“The problem with using LDL cholesterol levels to determine heart attack risk is that the test measures only the amount of cholesterol in the LDL cholesterol particles, not the number or size of these particles. Apo B measurements, on the other hand, provide information on the number of LDL cholesterol particles.

For example, people with a higher apo B value than LDL cholesterol value tend to have smaller, denser LDL cholesterol particles. Studies have shown that small, dense LDL cholesterol particles are more strongly associated with heart attack risk than large, “fluffy” LDL cholesterol particles.”

So if you have high LDL cholesterol (goal is under 130), you might want to find out if you have the ‘fluffy’ kind of LDL (pattern A), or the more dangerous, small, dense type of LDL (pattern B). Indeed, the Johns Hopkins Health Alert goes on to explain, “Research published in The Lancet reviewed five studies of LDL cholesterol and ApoB in nearly 200,000 people. The researchers concluded that high levels of ApoB were more strongly linked with future heart attack risk than LDL cholesterol levels.”  Compelling, no?

Low Density Particle Number, or LDL-P, is a similar measure – and again, one that’s been shown to be a more accurate predictor of heart disease than the typical cholesterol measurements.  LDL-P measures the number of LDL particles in the blood, whereas LDL is just the total LDL cholesterol.

As explained in The Difference Between LDL-C and LDL-P on the Primal Docs website, two people with the same LDL numbers can have vastly different heart disease risk because one has low LDL-P (fewer LDL particles of the type A, big, fluffy kind) while the other has high LDL-P, or a lot of LDL particles, of the small, dense, type B kind:

“…one person (person A) may have large cholesterol rich LDL particles, while another (person B) may have smaller cholesterol depleted particles. These two persons may have the same LDL-C concentration. However, person B will have higher LDL particle number (LDL-P). Despite similar levels of LDL-C, person B is at higher risk four future cardiovascular events. Furthermore, person B will have more small LDL-particles.”

The doctor who wrote this explanation of LDL-C vs. LDL-P goes on to explain that both LDL-P and ApoB are stronger predictors of heart disease risk than typical cholesterol measures:

“Some studies have suggested that the size of LDL-particles may be of importance. People whose LDL particles are predominantly small and dense, have a threefold greater risk of coronary heart disease.

ApoB and LDL-P both reflect the number of atherogenic lipoprotein particles. Measurements of ApoB and LDL-P are better predictors of cardiovascular disease risk than LDL-C. Furthermore, ApoB and LDL-P may predict residual risk among individuals who have had their LDL-C levels lowered by statin therapy.”

Non-HDL Cholesterol is a third important measure — and you don’t even need to take a blood test. Non-HDL-C is simply your Total Cholesterol minus HDL Cholesterol.  The tricky part is figuring out goal: if your LDL cholesterol is “at goal” you can roughly estimate your non-HDL-C goal by simply adding 30 to your LDL goal (these goals are usually on the cholesterol report – they are also online or you can ask your doctor.) And if it’s not at goal, discuss this ratio with your doctor.  I wrote about non-HDL-C and how to calculate it in this blog post, Do You Know Your Non-HDL Cholesterol?

While researching these in-depth cholesterol tests, I came across this compelling medical case study. It socked me in the gut, as this woman’s lipid panel cholesterol results were similar to mine, and yet it turns out from the additional LDL-P and ApoB testing that she was at high risk for cardiac disease. And needed statins.

Gulp.

So how do you get these tests?

I asked my internist about them months ago, and she said I didn’t need them — that my cholesterol numbers are fine. But now that I’ve read this case study I feel I would love more information.  I’ll have to ask her again about additional testing – especially now that I have more info.

And just so you know, you don’t have to travel to the Cleveland Clinic or the Mayo Clinic or Berkeley, California to get these tests. The Johns Hopkins Health Report explains,

“One widely used test, called the NMR LipoProfile, analyzes the size of lipoprotein particles in the blood by measuring their magnetic properties. Several others, including the LipoPrint and the Berkeley (from Berkeley HeartLab) use electrical fields to distinguish the size and other attributes of lipoprotein particles. Still another, known as the VAP (for Vertical Auto Profile) test, separates lipoprotein particles using a highspeed centrifuge.”

Even though my cholesterol is at goal, I’ve got to put in a call to my internist to ask about getting both the LDL-P and ApoB testing done. Will keep you posted.

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