“My doctor said my cholesterol was fine . . . So why did I have a heart attack?!”
Let’s face it: Using cholesterol values alone to predict whether or not heart attack is in your future can lead to failure. Yes, it works statistically in a large population. But apply it to a specific individual, and you might as well roll the dice.
There are a number of reasons for the shortcomings of cholesterol values to predict heart disease. Among the reasons:
- LDL (bad) cholesterol is usually not measured, but calculated─The calculation used is 40 years old, harking back to an age when measured LDL was not readily available. Calculated LDL is subject to enormous inaccuracy. (See “It’s not the LDL, stupid!”)
- There’s more to causes of heart disease than high cholesterol─Some causes, like low HDL or high triglycerides, are evident on any standard cholesterol panel. Others, like small LDL (number one cause for heart disease in the U.S.!), intermediate-density lipoprotein (IDL), and lipoprotein(a) (), are not part of a standard cholesterol panel.
For these reasons, lipoprotein testing is one useful solution that more confidently uncovers causes for heart disease. In past, lipoprotein testing was costly and only people deemed high risk (family history of early heart disease, diabetics, complex cholesterol disorders) would “qualify” for having the testing performed. However, costs for lipoprotein testing have dropped substantially (e.g., a basic NMR lipoprotein panel is under $100) and it’s difficult to ration use of these tests any longer based on excessive cost. Yes, it is an added expense over and above standard cholesterol testing, but if the information provided is superior and more effectively prevents heart attack, hospitalization, and heart procedures, it’s not too hard to justify.
There are three different methods used in lipoprotein testing:
1) Nuclear magnetic resonance (NMR) ─Your blood (plasma, actually) is placed in a magnetic field, similar to that of an MRI scanner. But in this case it’s not your head being scanned, but your blood proteins. This is performed by a North Carolina company, Liposcience, Inc. (www.liposcience.com)
2) Gradient gel electropheresis (GGE) ─ Blood proteins migrate in an electrified gel based on size and electrical charge. This service is provided by Berkeley HeartLab (www.bhlinc.com).
3) Vertical Auto-Profile (VAP) ─ Blood proteins are separated by density by spinning rapidly in a centrifuge. This service is provided by Atherotech, Inc. (www.thevaptest.com).
Despite the considerable advantages over standard cholesterol testing, these tests are often not well understood by most primary care physicians or even cardiologists. Many people therefore encounter difficulties in obtaining lipoprotein testing.
If your doctor is unable, unknowledgeable, or unwilling to help you, then what can you do?