Cholesterol follies

Rudy is a 59-year old man. He’s had three heart catheterizations, two of which resulted in stent implantations. Obviously, Rudy should be the beneciary of a prevention program.

His basic cholesterol values:

Total cholesterol 164 mg/dl–pretty good, it seems.

LDL cholesterol 111 mg/dl–Wow! Not too bad.

HDL cholesterol 23 mg/dl–Uh oh, that’s not too good.

Triglycerides 148 mg/dl–By national (NCEP ATP-III) guidelines, triglycerides of 150 mg/dl and below fall within the desirable range.

So we’re left with an apparently isolated low HDL cholesterol, nothing more. On the surface, it doesn’t seem all that bad.

Of course, we need to keep in mind that this pattern landed Rudy in the hospital on several occasions and prompted several procedures.

Should we rely on these results? How about Rudy’s lipoproteins?

Here they are (NMR; Liposcience):

LDL particle number 2139 nmol/l–Representing an effective LDL of 213–over 100 mg higher than the standard value (above) suggests.

Small LDL particles 2139 nmol/l–In other words, 100% of all Rudy’s LDL particles are small. (Thus, weight-based measures of LDL cholesterol fail to tell us that he has too many small particles.)

Large HDL 0 (zero) mg/dl–Rudy has virtually no functional HDL particles.

If we had relied only on Rudy’s standard cholesterol values, we would have focused on raising HDL. However, lipoprotein analysis uncovered a smorgasbord of additional severe patterns. The high LDL particle number comprised 100% of small particles is especially concerning.

Truly, conventional cholesterol testing is a fool’s game, one that time and again fails to fully uncover or predict risk for heart disease. One look at Rudy’s lipoproteins and it becomes immediately obvious: This man is at high risk for heart disease and the causes are clear.

Of course, many physicians and insurance companies argue that the added information provided by this portion of the lipoprotein test added around $70 more to the expense.

When you see results like this, is there even a choice?



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5 Responses to Cholesterol follies

  1. Thomas says:

    It’s this type of analysis that’s most instructive and most interesting. If I were 20 years younger reading this post, I’m confident I’d have avoided open heart surgery I went through this past April.

  2. Andy says:

    I couldn’t find another place to give you general feedback, so it goes here: thanks for what you do.

    I’ve been an insulin dependent diabetic for 6 years now with a family history of CAD. While I have moderately good scores (59 for HDL, triglycerides below 60), I’ve been concerned about getting a better picture.

    I had a CT Heart Scan Wednesday, which resulted in a wonderful 0 reading. While I plan to push my family practitioner for NMR tests in the future, it’s nice to get some validation now. At $125, the price was a major bargain, as well.

    Again, thanks for sharing what you know.

  3. Dr. Davis says:

    Well, then, more to come!

  4. keith says:

    Interestingly, given a LDL particle count of 2139, Rudy would have been better off with a LARGER standard LDL cholesterol value, as this would imply his particles were larger and hence less atherogenic.

  5. Dr. Davis says:

    Yes, ironically.

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