High Cholesterol, Will It Kill Me Doc? Could I Have a Heart Attack?

Welcome back to my NETrageouz! Medical Hub...

I promise to entertain while I try to enlighten you on a confusing medical problem that I face with my patients on a daily basis.

A little disclaimer here, please understand that by offering the following information I am in NO WAY establishing a patient-physician relationship, I'm not making a diagnosis for YOU, and I'm not suggesting that you quit taking your meds just ‘cause I SAID SO online. Okey dokey?

Boy, if I had a nickel for every time I hear someone say, "Doc, what's my cholesterol level? ...Oh, just 231 that's great! That's not so high, right?"

POOP...There's a loaded bunch of questions!

For one thing, you may not realize that it's never your total cholesterol levels that will seal your fate. The sum is not the issue. Rather the devil's in the details here, so the parts are far more important that the sum of those parts.

Let me explain...

You see, this total cholesterol number your doctor reads off consists of the sum of many different particles of cholesterol. And it's not just the particle itself but rather the size of those particles that is so import. So imagine how confusing it is. Or is it? Let's explore that.

By now, unless you've been hibernating and avoiding all news channels, you know that high cholesterol is well established as a major risk factor for heart disease and strokes. Well, that sure doesn't tell the whole story because focusing on just that ignores the 50-80% of people that will end up getting heart disease. The full story involves other abnormalities in the blood lipids (the parts making up the whole) that are far more common and way more dangerous than simply high cholesterol.

Since most people are on the usual cocktails for cholesterol (you know the ones- Lipitor, Zocor, Pravachol, anything-chol...) it's not at all comforting to know that those dangerous little fragments of lipids are not corrected by the more common and wildly popular of these cholesterol lowering meds. Not so comforting.

Now what?

The solution lies in choosing the proper tests that measures all of your lipid components, especially if you come from a family of people that have had heart disease, strokes or other diseases due to clogged arteries (atherosclerosis).

The most commonly inherited problem is the elevation of the LDL particle (the bad stuff... I tell my patients "L" for LOWSY)which comes from inheriting a collection of metabolic disorders that increase your risk of heart disease. This problem is present in 45-50% of men with heart disease.

The worse of these combinations involves having lots of LDL particles of the small and dense type. So it's not just the LDL but also the SIZE of that LDL that's gonna be getting you in trouble! These small LDL particles are known as LDL pattern- B ("B" for BAD).

Yeah, that's how I got through med school & exams... hooked on mnemonics and phonics, bear with me a bit more...

To get the picture on just how important this is, imagine that 80% of the people that end up having heart attacks have the IDENTICAL blood cholesterol levels as those that don't. Are you confused yet?

It's true!

The very reliable and often quoted Framingham Study revealed that while high cholesterol reflects high risk of heart disease, low cholesterol did NOT reflect low risk at all. In fact lots of heart attacks occur in patients with low or even normal cholesterol levels.

"Doc, now I'm really confused! What's my cholesterol level again? Say, why even bother with my cholesterol? Even if it's normal you're telling me I could kick the bucket any old time! I give up... I'm going to Mc Donald's, see ya!"

Okay Alice, let's just explore a little deeper down that rabbit hole before you go doing that to your body, shall we?

The truth is never hidden. But the problem is complex. It starts in how much money your insurance company is willing to spend to discover the truth for ya' and in how deep your doc will dig for the answers. You see, most traditional blood labs detect the "classic or textbook" blood lipid abnormalities, which are present in less than 20% of heart disease patients. These include people with:

1. High total cholesterol or heterozygous familial hypercholesterolemia (...say it 5 times fast...I double dare ya')

2. Very low HDL or hypoalphalipoproteinemia ("H" for Healthy... there's those phonic mnemonics again) &

3. Familial combined hyperlipidemia, which combines the combo of family history, high cholesterol & high triglycerides.

But lurking in murky waters are the other metabolic abnormalities linked to heart disease that are not detectable by routine lipid panels. So what can I do, you ask!?

