Diabetes and Lipid Clinic of Alaska

 

 


What do your cholesterol numbers tell you?

For the past fifty years, medical science has learned a lot about the causes of heart disease.  At first, doctors looked at total cholesterol numbers but then discovered that not all cholesterol was dangerous.

That's when doctors discovered the importance of identifying the different types of cholesterol - LDL (the "bad" cholesterol) and HDL (the "good" cholesterol).  Generally speaking, the lower the LDL numbers and the higher the HDL numbers, the better.

While measuring cholesterol is helpful, knowing these numbers wasn't enough for all patients.  Doctors are beginning to realize that determining your risk of a heart attack is not as simple as just measuring your cholesterol.  A staggering fact shows this:

Doctors now know that approximately 50% of people
who have had heart attacks have had
"normal" cholesterol numbers!

This has caused many doctors to look for answers beyond cholesterol.

What is The Particle Test?

The NMR LipoProfile test—The Particle Test—is more than a cholesterol test. It measures the number of LDL particles (LDL-P) in your blood. Having a high number of LDL particles is bad because they carry and deposit cholesterol into the wall of your arteries to form plaque or ‘atherosclerosis’.

What are LDL particles?

Lipoprotein particles are the principal way lipids like cholesterol are transported in the blood.  These are the particles that can build up in a person's arteries and cause heart attacks.

There are three major types of lipoprotein particles:

  • Low Density Lipoproteins (LDL)
  • High Density Lipoproteins (HDL)
  • Very Low Density Lipoproteins (VLDL)

Today, scientists have realized that determining your risk for heart disease is not as simple as just measuring your cholesterol.  No matter how much cholesterol is being carried by these lipoprotein particles, it is the number of various lipoprotein particles present that contribute to heart disease. 

What Can You Do to Lower Your Particle Number?

For some patients diet and exercise may be very effective at lowering your LDL particle number (LDL-P). Talk to your doctor about lifestyle changes that can keep you heart healthy.

There are many treatment options to lower your LDL particle number. Some patients may need to take prescription medicine such as statins to help lower their LDL-P. Work with your doctor to find out what treatment plan is best for you. Follow-up particle tests will  validate your progress.

Why do LDL Particles Cause Plaque?

Cholesterol and triglyceride cannot move through the artery wall unless it is carried inside a lipoprotein particle.  Lipoprotein particles serve as the vehicles that transport cholesterol in the blood. 

LDL particles are the containers that transport cholesterol through your blood stream. They carry and deposit cholesterol into your arteries that become plaque — ‘atherosclerosis’ or ‘hardening of the arteries’. Without the ‘particles’ — the containers that carry cholesterol—there would be no way for the cholesterol to enter the artery wall and cause plaque build-up.

The higher the number of LDL particles, the greater the likelihood for them to enter the arterial wall and deposit their contents forming atherosclerotic plaque. Measurement of LDL-C on traditional lipid panels does not reflect LDL particle number.

If you have a high LDL particle number (LDL-P), your doctor may recommend changes to your diet, exercise and LDL particle-lowering medications. Knowing your LDL particle number (LDL-P) along with your other cholesterol numbers gives you and your doctor the information that you need to manage and maintain your heart health.

Video link http://www.liposcience.com/cardiovasculardisease/patients/

As lipoprotein particles move through the blood, they can enter the wall of an artery.  As the number of lipoprotein particles increases in the blood, more particles move into the walls of arteries.  Once inside the artery wall, lipoprotein particles undergo changes that lead to the formation of blockages inside the artery wall.  These blockages grow over time leading to increased risk of heart attack.

The NMR LipoProfile test is especially important for people with certain risk factors, even if they have normal cholesterol numbers. 

The NMR LipoProfile test is most important for people who:

  • Have heart disease now
  • Have diabetes
  • Have metabolic syndrome

Others at risk may include people who:

  • Have several risk factors (smoking, high blood pressure, family history)
  • Have a family history of heart disease
  • Have high cholesterol
  • Are on cholesterol-lowering medications

Your LDL Particle Numbers

The LDL Particle Numbers are the most important information and is the main part of the report.  This is located in the middle of page one.

Your LDL-P number is the most important value of the NMR LipoProfile report. 

