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“Advanced” cholesterol testing: Is it for you?

A discussion with your doctor can help to determine whether an advanced cholesterol test will be beneficial for you.

For most people, there is no advantage to tests that measure cholesterol and triglyceride particle size.

The familiar serum lipid profile (cholesterol test), which measures blood levels of total cholesterol, HDL (good) cholesterol, LDL (bad) cholesterol, and triglycerides, has been getting some bad press lately. Advertising and media reports on “advanced lipoprotein testing” say the current test—a mainstay of cardiovascular screening for decades—falls short in identifying everyone at risk for heart disease. Manufacturers claim that newer tests, which give more detailed information about the size and quantity of subtypes of cholesterol and triglyceride particles, flag risks that the older tests don’t measure.

Despite such claims for advanced testing, the American Heart Association and the American College of Cardiology still back the standard cholesterol test. Dr. Jorge Plutzky, director of the vascular disease prevention program at Harvard-affiliated Brigham and Women’s Hospital, agrees. “The advanced lipoprotein profile is something that the majority of people really don’t need,” he says. The reason: there aren’t any therapies based on the information the new tests deliver.

When the tests may be helpful

There are some circumstances where advanced testing can be useful, Dr. Plutzky says. He explains that they may help to identify the source of the problem in people with cardiovascular disease who have no known risk factors and in those who aren’t responding to treatment. For example, an advanced test may reveal that a person with a seemingly normal LDL level has a large amount of small, dense LDL particles, which increase risk. In that case, a doctor might prescribe a statin drug like atorvastatin (Lipitor) or pravastatin (Pravachol), or increase the dose of a statin, to reduce all forms of LDL.

You are more likely to benefit from an advanced test if you have the following:

  • a sibling or parent with cardiovascular disease

  • cardiovascular disease but no apparent risk factors

  • cardiovascular disease that continues to progress despite aggressive treatment.

What else you can do

Dr. Plutzky says it’s possible to get a better idea of your risk simply by subtracting your HDL from your total cholesterol to get your non-HDL cholesterol. (As a rule, your non-HDL cholesterol level should be no more than 30 mg/dL higher than your target LDL level—around 100 mg/dL for most people.)

Because there aren’t any therapies specifically aimed at changing cholesterol subtypes or particle sizes, the time-honored advice is still the best way to prevent heart disease: keep your weight at normal levels, exercise regularly, follow the Mediterranean diet, sleep well, minimize stress, stay connected to your family and friends, and participate in your community.

How lipoproteins influence your heart disease risk

There are two types of lipid in your bloodstream—cholesterol, which is used to make hormones and cell membranes, and triglyceride, which supplies energy. Both are attached to proteins that enable them to travel through the blood. The resulting compounds are called lipoproteins. Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) carry cholesterol. Another lipoprotein, called very-low-density lipoprotein (VLDL), transports triglyceride as well as cholesterol.

LDL has a relatively small amount of protein and a large amount of cholesterol, some of which it deposits on the walls of the arteries. (That’s why it’s called the “bad” cholesterol.) A large amount of one form of LDL, called lipoprotein (a) or Lp(a), signals an independent, genetic risk for heart disease. Small, dense particles of LDL and VLDL are also associated with a greater risk than larger particles. Advanced tests often include measures of all of these particles.

HDL has a lot of protein and a smaller amount of cholesterol. As it circulates, it picks up cholesterol from the walls of the arteries and carries it to the liver. (That’s why it’s called the “good” cholesterol.) Research has shown that HDL2—a larger particle—may be better than smaller, denser HDL3 at getting cholesterol out of the arteries. Advanced tests may include measures of HDL2 and HDL3.

Posted by: Dr.Health

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