There's hope, you'll see...

You need a lab that can scoop out these tiny but deadly piranhas. These bad guys are the apolipoprotein E abnormalities, homocysteinemia, lipoprotein-A disorders, HDL abnormalities & a full party of clogging lipoproteins (the atherogenic lipoproteins).

Did I say I was going to make this easy and painless?

These are the hidden cholesterol or lipid disorders that explain why so many people with heart disease have either normal or slightly elevated lipid levels yet still end up with heart attacks and strokes! And despite lowering your cholesterol, if you have one of these piranhas in your pool you could still end up with a heart attack or stroke. So these metabolic abnormalities cannot be ignored.

Heart disease is now considered to be very genetically influenced. In fact, one or more familial traits can be found in about 80% of heart disease patients. And these traits are the result of multiple genes (not just one defect) combined with environmental effects plus the effects of a poor diet and a lack of exercise.

"Oh no! The doctor just said those ugly ‘D and E' words to me!"

There is a test known as the Berkeley Test and another known as the VAP test that can directly measure the components of your lipid particles, measuring out the actual particle size (remember the LDL pattern-B for "bad") and a host of intermediate particles that determine the true nature of your cholesterol risk factors.

In fact, if you have the LDL pattern-B, you may be at three times greater risk for heart disease than if you had LDL pattern-A, which is the larger size particle that is unable to penetrate into the arterial wall as easily as the smaller B-type that deposits plaque build up.

In case you are one of those that just LOVE THE DETAILS the story goes like this...

The lipoproteins originate in your liver as large particles called VLDL (very low density lipoproteins). The VLDL is rich in triglycerides and poor in cholesterol. This VLDL delivers triglycerides (TG, for short) to places like muscle and brain. Some VLDL gets changed by enzymes into IDL (intermediate density lipoproteins) and then into LDL (low density lipoproteins). The LDL is richer in cholesterol but poorer in TG so it serves to deliver cholesterol to the tissues. The less TG contained in the LDL particle, the smaller the LDL particle becomes (LDL pattern-B) which causes a rebound overproduction of VLDL by the liver and the elevating levels of TG in the blood. So in patients with the bad LDL pattern-B there is almost always high triglyceride levels, and these we can measure with our traditional blood labs for lipid levels.

This is important for you because if your doctor tells you that you have hightriglycerides, you should be asking him/her for a Berkeley or VAP test to confirm the LDL particle size.. VERY IMPORTANT!!

Remember I had mentioned the HDL (high density lipoprotein) cholesterols? They're the heroes in this plot and are made in the liver with the rest of the lipoproteins. The HDL are the smallest, densest lipoproteins whose job it is to carry all that extra cholesterol laying around back to the liver for either recycling (into VLDL) or elimination.

There are two types of HDL that can be measured by the more costly tests mentioned above, the HDL2 and the HDL3. The HDL3 Is cholesterol poor (less mature), and the HDL2 is hauling a full load back to the liver (that's the one you want!).

Now step back a moment, take a deep breath and let's just see what the big deal is with all of this stuff anyways...

In essence, the Framingham study using the Berkeley Laboratories revealed that people that got heart disease and clogged arteries had way higher levels of LDL (pattern-B), IDL and triglyceride rich particles. Another study after that confirmed that elevation in lipoprotein classes (aside from the LDL measured in standard labs) combined with high TG and low HDL contributed significantly to heart disease.

So when we dig up this rabbit hole we get the bigger picture. If we look closer we will find the little buggers. They are the high levels of the clot forming (atherogenic) lipoproteins include the small dense LDL (pattern-B), an abundance of IDL, a reduced HDL2, and a host of other factors. Factors including, elevated levels of blood lipid levels for 8 hours after a meal, lipoproteins that are more susceptible to oxidation due to low antioxidant vitamin levels, high lipoprotein uptake into the walls of the arteries, and high blood insulin levels. .