The lower this number is, the less risk you face.  In the example shown above, the relative risk of the LDL-P score is indicated by the highlighted box.  The higher your LDL-P number is, the boxes further to the right will be highlighted.  As risk goes down, the highlighted box will shift to the left.  Your LDL-P number can range from less than 1000 to more than 2000.  Based on this number, your doctor can advise you on a treatment plan designed to lower your score to a low-risk level.  Your LDL-P goal will depend on your medical history.

Your small LDL-P number is a measure of the number of small LDL particles in your blood.  These particles are associated with an increased risk of heart disease; more of these small particles lead to greater risk. If your total particle is less than 1000, the significance of the size is less important. 

Your small LDL-P score can vary widely, with a lower score being much better.  Patients are generally at lower risk for heart disease if their small LDL-P is less than 850.  Patients are at the lowest when both their LDL-P and small LDL-P number are low.  Your doctor will look at both of these numbers to determine your heart disease risk and to develop a treatment plan for you.  

Your lipid panel is a regular cholesterol test.  It is made up of four values:  LDL-C ("bad" cholesterol), HDL-C ("good" cholesterol), triglycerides and total cholesterol.


Your Metabolic Syndrome Markers

After you and your physician have reduced your LDL particle number, you may need to focus on increasing your HDL.  The treatment plan you develop with your physician should include a goal of increasing your HDL-C and HDL-P.

Finally, the Metabolic Syndrome Markers section shows the number of large VLDL (triglyceride) particles.  Unlike the LDL and HDL particles where small particles mean increased risk, large VLDL particles have a higher association with heart disease. 

The more checks you have, the higher your risk for heart disease.  You receive a check in the "Lipoprotein Traits of the Metabolic Syndrome" boxes when you have the traits listed above.  These include small LDL size, low levels of large HDL, or high levels of large VLDL.  Metabolic Syndrome is considered by many healthcare professionals to be and indication that you could develop Type 2 Diabetes, and places you at increased risk for heart disease. 

Your Lipoprotein Subclass Analysis

The Lipoprotein Subclass Analysis shows the distribution of large, medium and small subclasses of VLDL, LDL and HDL particles.  This is located at the top of page two of the report.

The NMR LipoProfile test shows lipoprotein particles broken up into groups based on their size, or subclasses.  The absolute number of particles in each subclass is shown above each bar in nanomoles per liter.  The left section in blue shows how your VLDL (triglyceride) particles are broken down across the different sizes of VLDL. 

The middle section in red shows subclass information for LDL particles.  The absolute number of small LDL particles is shown above the red bar to the right (small LDL) and a bar showing treatment goal is also shown. Remember that a high number of small particles means you are at increased risk for heart disease. Reducing the number of small LDL particles to below the 50% goal shown is a secondary goal of therapy.

The right section in green shows how your HDL particles are broken down across the different sizes of HDL.  Unlike LDL particles, you want a high number of HDL particles, especially the large HDL particles since they take cholesterol out of your artery walls.

Consumer and Patient FAQs

What is the NMR LipoProfile® Test?

The NMR LipoProfile® test is an unique blood test your doctor can perform to determine your risk of developing heart disease.  This breakthrough test will tell you and your doctor detailed information about your heart risk – information that no other test can give you.

What does the NMR LipoProfile test tell your doctor?

The NMR LipoProfile gives your doctor in-depth information about your heart health.  The test report shows your doctor how many of certain particles (called lipoproteins) are in your blood.  Some of these particles are harmful, while others are not.  These various particles are described in detail in the NMR LipoProfile report. 

The NMR LipoProfile test report gives your doctor a clear picture of your risk for developing heart disease in the future.  With the information in this report, your doctor can make better treatment decisions about your heart health.

What is most important on the NMR LipoProfile report?

Scientists have discovered that certain kinds of lipoprotein particles, LDL particles, are the most important particles to measure.  Patients who have a high number of LDL particles have a higher risk of developing heart disease than patients with a smaller number of LDL particles.  Your doctor will look at your LDL particle number first to measure your heart risk.  
  

Who should get the NMR LipoProfile?

While anyone can benefit from the NMR LipoProfile test, some patients are at higher risk for developing heart disease or having a heart attack.  The NMR LipoProfile can benefit those patients the most.  These patients include:

  • Patients with Diabetes or Metabolic Syndrome
  • Patients with existing heart disease
  • Patients with a family history of heart disease
  • Patients with several risk factors such as smoking, high blood pressure, a family history of heart disease, to name a few

These patients may be at higher risk for heart disease than they think! 

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