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Limitations of traditional
Lipid Testing And Role of Expanded Lipid Testing
Heart Disease is the result of complex interactions between
multiple inherited traits and environmental issues including
Diet, body weight. Blood pressure, Diabetes, and life
style habits. For this reason, it is not surprising that
single treatment does not have the desired effect in all
patients. Despite the success in LDL- C reduction, close
examination of the trial results reveals that a substantial
number of subjects, who received treatment and achieved
significant LDL-C reduction, still had a clinical event
of CAD.
Although Total Cholesterol, High Density Lipoprotein (HDL)
and low density Lipoprotein (LDL) Cholesterol levels have
long served as the primary indicators of risk for CAD
(Coronary Artery Disease) it misses 50% of people who
ultimately have Heart Disease. Only 40% of Americans at
risk of Coronary Artery Disease are identified using the
current Lipid Testing method.
If traditional lipid panels were sufficient for risk stratification,
we would not be continuing to see heart disease at the
rates we are now. There are people who have normal traditional
lipid profiles who develop disease and we don't know why
….
Analyzing the extended Cholesterol profile of people with
heart disease , 50% of the men have pattern B ( small
dense) LDL, which is associated with up to four and a
half fold increase risk of Coronary Artery Disease. If
you keep LDL at less than 100mg/dl but has a LDL pattern
B distribution and you are using Statin Therapy you are
missing the boat.
Typically I look first at the total LDL then, in order
of importance I look at the LDL pattern, HDL sub fraction
and Lpa. because patients with high Lpa and Pattern B
LDL will not respond to Statin they need Niacin.
The best example I have is of a young female patient who
exercised and hiked she was in the best physical shape
and her total HDL was 90 mg/dl. Nevertheless she had a
heart attack. Expanded testing showed that her LPa was
90 mg/dl and had LDL tyle B pattern.
For Asian Indians the Metabolic Syndrome is a huge p [problem
so in them Expanded testing will help in screening of
premature of Heart disease. The three Amigo's Atherogenic
Lipid Triad is High Triglycerides, small dense LDL and
low HDL2 are important in the diagnosis and treatment
of Metabolic syndrome.
Heart disease prevention treatment and diagnosis is more
than a spy novel where all the foot prints need to be
revisited otherwise you will miss an important clue to
be successful.
You could be at risk if you following characteristics
| If you have one of the following: |
If you have two of the following |
| 1. Family History of Heart
Disease |
1. Total Cholesterol more then
200mg/dl |
| 2. You have Heart Disease |
2. LDL more than 130 mg/dl |
| 3. Triglycerides higher than
150 |
3. Triglycerides higher than
150mg/dl |
| 4. HDL less than 35mg/dl |
4. HDL less than 35 mg/dl |
| 5. Insulin Resistance/Diabetes
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5. Diabetes |
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6. Obesity |
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7. Family History of Heart Disease |
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8. Systolic > 140 mm & Diastolic>
90 mm |
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9. Type a Personality |
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10. Sedentary lifestyle |
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Family and Individualized Care
If parent has a disease there are 50% chances that family
members could. Since every trait respond differently to
different treatments, learning about your inherited factors
is important to prescribe an individualized treatment
plan. This provides a framework for future focused medical
follow up in battling heart disease for the family. We
know that with proper focused treatment Heart disease
can be prevented, stabilized and or reversed...
Recommended Next generation of Cholesterol Care
LDL particle size:
Test for the LDL size distribution classifies the LDL
in Small LDL (pattern B) and Large LDL (pattern A) Small
dense LDL (pattern B) is associated with three fold increase
of Coronary Artery Disease
HDL sub classification
HDL 2 subtractions associated with reverse cholesterol
transport and reduced risk for Coronary Artery Disease.
Larger HDL fraction you have the more cardio protective
it is.
LP (a)
LPa is an LDL particle with abnormal (a) protein attached
to it. Elevated LPa increases risk for Heart disease by
three fold.
Homocysteine
Elevate level of Homocysteine which is derived from the
amino acid methionine is shown to have increased risk
of Heart disease.
Next Generation Treatment for Heart Disease and Why
it is important for you
The advanced Cholesterol management clinic helps in Diagnosing
and management of proper Cholesterol management for Prevention
of heart disease by analyzing and tailor made treatment
modalities recommendation for the abnormal Cholesterol.
By using these advanced next generation testing we could
determine risk factors not detected in traditional blood
test which may put you at risk of heart disease By proper
evaluation of the heart risk factors, individualized treatment
regimen is recommended to stop and in some case reverse
the progression of heart disease by life style changes
and in some of the Abnormal Lipids can be treated by inexpensive
Vitamins like Niacin (B 3) Vit B6, B 12, Folic acid and
other vitamins
For more questions you can fill out
the form and I will try my best to answer it prompty
With Helthy Heart Wishes,
Narinder Saini, M.D.
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