Most heart attacks occur in folks who have not only normal cholesterol, but decent levels of its subtypes, HDL (Healthy Dynamite Lipid) and LDL (Lousy Darn Lipid). Also some who have elevated cholesterol and LDL with a low HDL have no cardiovascular disease. Oxidized LDL is really the villain. But more important, there is an advance lipid test that gives much better information. Three Labs that do these: the VAP test (short for Vertical Auto Profile), developed at the University of Alabama, Birmingham (UAB) Medical Center, and the LPP (Lipoprotein Particle Profile) test offered by SpectraCell Laboratories in Houston and The Cleveland Heart Laboratory. These are a boon for doctors and better for their patients who do not want to be just treated for heart disease, but rather prevent it. This is a reliable risk assessment in that we can now break down the components of cholesterol, and single out the most dangerous fractions.
Here are just a few of
the key readings these tests give you that the old ones do not. Your
LDLs were considered to increase the risk of heart attack and
necessitate treatment. But LDL, for the most part, is really a good
guy-a sheep slapped with a wolf’s reputation. Your basic cholesterol
is mostly LDL, and wrapped in a protein coating (Lipoprotein) that
allows it to circulate in the bloodstream. Cholesterol is essential in
the body for vitamin D, steroid hormones (like estrogen, progesterone, testosterone,
and cortisol), bile acids and as part of our cells membranes. It also
makes up 28% of our Brain! LDL can be bad or good as identified by
these tests. LDL becomes dangerous when it is oxidized or overly
present as a small dense particle as opposed to a larger, fluffy more
"buoyant" one (Pattern A}.
The small dense LDL is nefarious and is
labeled Pattern B. B for Bad!! This is because the smaller Beebe like
particles are more easily able to penetrate the endothelium. There also
is a determination of Intermediate Density Lipoprotein or IDL remenants. These can be
incorporated into the arterial wall without the oxidation that the
other lipids can and are considered extremely dangerous.
The tests also
indicates a really bad type of LDL, Lp(a). This genetically endowed
particle increases the risk of heart attack up to 25 times! It is
highly inflammatory and thrombotic. There is no conventional medication
for Lp(a), but niacin (vitamin B3), high dose vitamin C with Proline,
and N-Acytel Cysteine (NAC) may help. When using Niacin beware that
Homocysteine, another risk factor in the blood does not increase. It
also raises blood sugar, uric acid and liver enzymes and can cause
heart burn and even eye problems. There is some controversy about long
acting non flush Niacin in that the wax impregnated variety may cause
more liver disease, but the long acting IHN (IsoHexoNiacinate) works
very well. The dose of this vitamin must be high. I usually start at
3000 mg, taken once a day and increase to 6000 mg, to reach goal
because it is so helpful in all the other lipid disorders. This dose
not only improves Lp(a), but lowers the LDL, raises the HDL-2, and
converts the bad pattern B to the good A. It is cheap and does not
require a prescription.
A high level of HDL,
the so-called good cholesterol, is generally associated with
protection against heart attack. We now know that HDL is further
classed into HDL2 and HDL3. The difference between the two is HDL2 is
far superior to HDL3 in providing protection for the heart.
Triglyceride which are incorporated in VLDL, are measured too and
anything above 100 (fasting) is considered abnormal. With these tests,
the bad triglyceride (VLDL3) is singled out. This is the most
inflammatory triglyceride, a prime indicator for coronary artery
disease progression, insulin resistance, and type II diabetes.
Triglycerides are fat globules in the bloodstream. In a concentrated
form, they create abdominal fat. This then increases HsCRP that
“rusts” our arteries. A significant test incorporated in the VAP and
Cleveland Heart Study is the PLAC-2, which more specifically reveals
not only how much plaque we have, but how stable it is. Unstable
plaques rupture causing a sudden heart attack or what is even worse A
STROKE !!
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