Cholesterol test from A to Z (Long)

[Buckeye]

DH turned 65 at the end of last year. He recently got into the VA system but we thought he should also to get a Medicare primary care physician. He has the AARP United Healthcare Advantage plan. He sees the chiro a couple of times a year but hasn't seen a doctor in years.

He had a full physical at the VA and everything was good except his total cholesterol is high (and always has been) at 260. His LDL is 174 and his HDL runs around 60. He has never smoked, has been the same normal weight for at least the last 20 years, is active and is a glass half-full personality. His mother lived a healthy life to nearly 95 (with elevated cholesterol). His father lived to his mid-70's but seriously abused his body with smoking (1.5 lungs removed), drinking (lifelong alcoholic), and anger.

When the VA saw his numbers, his lifestyle, and his family history, they were curious about what might be going on inside and suggested he might want to do a scan to determine a calcium score (I think). Nobody suggested he start taking a statin.

When he went to see his Medicare PCP (a guy about 40), his first comment was about DH's high LDL and how risky it was. DH let his PCP know he wasn't going to be taking a statin. I let PCP know we had an NMR study we had done through the internet and wondered whether he could interpret the results. He said he could not but there was an Internist a couple doors down who was a total cholesterol nerd and could read it.

DH and I went to see the Internist and, based on the NMR test, the Internist gave us some interesting information about my husband's situation. DH has high LDL-C and very high LDL-P (quantity of particles). The internist assumed that DH's system would show markers of inflammation and he would need to take a statin (which wasn't going to happen). He said he had this whopper test DH could take that would give much more info than just the regular stuff and tell him whether his system was inflamed (which would definitely put him at cardiovascular risk).

We discussed DH watching (okay, me watching!) what he ate for the next 8 weeks and whether we should do a baseline test and one after 8 weeks or just one after 8 weeks. I requested we do a baseline test so DH would know where he was starting.

We received the result of the baseline test and DH's system shows no, none, nada, zero indication of inflammation. DH is solidly in the green on all the inflammation markers. This is before DH did anything related to his diet (which really isn't bad to start with). We have a follow-up appointment in early May but when we picked up the test from his office, the nurse said the doctor's only recommendation was for DH to take some fish oil because his DHA + EPA level was low. No mention of a statin. Based on the nurses other comments, it seems the Internist is no longer concerned about DH cardiovascular risk. We'll find out more in May. IMO, I think the Internest was surprised by the total lack of inflammation even though LDL-C and LDL-P were both elevated.

If you ever want to do a cardiovascular risk assessment beyond your HDL and LDL, this test is pretty interesting. There are 6 pages of results and 2 pages of explanation. About 50 different things are measured. You can get more info on the test at the myHDL website. The test doesn't really have a name. The header just says 'Laboratory Results.' I guess it's just 'the' test.

 

[Katsmeow]

Did you have the testing done to find out if his LDL particles were the small, dense kind or the large, fluffy kind? My understanding (but I am not totally clear on this) is that particle number is important, but so is particle size. I had the idea that a large particle number sometimes meant small, dense particles (bad) but that this wasn't necessarily the case. That is particle number could be high without having a lot of small, dense particles. I'm not too sure how that works though.

 

[donheff]

It sounds like you have lots of small dense particles (supposedly bad). Does the internist cholesterol nerd believe that inflammation is actually the best marker of CV risk?

 

[Buckeye]

Did you have the testing done to find out if his LDL particles were the small, dense kind or the large, fluffy kind? My understanding (but I am not totally clear on this) is that particle number is important, but so is particle size. I had the idea that a large particle number sometimes meant small, dense particles (bad) but that this wasn't necessarily the case. That is particle number could be high without having a lot of small, dense particles. I'm not too sure how that works though.

Yes, I wanted to do the NMR study to get results on particle sizes. I will ask more questions at DH's next appointment but my interpretation of the numbers on DH's current test (which also has NMR results) is that his Apo B (undesirable particles) is high but so also is his Apo A-1 (desirable particles). His ratio, Apo A-1/Apo B, is .82 which puts him just into the red (red starts at .81). Even though his ratio is slighlty out of acceptable, there is no inflammation in his system.

His Lp(a) (another undesirable, I think) is almost in the green. DH is 78 and green is <75. High risk is > 125.

My interpretation is that he has high bad but also high good so there is no inflammation in his artery walls and his risk for cardiovascular disease is relatively low. I'm really looking forward to the next appointment with the Internist. The Internist was pushing statins pretty hard after looking at DH's first round of numbers. Interesting to think my husband could have been on a lifetime statins if we had not pushed back. Based on what the Internist discussed with us, there would be no reason to take them based on the numbers from this test.

 

[braumeister]

If you ever want to do a cardiovascular risk assessment beyond your HDL and LDL, this test is pretty interesting. There are 6 pages of results and 2 pages of explanation. About 50 different things are measured. You can get more info on the test at the myHDL website. The test doesn't really have a name. The header just says 'Laboratory Results.' I guess it's just 'the' test.

Is that the HDL that just paid $47 million to settle a fraud case?

 

[Buckeye]

Don't know if it's the same company. Did they get in trouble with Medicare? What was the nature of the fraud?

 

[athena53]

Interesting to think my husband could have been on a lifetime statins if we had not pushed back. Based on what the Internist discussed with us, there would be no reason to take them based on the numbers from this test.

Thanks. This is good to know; my total cholesterol isn't great but the good cholesterol is high and some of the ratios are excellent. I started statins but quit after getting really bad tendonitis in my elbows. The doc was OK with it (heck, I'd be in a wheelchair if I hadn't quit). Like your DH, I'm normal weight, active, don't smoke, etc. If someone starts pushing the statins again (I'm "only" 62 so it could happen) it sounds like those tests would give me a lot better indication of whether I'm at risk.