Now there's one more reason why it's so very important to get the right multivitamins packed with highly absorbable concentrations of antioxidants. Send me an email and I will send you the same information I give my patients on the best compounding labs for nutriceuticals.

Further research revealed that it's the small, dense LDL that exerts the most powerful influence on the progression to coronary artery disease and heart attacks in middle-aged men with high cholesterol levels. And that despite identical reduction of LDL levels in patients with either LDL-A or LDL-B types, it was the patients with the LDL-B types that showed a significant reduction in the rate at which their coronary artery disease progressed compared to the control groups. It was later known that by changing the LDL-B pattern to the more favorable LDL-A pattern, this group would be the most significantly affected as seen by a slowing of their progression to heart disease.

This little piece of the puzzle answers why some people can receive the same treatment but have very different blood lipid or heart disease progression responses. For example, low fat diets lowers LDL cholesterols much more in LDL-B than in LDL-A patients.

So what medicine is right for me if I have LDL pattern-B, doc?

In terms of medication choices there is a huge difference in the response rates of these LDL subtypes. For instance, Lopid (gemfibrozil) used to treat patients with high TG and low HDL works best on patients with LDL pattern-B and has very little effect on patients with LDL pattern-A. What's curious is that the LDL does not appear to lower at all when measured through conventional lab testing. More dramatic is what is happening that we can't measure (unless we are following the VAP or Berkeley Labs) which is a shift from the LDL-B pattern to the LDL-A pattern. This is what is significantly slowing the progression to heart disease in these patients. This response is almost identical to the response seen with Niacin treatment (a B vitamin).

One argument would be that the more sophisticated tests increase the cost of delivering healthcare. But these tests are the exceptions because accurate diagnosis would allow for better treatment choices as you can correct the underlying disorder and because properly correcting the most atherogenic lipoproteins (LDL pattern-B) involves diet, exercise, weight loss, niacin and gemfibrozil which are all relatively inexpensive as compared to the other meds.

Using VAP or Berkeley tests could save the US healthcare industry $2 to $10 billion dollars per year by the reduced cost of the less expensive meds, reduced blood testing for liver toxicity from the statin drugs, and reduced need of angioplasty (stents) and bypass surgery in the long run. Limited health care dollars can then be spent on other matters.

So the next time you are at your doc's office, don't just ask, "Hey Doc, what's my cholesterol levels?" Print out this report and ask your doc to run the more sophisticated exams on you. Labs like your homocysteine levels, highly sensitive CRP (marker of inflammation), your lipoprotein-A levels, and a Berkeley or VAP test. And listen up;

"It's worth every cent you pay EVEN if your stingy HMO insurance won't cover it, ok?"

while you're at it, have your whole family screened as this is highly inherited. Your family can start early preventive steps to delay or prevent heart disease with this valuable information.

Well, if you're still with me I congratulate you on your endurance. Now you see what I'm up against when I deal with this patient day in and day out. And after all, this could be you I'm talking about! So listen up and get your physician batting for you right now!

I hope you have enjoyed this report and that you benefit with years of good health by knowing this information. Please sign up to my feed and be the first to receive any updates. Also, feel free to join my fan club and to post me a message.

Remember, this is for informational purposes only, so please do not ask for personal medical advise as I respect strict licensing restrictions and cannot practice medicine over the internet. It is both illegal and unethical. I will entertain generic questions and answer as many of them as I can.

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About the Author: Dr. Ana Hernandez is the editor/publisher of NETfabuous! Marketing Course Online. Her Website at http://www.netrageouz.net offers the portal to her delicious recipes for creating the perfect marketing success campaign on a fixed budget. If you’ve been researching ways to make your first dollar online, then you’ll definitely want to sign up for her training course. Ana’s easy reading style and FREE E-course NETfabuous! Marketing Course Online is jam packed with tips and techniques for any level marketing enthusiast. Subscribe for FREE by visiting www.netrageouz.net and signing up to her feed.

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