How To Use Advanced Lipid Testing To Assess Your Cardiac Risk

by 
Dr. Eve Henry, MD
How To Use Advanced Lipid Testing To Assess Your Cardiac Risk

Boston Heart Lifestyle Panel

One of the most popular Boston Heart Labs ordered at Rupa is the Lifestyle Panel which contains a basic lipid panel (LDL, HDL, triglycerides), a hs-CRP, and two unique tests called the HDL Map Test and the Cholesterol Balance test. This panel goes beyond the basics to provide multiple markers of cardiac risk as well as a unique analysis of cholesterol synthesis and HDL particle size. The Lifestyle Panel allows practitioners to further stratify their patient’s personal cardiac risk as well as provides insight into the best possible medication regimen for each unique individual.

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Basic Lipid Panel

Low-Density Lipoprotein Cholesterol (LDL-C)

LDL-C is the most well-known lipid marker and is considered an independent risk factor for cardiovascular disease (1). LDL-C values are the established target of most cholesterol interventions as reductions in LDL-C are associated with decreased cardiovascular risk (1). Boston Hearts LDL-C is a direct measurement of LDL and not a calculation dependent on the other lipid markers such as triglycerides. Due to the direct measurement, fasting is not specifically required to discern LDL-C levels correctly.  

High-Density Lipoprotein Cholesterol (HDL-C)

HDL-C is a direct measurement of the total HDL particles in a sample. Low HDL is a known risk factor for cardiovascular disease. However, research now shows that the cardioprotective effects of a High HDL are dependent on the HDL subtype (see HDL MAP test below) (1) (2). While low HDL may be the result of genetics (3), it may also be a sign of metabolic syndrome and insulin resistance (1).

Small-Dense Low-Density Lipoprotein Cholesterol (sdLDL-C)

sdLDL-C is a calculated value that shows the amount of the LDL-C that is made up of the more atherogenic small dense LDL (4).

Triglycerides

Triglycerides are fatty acids that come from the food we eat and are in transit to our fat cells. They are the primary lipid component in chylomicrons but are found in a variety of cholesterol particles (5). Although genetics can play a role in triglyceride levels, triglycerides are usually modifiable based upon dietary choices (5).  

High Sensitivity C-Reactive Protein (hs-Crp)

hs-Crp is a plasma protein whose levels rise in the setting of inflammation. The high sensitivity Crp (hs-Crp) allows you to detect very low levels of inflammation. Numerous epidemiological and intervention studies have shown that even low elevations of CRP as detected by hs-CRP are associated with risk of future cardiovascular events and an increased risk of type II diabetes (6).

HDL Map Test

HDL Map is an exclusive lab test that is only available through Boston Heart Labs. Although HDL-C has been used for decades as an important lipid marker of cardiovascular risk, research has shown that evaluations of HDL sub-particles provide a much more accurate assessment of CVD risk (2).

HDL-C is made up of a heterogeneous group of particle types that have their own unique cardiovascular effects (7). Some HDL particles confer the cardioprotective effects we tend to think of with HDL particles, while other subtypes actually confer increased cardiovascular risk. A “high HDL” may not actually be a good thing unless you are confident that the beneficial HDL subtypes are driving up the particle number.  

The HDL Map test uses a proprietary gel electrophoresis technique that quantifies the amount of ApoA1 in each particle and divides the HDL particles into five unique particle subtypes. Research has shown that individuals with higher amounts of A1 and A2 subsets of HDL enjoy more of the cardioprotective benefits of HDL while individuals with higher volumes of A3, A4, pre-B1 suffer increased cardiovascular risk (2).

Cholesterol Balance Test

The Cholesterol Balance Test is a proprietary lipid extraction method that measures markers of cholesterol production and gastrointestinal cholesterol absorption. Our total body cholesterol comes from both what we make in our cells and what we absorb from our gastrointestinal tract.

Lathosterol and desmosterol are markers of cholesterol production within the body (8). Statins, the most commonly used cholesterol medication, work by inhibiting the cellular production of cholesterol. When cells can’t make enough cholesterol to meet their needs, they increase their surface LDL receptors and remove cholesterol from the plasma, thus lowering the plasma LDL concentration (9).

Our gastrointestinal tract absorbs cholesterol from the food we eat and from the cholesterol that is attached to bile salts (10). One of the ways we clear cholesterol from our system is by attaching it to bile salts and excreting it via stool. The gastrointestinal tract can inhibit this cholesterol excretion by reabsorbing and recycling cholesterol that is on its way out. Rates of cholesterol absorption in the Gi tract vary widely between individuals due to genetic differences and can range from as little as 25% absorption to 80% absorption (11).

The Cholesterol Balance Test gives you powerful and personalized information on what physiologic mechanism is driving an individual’s elevated cholesterol levels and allows you to choose a therapy targeted to that specific pathway.

Summary

The Boston Heart Lifestyle Panel goes beyond the traditional lipid panel to give you a more detailed analysis of cardiovascular risk factors as well as unique insight into what treatments might specifically benefit that patient.


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References

Dr. Eve Henry, MD
Website
Rupa Advisor
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