 

[Buckeye]

It sounds like you have lots of small dense particles (supposedly bad). Does the internist cholesterol nerd believe that inflammation is actually the best marker of CV risk?

Yes, to the Internist it's all about inflammation. If there is no inflammation, the cholesterol is not harming the artery. All the stuff with foam cells etc. Is not happening in the wall of the artery. Sounded like he thought the main point of the statin was inflammation reduction and not specifically cholesterol reduction. Also, lots of people with normal total cholesterol have heart attacks but he says there can still be inflammation and risk.

 

[donheff]

Thanks. This is good to know; my total cholesterol isn't great but the good cholesterol is high and some of the ratios are excellent. I started statins but quit after getting really bad tendonitis in my elbows. The doc was OK with it (heck, I'd be in a wheelchair if I hadn't quit). Like your DH, I'm normal weight, active, don't smoke, etc. If someone starts pushing the statins again (I'm "only" 62 so it could happen) it sounds like those tests would give me a lot better indication of whether I'm at risk.

It is not like failure to take the statins is a huge deal even if all signs point to the need. The difference in outcomes is pretty slim so the presence of a serious side effect easily tips the balance away from using them, in my opinion. Many doctors would disagree with that sentiment but I suspect that is because statins are the only simple tools in their chest that have any evidence behind them. Life style changes have even better evidence but many doctors merely give lip service to those since they are hard to make and no one agrees on how to make them.

 

[braumeister]

Don't know if it's the same company. Did they get in trouble with Medicare? What was the nature of the fraud?

Apparently it was false claims.
More layoffs at HDL; settlement reached with Justice department

 

[Buckeye]

It is not like failure to take the statins is a huge deal even if all signs point to the need. The difference in outcomes is pretty slim so the presence of a serious side effect easily tips the balance away from using them, in my opinion. Many doctors would disagree with that sentiment but I suspect that is because statins are the only simple tools in their chest that have any evidence behind them. Life style changes have even better evidence but many doctors merely give lip service to those since they are hard to make and no one agrees on how to make them.

+1

 

[dallas27]

Before putting too much stock in lowering cholesterol, get to know this chart from the WHO. Eye-opening.

http://perfecthealthdiet.com/wp/wp-content/uploads/2011/06/O-Primitivo-Cholesterol.jpg

 

[Amethyst]

I have elevated total cholesteral and LDL but also very high HDL (84). My cholesterol was never terribly low, but it has only started going above "normal" the past few years (yay aging).

Maybe it's because I'm female, but my Dr. has never recommended further testing (let alone statins) even though there is considerable heart disease in my family. As you mentioned, she feels statins are a higher risk than leaving well enough alone (exercising, maintaining healthy weight) just now. Personally I think health decisions are just like promotion decisions. You can easily tell who's a disaster and who's a superstar. Everything else in the middle is guesswork and intuition.

Amethyst

It is not like failure to take the statins is a huge deal even if all signs point to the need. The difference in outcomes is pretty slim so the presence of a serious side effect easily tips the balance away from using them, in my opinion. Many doctors would disagree with that sentiment but I suspect that is because statins are the only simple tools in their chest that have any evidence behind them. Life style changes have even better evidence but many doctors merely give lip service to those since they are hard to make and no one agrees on how to make them.

 

[ERhoosier]

Before putting too much stock in lowering cholesterol, get to know this chart from the WHO. Eye-opening.

http://perfecthealthdiet.com/wp/wp-content/uploads/2011/06/O-Primitivo-Cholesterol.jpg

This historical chart has been around for many years (WHO All-Cause mortality data from 2002), and is now widely criticized. It includes much poorly-controlled and non-comparable data...and has been taken out of context by folks selling stuff like fad diets, supplements, and seminars. Low cholesterol is associated with poor nutrition and/or serious underlying disease in many parts of the world- even subpopulations within developed nations. IOW, a marker, not necessarily a cause. So looking at total cholesterol alone without considering other health issues can be misleading.
Anyway it is now known that cholesterol subtypes (like HDL) are more important than total cholesterol itself.
FWIW the graph's (supposed) publisher, British Heart Foundation (BHF), strongly supports cholesterol reduction efforts.
https://www.bhf.org.uk/heart-health/risk-factors/high-cholesterol

 

[braumeister]

looking at total cholesterol alone without considering other health issues can be misleading.

Utterly meaningless, IMHO.

 

[Buckeye]

Apparently it was false claims.
More layoffs at HDL; settlement reached with Justice department

Looks messy. Fee forgiveness? Cigna was not happy. Glad it was nothing about the quality of their work.

 

[Buckeye]

Utterly meaningless, IMHO.

I was actually pretty disappointed in how quickly the Internist defaulted to putting DH on statins for the rest of his life (which was never going to happen). I thought since he was the cholesterol expert, he would be less statin driven given that all of DH's other information and numbers looked good. DH had only one number that was an outlier (LDL) but that was enough for the Internist to head straight for the presciption pad.

I kind of knew how it was going to go when we mentioned that DH's mother had been prescribed a statin when she was 90 but had stopped taking it a year later because it was making her confused and forgetful. I had been trying to get her to stop during that year but she refused until she noticed the side effects. The Internist's response to my comment was that she was probably taking the wrong statin!

 

[haha]

I was actually pretty disappointed in how quickly the Internist defaulted to putting DH on statins for the rest of his life (which was never going to happen). I thought since he was the cholesterol expert, he would be less statin driven given that all of DH's other information and numbers looked good. DH had only one number that was an outlier (LDL) but that was enough for the Internist to head straight for the presciption pad.

To a man whose only tool is a hammer, everything is a nail.