Advanced Lipid Testing

Standard lipid tests may not completely represent your cholesterol-related risk for heart attack and stroke. If you have diabetes, insulin resistance, or cardiovascular disease, those conditions may progress even when your low-density lipoprotein (LDL) is at its best level.

In addition to a standard lipid panel that measures total cholesterol, LDL, high-density lipoprotein (HDL) cholesterol and triglycerides, commonly-used advanced tests are apolipoprotein B (apoB) and LDL particle number (LDL-P). Unlike standard lipid tests, apoB and LDL-P do not require fasting.

The total number of apoB indicates the total quantity of bad cholesterol. LDL can occur as large buoyant LDL particles or as small dense LDL particles with less cholesterol per particle. These small dense LDL particles are more atherogenic—tending to promote the formation of fatty plaques in the arteries—than large buoyant LDL particles, and they more easily invade the walls of the arteries, increasing the risk of plaque formation.

When the tests might be helpful

When you don’t seem to have risk factors to explain your cardiovascular disease and you are not responding to treatment, advanced lipid testing might help, especially if you also have a sibling or parent with cardiovascular disease. An advanced test may reveal that a person with a seemingly normal LDL level has a large amount of small, dense LDL particles, which increase risk. A doctor might prescribe a statin like atorvastatin (Lipitor) or pravastatin (Pravachol), or increase the dose of a statin, to reduce all forms of LDL.

What is lipoprotein?

Your bloodstream contains cholesterol, which is used to make hormones and cell membranes, and triglyceride, which supplies energy. Both are attached to proteins…lipoproteins…that help them travel through the blood.

Low-density lipoprotein (LDL) has a small amount of protein and a large amount of cholesterol, some of which it deposits on your artery walls. Lipoprotein(a) may indicate a genetic risk for heart disease.

High-density lipoprotein (HDL) picks up cholesterol from the walls of the arteries and carries it to the liver. HDL2, a larger particle, may be better than smaller, denser HDL3 at getting cholesterol out of arteries. Advanced tests may include measures of HDL2 and HDL3.

What therapy would advanced testing indicate?

Identifying a cause for your vascular disease will make it easier to treat. The best advice is still to keep your weight at normal levels, exercise regularly, follow a Mediterranean diet, sleep well, minimize stress, stay connected to your family and friends, and participate in your community. Vedas can help with weight, diet, and stress issues. Come see us!

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