Harvard Health: Cholesterol testing is seriously flawed

[oldtrig]

Thanks for posting this. I have PVCs, too, but my cardiologist never mentioned anything about serum ferritin. He did say to stay away from caffeine and other stimulants and to make sure I was getting enough magnesium in my diet, yet the PVCs have persisted for years now even after following this advice pretty diligently.

Definitely going to look into serum ferritin and donating blood.

I tried staying away from caffeine and didn't make a difference. Some days are worse than others.

Mine seems to happen at night because I stay moving all day.



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[googily]

Back to the coronary calcium score, I mentioned recently in the No Statins thread that I had one, at age 55. Having never been at normal BMI my entire life (and for probably 25 years I weighed 40-70 lbs more than I do now), and as an avowed hater of vegetables and fish and exercise and lover of junk food, my CAC score was a big fat zero. My cholesterol has always been borderline high.

I have eaten lowish carb for the past four years, but I'm not sure that four years of that could reverse years of damage if I had any (though it did drop my triglycerides nicely).

I also have an A1C of 5, and wearing a CGM for the past few weeks has shown that my glucose is extremely well controlled. Like, I basically never go above 140. Even after eating two pieces of birthday cake with serious frosting.

I'm sort of shocked, actually.

But I'm still downing a teaspoon a day of Carlson's fish oil just in case!

All this to say that if I were being treated just on Cholesterol results, I'd be on a statin, but the CAC score ended that discussion. It's an easy test, I paid $99 for it, and I think everyone should have one.

 

[Out of Steam]

DH has hemochromatosis (high ferratin) but it didn't present any heart stuff. Showed up in a couple of borderline blood tests which led to more tests and more tests before diagnosis. Left untreated it can cause serious organ issues.

For people of Irish descent, it's not uncommon. Leaned about it when a friend was diagnosed several years ago. Though, not me as I have some history of anemia.

https://www.irishcentral.com/roots/undiagnosed-celtic-blood-disease

 

[RAE]

Based on one anecdote from SGOTI? You guys crack me up.

anecdote? You really should do more reading on topics like this, so you are better informed. Here are a couple articles to start with:

https://irondisorders.org/iron-overload/

https://www.ncbi.nlm.nih.gov/books/NBK526131/

https://www.winchesterhospital.org/health-library/article?id=14116

 

[RAE]

DH has hemochromatosis (high ferratin) but it didn't present any heart stuff. Showed up in a couple of borderline blood tests which led to more tests and more tests before diagnosis. Left untreated it can cause serious organ issues.
But it's not terribly common. .

Actually, it's not that uncommon. An estimated 16 million Americans have some degree of iron overload. A lot of doctors don't test for it routinely, although they probably should, especially in males over 50 years old. The blood tests used to diagnose it (serum ferritin and transferrin saturation) are inexpensive, and usually covered by insurance. I'm certainly glad I finally got tested and discovered that I had way too much iron in my system.



https://www.ncbi.nlm.nih.gov/books/NBK526131/

 

[Sunset]

I developed a heart skip (technical name for mine was PVC........premature ventricular contraction) several years ago. Just annoying at first, but eventually it got to the point where I could not sleep at night, as the irregular/hard heartbeats were keeping me awake. I went to the doctor, and had all the heart tests, including an electrocardiogram - everything turned out fine (except the PVC was still there). Doctor had no answer as to why it was happening. So I did my own research, and found out one possible cause for this was too much iron in your system..........iron overload. Went back and had my iron tested (serum ferritin test........simple blood test, inexpensive, insurance covers it). Found out my serum ferritin was over 450, which is sky high! The best way to reduce iron is to donate blood, so I started doing that, and the problem gradually went away. Got my serum ferritin down to under 100 now, and the heart is fine, no more issues. I now donate blood 3X yearly to keep my ferritin where it should be. Some people have a tendency to accumulate too much iron over time, and I am apparently one of them. It's actually not all that uncommon.

Interesting.
Any chance you cook with cast iron fry pans ?

I should get my iron tested , I don't think it's ever been tested.

 

[RAE]

Interesting.
Any chance you cook with cast iron fry pans ?

I should get my iron tested , I don't think it's ever been tested.

