Controversies in Cardiovascular Medicine is the intriguing title of a 2009 article in the American Heart Association’s Circulation publication.
Stop laughing – cholesterol research can be intriguing! I’d label the situation frustrating more than intriguing, but here’s what is going on.
The controversy is essentially that advanced lipid testing (explained in Cholesterol Tests Your Doctor Hasn’t Told You About) has been around for 50 years and is a better predictor of cardiovascular disease risk than standard cholesterol blood tests, and yet these ‘advanced’ tests are still not widely prescribed.
In fact, the ‘standard’ cholesterol blood panels (total cholesterol,
In Cholesterol Tests Your Doctor Hasn’t Told You About, I briefly describe a cholesterol blood test for Apolipoprotein B (ApoB). This simple blood test measures the number and size of LDL (bad) cholesterol: it’s an important test if you have high LDL (bad) cholesterol or are at ‘high risk’ of cardiac disease, as it provides a more finely tuned assessment of cardiovascular risk.
In fact, it might be a critical test for those with low LDL (bad) cholesterol – because it can reveal hidden cardiac risk.
While studies show ApoB is a better predictor of cardiac risk,
The cholesterol-watching world is filled to the brim with acronyms and easily confused verbiage. Who can remember what LDL and HDL stand for – much less which is the good and which is the bad cholesterol? And then there’s Apo-B and LDL particle size to boot. But today I learned one that was total news to me: FH.
Turns out, FH stands for Familial Hypercholesterolemia which, in a nutshell, is very high LDL (bad) cholesterol that is caused by genetics. A more complete definition is given on The FH Foundation website:
If non-HDL cholesterol was viewed as a key predictor of cardiac disease risk (on par with apoB or LDL particle testing), why was it abandoned in the new November 2013 cholesterol guidelines?
This is something I’ve been thinking about for a while. Because for those with diabetes or high triglycerides, it was considered vital to know non-HDL cholesterol. (Do You Know Your Non-HDL Cholesterol? explains why, and how easy it is to calculate from just a standard cholesterol lipid blood test.)
Let me start with a brief, very non-technical definition (for more technical info click blog post link above).
The American Heart Association and the America College of Cardiology released completely new, totally different guidelines for the treatment of high blood cholesterol back in November 2013.
As explained in my post, The NEW Guidelines For Cholesterol-Lowering Statin Meds, in broad strokes the new guidelines state that if you are in one of the following four groups you have elevated heart disease risk and should take statins:
those who already have cardiovascular disease
anyone with LDL (bad) cholesterol of 190 mg/dL or higher
anyone between 40 and 75 years of age who has Type 2 diabetes
people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher.