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patient handout (Diagnoses)
cholesterol and lipoproteins
diagnoses

definition

CHOLESTEROL AND LIPOPROTEINS

In patients with premature coronary artery disease, serum levels of low-density lipoprotein cholesterol (LDL) are generally higher than normal, whereas serum levels of high-density lipoprotein cholesterol (HDL) are generally lower than normal. LDL is considered to be atherogenic (causing fatty plaques to develop inside arteries), by carrying cholesterol from the liver out into the walls of your arteries. HDL cholesterol is thought to protect against atherosclerosis by removing cholesterol from the artery walls and transporting this cholesterol to the liver to be removed from the body.

Epidemiologic data shows that there is a strong relationship between lower levels of HDL cholesterol and an increased risk of heart disease. Data has also shown that higher levels of HDL cholesterol have been found to be protective against atherosclerosis and have been strongly associated with longevity.

INTERPRETATION OF HDL RESULTS

Serum HDL cholesterol Risk of Coronary Heart Disease

25 OR less mg/dl Risk at dangerous level;
needs prompt attention with diet, supplements and exercise

26-35 mg/dl High risk;
diet and appropriate supplements and exercise needed

36-44 mg/dl Moderate risk;
diet intervention and moderate supplementation

45-59 mg/dl Average risk (in the U.S. this is not a good risk);
diet changes and moderate exercise indicated.

60-74 mg/dl Below average risk;
mild dietary changes along with mild exercise indicated
depending upon family history.

Above 75 mg/dl Protection probable;
associated with longevity.

NOTE - Ideally on your blood chemistry you should have a ratio of cholesterol to HDL of 3 to 1 or lower. This means, for example, that if your cholesterol is 180, your HDL should be 60 or higher.

Cardiovascular Disease Risk factors and what you can do about them.

If you have a history of heart disease, stroke, diabetes, or other cardiovascular disease related condition in your family you may want to consider a more thorough and complete evaluation by your health care provider. Below is a guideline to the diagnostic evaluation of your cardiovascular system. Your family history of cardiovascular disease, your age, your diet and level of exercise will determine how extensive your testing should be.

Evaluating your cardiovascular risk factors; How to thoroughly assess your risks:

— If you have had one or more relatives (sister, brother, parent, grandparent, uncle, aunt or other blood relative) that died of a heart attack, had a heart attack, had coronary bypass surgery or was diagnosed with diabetes before the age of 70 you should be aware of the following tests to evaluate your condition more thoroughly:
1) Basic blood chemistry including cholesterol, HDL, LDL, TG’s, ferritin and fasting glucose. If fasting blood glucose on 2 or more occasions is above 100 mg/dl then a glucose insulin tolerance test is strongly advised especially if there is any history of diabetes in family.

— If you have 2 or more relatives (sister, brother, parent, grandparent, uncle or other blood relative) that died of a heart attack, had a heart attack, had coronary bypass surgery or was diagnosed with diabetes before the age of 70 you should have:
2) Apolipoproteins A and B along with Lipoprotein A added to #1.

— If one family member (sister, brother, parent, grandparent, uncle, aunt or other blood relative) died of a heart attack, had a heart attack or had coronary bypass surgery before the age of 60 you should consider the following tests to evaluate this condition more thoroughly:
3) Apolipoproteins A and B and Homocysteine added to #1
When premature coronary heart disease is found in a family there is a good chance that they have elevated levels of homocysteine in the blood. This is a simple test that if abnormal can easily be corrected through nutrition and vitamin intervention.
Also have a stress EKG done.

— If two or more family members (sister, brother, parent, grandparent, uncle, aunt or other blood relative) died of a heart attack, had coronary bypass surgery or was diagnosed with diabetes before the age of 60 you should consider the following tests to evaluate your condition more thoroughly:
4) Apolipoproteins A and B, lipoprotein A and Homocysteine added to #1. Also have a stress EKG done.

— If one family member (sister, brother, parent, grandparent, uncle, aunt or other blood relative) died of a heart attack, had a heart attack, had coronary bypass surgery or was diagnosed with diabetes before the age of 50 your should consider the following tests to evaluate your condition more thoroughly:
5) Apolipoproteins A and B and Homocysteine and Ionic magnesium levels added to #1. Also have a stress EKG done.
Most people who have early age angina or heart attacks have low tissue levels of magnesium.

— If two or more family members (sister, brother, parent, grandparent, uncle or other blood relative) died of a heart attack, had a heart attack, had coronary bypass surgery or was diagnosed with diabetes before the age of 50 you should consider the following tests to evaluate your condition more thoroughly:
6) Apolipoproteins A and B, Homocysteine and Ionic magnesium levels added to #1. Also have a stress EKG done.

— If one or more family members (sister, brother, parent, grandparent, uncle, aunt or other blood relative) died of a heart attack, had a heart attack, had coronary bypass surgery or was diagnosed with diabetes before the age of 40 you should consider the following tests to evaluate your condition most thoroughly:
7) Apolipoproteins A and B, Homocysteine and Ionic magnesium levels added to #1 along with a hair analysis for heavy metals especially cadmium and lead which could damage blood vessels. In addition platelet aggregation tests could also be done. Also have a stress EKG done.

Apoliprotein A is the more valuable component of HDL so it is possible to have a good level of HDL cholesterol and the apolipoprotein A is low showing a high risk of coronary heart disease. The same is true with apolipoprotein B and LDL cholesterol. You could have a lower level of LDL, but if the apolipoprotein B level is high then this could be an ominous sign.

 

footnotes

Marz, Russell. Medical Nutrition From Marz. Second Edition. Omni Press: Portland, OR, 1997; p. 288-289.