Rarely. Cast iron cookware can be a source of iron in the diet, but usually not a major source. Foods fortified with iron (flour, grain-based cereals, etc) are typically a much bigger source. Check the labels on that stuff and you will see that there is a lot of iron added. Red meat is another major source of iron, and that can be a good thing, as the body does need some iron to function. Iron overload can happen, though (for people like me, and 16 million others in the U.S.) when too much iron accumulates over time, overwhelming the body's ability to deal with it. The reason it tends to accumulate is that the male body really has no efficient way of getting rid of excess iron. Women (at least through menopausal age) have a mechanism for reducing iron........men do not. The good news, though, is that regular blood donation is an effective way to keep your iron at the proper level. I now donate blood 3X yearly, which is what I found I have to do to keep my iron levels where they should be.

One more thing to be aware of: when you get your serum ferritin checked, there will be a reference range shown with it. The reference range when I got mine tested was 25 - 500 ng/mL. That is obviously a huge range. Mine turned out to be about 450 the first time I had it tested, and I was told that that was okay, not a problem. I later found out, however, that many European countries, and Japan, use 200 or 250 ng/mL as the upper limit. And through further reading, I found out that the optimum range for good health is more like 60-100 ng/mL. So, I now keep my ferritin within that range (through regular blood donation), and I feel fine.

I'm just relating my experience here, FWIW. I clearly had a problem with excessive iron, and it was causing some problems for me. Excessive iron in the body can damage almost all bodily organs, as is discussed in some of the articles I posted links for above. My feeling is that there is no harm in testing for it when you get your blood work done, as the serum ferritin test is inexpensive and might reveal some useful information.

 

[Sunset]

I did my DNA testing recently, and because of this thread, I looked carefully at the results again to see that I was in the clear, but I'm not.

Turns out I've got a lot of IRISH in me, and more importantly, I have the genetic variant associated with the excessive iron buildup (Hemochromatosis).

My esteemed doctor and all previous doctors I've had, all stop at the " I'm adopted" statement, and skip thinking of inherited diseases

I'll tell my doc to test for this.

 

[f35phixer]

my dr said he was going to do this test for size too. I do have high C, was on pravastatin and after a while, felt like i was getting STUPID, the big A and D run in the family. Did cognitive and Cat scans of brain all looked good. Dr took me off for 6 months and felt like I could function again. Then put me on Ezetimibe and all was fine ~ 2years, recently though i again am feeling like i'm getting stupid again;-( So he said was going to look at size of particles....

here's what came back on my sizes.
Cholesterol, Total 289 H 100-199
HDL Size 8.9 L >=9.2
LDL Size 20.8 >20.5
LDL Size 20.8 >=20.8
LDL-C (NIH Calc) 184 H 0-99
LDL-P 2330 H <1000
LP-IR Score 65 H <=45
Small LDL-P 1098 H <=527
Small LDL-P 1098 H <=527
Triglycerides 176 H 0-149
VLDL Size 53.3 H <=46.6

i'm going to go back to taking Ezetimibe 7 days a week.

i'll deal with the stupidness.

 

[audreyh1]

How about getting your triglycerides well below 100?

 

[wyecrabber1]

Just a caveat to the thought process of my coronary calcium score is zero, therefore I'm not at risk for a heart attack or cardiac death. Calcium gets deposited in lipid plaques and in the process makes these coronary burdens more stable. The lipid plaques with no calcium deposits are called soft or vulnerable plaques and are subject to rupturing or breaking apart more frequently. These soft plaques have 0 or a low score using a coronary calcium scan. Typically, it is the soft /vulnerable plaques that are responsible sudden death in asymptomatic individuals.

If you are concerned heart disease because of risk factors and/or family history -- find a respected cardiologist in the area -- discuss with him you concerns and manage this problem together.

 

[googily]

Just a caveat to the thought process of my coronary calcium score is zero, therefore I'm not a risk for a heart attack or cardiac death. Calcium gets deposited in lipid plaques and in the process makes these coronary burdens more stable. The lipid plaques with not calcium deposits called soft or vulnerable are subject to rupturing or breaking apart more frequently. These soft plaques have 0 or a low score using a coronary calcium scan. Typically, it is the soft /vulnerable plaques that are responsible sudden death in asymptomatic individuals.



If you are concerned heart disease because of risk factors and/or family history -- find a respected cardiologist in the area -- discuss with him you concerns and manage this problem together.

This is a pretty well known part of CAC scoring, and why CAC alone isn't the only story and why they aren't 100% predictive. Peter Attia discusses this on a couple of his podcasts. But it's a very good additional piece of information. You can be 35 with decent enough lipid numbers but have a high CAC score and that absolutely changes the dynamic of your care. You can also be 60 with a zero score and that shows that, alongside other markers, you would receive no benefit from a statin.

 

[Helen]

Regarding cholesterol and its relation to coronary artery disease and specifically atherosclerosis.

Why don’t we just cut to the chase and use CT and angiography from the start? This is the gold standard to assess arterial plaque, correct?

I've wondered this too. My PCPs have tried to get me to take a statin ever since they started testing my cholesterol. My LDL has always been high, but my ratios are great and my triglycerides are low and I have more of the larger LDL particle size than the small particle size.

I had an angiogram done prior to an endovascular coiling for a brain aneurysm and my neurosurgeon told me my arteries looked better than more than 95% of his patients.

Even after relaying that to my PCPs they still encouraged me to take a statin.

 

[chassis]

I've wondered this too. My PCPs have tried to get me to take a statin ever since they started testing my cholesterol. My LDL has always been high, but my ratios are great and my triglycerides are low and I have more of the larger LDL particle size than the small particle size.

I had an angiogram done prior to an endovascular coiling for a brain aneurysm and my neurosurgeon told me my arteries looked better than more than 95% of his patients.

Even after relaying that to my PCPs they still encouraged me to take a statin.

@Helen thanks for sharing your experience. The next time your PCP encourages you to take a statin, ask him/her if he/she receives a commission from the statin distributor or manufacturer.

 

[Sunset]

I did my DNA testing recently, and because of this thread, I looked carefully at the results again to see that I was in the clear, but I'm not.

Turns out I've got a lot of IRISH in me, and more importantly, I have the genetic variant associated with the excessive iron buildup (Hemochromatosis).

My esteemed doctor and all previous doctors I've had, all stop at the " I'm adopted" statement, and skip thinking of inherited diseases

I'll tell my doc to test for this.

I had the test, and I'm fine.... with quite a normal low number of 65.

Looking back, I slightly mis-read my genetic test, as I needed to have 2 variants to have more than normal risk, and I only have 1.
Oh well, at least now I know.

 

[daylatedollarshort]

I had heart palpitations at one time and had to wear a heart monitor for a few days. The cardiologist decided that it was within the realm of "normal" and no treatment needed. I read in a magazine that low magnesium could cause palpitations. That apparently was my issue. I changed my diet to include more magnesium rich foods and the palpitations stopped and never returned. Apparently many people in the U.S. are deficient in magnesium so perhaps that is the new normal.

 

[Dtail]

I had heart palpitations at one time and had to wear a heart monitor for a few days. The cardiologist decided that it was within the realm of "normal" and no treatment needed. I read in a magazine that low magnesium could cause palpitations. That apparently was my issue. I changed my diet to include more magnesium rich foods and the palpitations stopped and never returned. Apparently many people in the U.S. are deficient in magnesium so perhaps that is the new normal.

Same with me, but also taking magnesium helps with prevention of charley horse muscle pain after exercise.

 

[audreyh1]

Same with me, but also taking magnesium helps with prevention of charley horse muscle pain after exercise.

I take magnesium supplements every night before bed. Also helps sleep. Going low carb uncovered a magnesium deficiency as night foot/calf cramps became common. I’ve tried reducing the dose but after a few nights the cramps will return. So back to regular dose. And yes, extra physical activity = need more magnesium.

 

[daylatedollarshort]

We had our magnesium levels tested recently and we were both out of range on the high side. Just a little bit, but I have wondered if we are really that high compared to a healthier population like hunter gatherers, or just high because normal magnesium levels in the U.S. are just that low because of the Standard American Diet with processed foods and not so much produce.

 

[audreyh1]

My wild guess is you are being compared with the regular population ranges, and the US population is notoriously in poor health according to medical surveys. That's generally how "normal" blood ranges are determined.

I personally go by symptoms. I take enough magnesium to keep my night time foot/calf cramping at bay. Also it helps with sleep which is sometimes a challenge for me. It's not a particularly large dose according to my doctor. Magnesium provides a lot of benefits including cardiovascular.

 

[braumeister]

I take enough magnesium to keep my night time foot/calf cramping at bay.

Same here. A physician I greatly respect once said "If I were asked to recommend a supplement, magnesium is the first one I would choose."

 

[popntx]

In 2017 at age 63 I had a Heart Calcium Score test done and got a result of 328, which was very concerning. Shortly afterwards I retired, started exercising regularly (mostly fast walking), lost 25 pounds and kept it off, and have been watching my diet. I do take statins, and my blood tests have always been excellent.

I was feeling very good about myself, and at my cardiologist appointment earlier this year I suggested getting another Calcium Score test. The results of that test was 662, DOUBLE my prior test. Consequently, my cardiologist ordered a nuclear stress test, which I did well on.

When I ask my cardiologist what my next steps are, they say just keep doing what I'm doing, come in for regular check ups, and get another calcium test in 3 years. I said in 3 years, and the rate that I'm going, my score will be well over 1,000. What do I do then? Nothing, they said, as long as I'm not having any symptoms (chest pain, shortness of breath, etc.). They said my situation is most likely hereditary, which I have no control over.

I feel like I'm a walking time-bomb, and the doctor won't do anything unless I have a heart attack (or close to it)! I feel fine, continue to exercise, and I'm sure will continue to get good blood tests, but the mental stress of my situation will probably be what does me in!

Long story short, as the thread title says, cholesterol testing is seriously flawed, and has given me a false sense of security all this time. I'm considering getting a second opinion on where to go from here, but my research is telling me that generally speaking an angiogram is not indicated unless there are symptoms.

 

[razztazz]

I feel like I'm a walking time-bomb, and the doctor won't do anything unless I have a heart attack (or close to it)! I feel fine, continue to exercise, and I'm sure will continue to get good blood tests, but the mental stress of my situation will probably be what does me in! .

Best of luck to ya! I was a walking time bomb with every reason to think I was in the clear. Had a calcium score test some years back. LOW. Super low BP and heart rate. Hollywood thin body. In May 2020 had kidney stone surgery. One fear I had was that the seriousness and intensity of it could, maybe, ya know, possibly trigger a heart attack in a 62 year old man. Nope. Came through golden with gold to spare. Twelve days later: Whammo! Heart attack. And not a Dick Cheney special. Neighbor saw me lying in the driveway.

Here's the not-so-funny part: The actual heart attack was on the right (not as important) side of the heart, and not all that serious. But unbeknownst to me two arteries on the (more important) LEFT side of the heart were nearly totally blocked. You'd think I'd have had some warning signs for a year or 6 months previous. Shortness of breath, angina, something! Nope.

The left side of my heart actually has more damage to it than the right side experienced from the heart attack, from being slowly strangulated over a long period of time. Now, I have 50% left side output and combination pacemaker/defibrillator in case I go into ventricular fibrillation which is part and parcel of low ventricular ejection rate.

More true adventures: Almost exactly 8 months prior to the HA I'm at my PCP for annual blood tests. I mention my super low BP and pulse (which I've had since at least the late 1970's). He says: Without other symptoms it means your system is in good shape has no problems moving blood around. I was thinking of getting a treadmill test done just for grins. Just to keep in touch with things, since I was 62. He listens to me and says: "Nice strong heart beat. No problems in there." So, I nixed the treadmill till age 65. Wrong move. I could have headed off a heart attack. Gotten three stents without any heart damage or much less. Now I am all damaged, on drugs, and plugged into a cardio-bug-zapper just in case.

More WTF: They cannot give me all the drugs they really would like, to take the strain off my heart, because of this fantastic, wonderful low BP, because all those drugs have the side effect of lowering BP.

 

[audreyh1]

In 2017 at age 63 I had a Heart Calcium Score test done and got a result of 328, which was very concerning. Shortly afterwards I retired, started exercising regularly (mostly fast walking), lost 25 pounds and kept it off, and have been watching my diet. I do take statins, and my blood tests have always been excellent.

I was feeling very good about myself, and at my cardiologist appointment earlier this year I suggested getting another Calcium Score test. The results of that test was 662, DOUBLE my prior test. Consequently, my cardiologist ordered a nuclear stress test, which I did well on.

When I ask my cardiologist what my next steps are, they say just keep doing what I'm doing, come in for regular check ups, and get another calcium test in 3 years. I said in 3 years, and the rate that I'm going, my score will be well over 1,000. What do I do then? Nothing, they said, as long as I'm not having any symptoms (chest pain, shortness of breath, etc.). They said my situation is most likely hereditary, which I have no control over.

I feel like I'm a walking time-bomb, and the doctor won't do anything unless I have a heart attack (or close to it)! I feel fine, continue to exercise, and I'm sure will continue to get good blood tests, but the mental stress of my situation will probably be what does me in!

Long story short, as the thread title says, cholesterol testing is seriously flawed, and has given me a false sense of security all this time. I'm considering getting a second opinion on where to go from here, but my research is telling me that generally speaking an angiogram is not indicated unless there are symptoms.

My understanding is that taking statins will increase your CAC score*. I’m not sure there is a point in getting another unless you had a zero or very low score, and have not been on statin therapy.

*https://www.verywellhealth.com/statins-and-your-calcium-scores-1746355
You can find plenty of references on the topic.