Those of you with Lipid Disorder or family with the condition Read This ->

[MrLabGuy]

Just an FYI the cholesterol test found in a basic Lipid profile really tells you nothing. There are some new and some existing tests on the market which give you and your doctor a much better picture as to what is really going on.

There is also something called "Metabolic Syndrome" which sometimes makes it look like primary lipid disease. There are some popular chemistry tests which can rule out the Metabolic origin.

Lp-PLA2

The PLAC Test uncovers the hidden cardiovascular risk for heart attack and stroke. The PLAC test measures Lp-PLA2 (lipoprotein-associated phospholipase a2), a vascular-specific enzyme involved in the formation of rupture-prone plaque. A "High Risk" result is a warning that the inflammatory phase of atherosclerosis is active.

hs-CRP

A measure of acute inflammation (an acute phase reactant). Elevated levels are associated with increased risk of cardiovascular disease.

Homocysteine

High levels are associated with significant risk of heart disease and stroke. Elevations may be genetic, or a result of folic acid, vitamin B6 or vitamin B12 deficiencies. Mechanism of action is 2 fold: direct arterial damage, and enhanced ability of blood to clot.

Lipoprotein (a)

The most common inherited lipid disorder in patients with premature coronary heart disease. Levels are genetically determined and not affected by changes in lifestyle. Risk is independent of other lipid tests. Statins and niacin may lower serum levels.

Apo B

Elevated levels are associated with increased risk even when LDL cholesterol is not in the high-risk range. Levels are affected by genetic and environmental factors.

sd-LDL

This test is a direct measurement of small density LDL cholesterol that is more precise, reproducible and better standardized than other methods for measuring the most atherogenic LDL subfraction. Studies have shown that people with a predominance of sd-LDL (so called Pattern B patients) have a 3-fold increased risk of myocardial infarction.

If the above tests are abnormal your doctor should consider these tests below.

HDL Fingerprinting

Assesses how well HDL particles are functioning to help remove cholesterol from the body by measuring the small HDL particles that pick up cholesterol from the artery wall and also the large HDL particles that deliver cholesterol to the liver. By knowing the sub fractions of a patient provides very precise information about heart disease risk and facilitates more targeted treatment. Measuring these particles also assists in determining how well therapy with medications is working in patients.

Lathosterol, Desmosterol, Campesterol, Beta-Sitosterol -

These tests measure cholesterol production and absorption to assist in selecting optimum LDL modifying therapy.

PAI-1 -

Increased levels of PAI-1 in obese and metabolic syndrome patients may increase the occurrence of thrombosis.

Glycated Albumin -

A marker of short term (2-4 weeks) glucose control that allows more rapid changes in therapy to optimize the treatment of diabetes. It is also a potent predictor of heart disease.

Adiponectin -

High levels are associated with a lower risk of heart disease.

NT pro-BNP -

A marker of heart disease stress. High levels have been associated with an increased risk of mortality in patients with heart disease.

ApoE Genotype -

About 20% of the population carries the apoE4 genotype and these people have higher cholesterol absorption, higher LDL cholesterol levels, and higher heart disease risk. Knowing the apoE genotype will assist in optimizing therapy.

Doctors...What do you think?

[noncom23]

Lipids by NMR is the way to go. Been doing it wrong for a long time. LDL particles, not cell count is the lethal one. Thats why people with normal LDL have heart attacks...

[soccerjunky]

you got any kind of group buy offer on those tests at the current time...

[MrLabGuy]

Originally Posted by soccerjunky

you got any kind of group buy offer on those tests at the current time...

We are finishing up on our interface with Boston Heart Lab who will be performing some the complex reflex testing. There are also 24 different treatment plans depending on the abnormal test mix and values which come with the final report. We have 4 panels with the following mix of tests.

The inital cardiac screen includes the following:

Cholesterol
HDL
Cholesterol/HDL Ratio
Non-HDL
LDL
VLDL
Triglycerides
Lp-PLA2
hs-CRP
Homocysteine
Lipoprotein (a)
Apo B
sd-LDL

There is also a Metabolic Syndrome component

TSH - excludes thyroid conditions which can cause marked changes in lipid levels
Insulin - verifies abnormalities that are associated with metabolic syndrome
Fasting Glucose- excludes diabetes mellitus and metabolic syndrome
ALT, AST, Total Bilirubin- liver tests to exclude hepatic causes of lipid abnormalities, and to establish a baseline to monitor statin hepatotoxicity
BUN, Creatinine- renal tests to exclude nephrotic syndrome, which can elevate lipids
Fibrinogen- a risk factor for myocardial infarction, when elevated

Depending on the results above there is a reflex to High Risk tests which include

HDL Subfractions
a-1
a-2
a-3
a-4
pre-B 1

Cholesterol syntheses Markers
Lathosterol
Desmosterol

Cholesterol Absorption Markers
Campesterol
beta-sitosterol

Clotting Factor
PAI-1

Additional Diabetes Markers
HbA1c
Glycated Albumin

Other reflex tests include
Adiponectin
NT-BNP
ApoE Genotype

As for the price it would depend on what is ordered and what reflex testing is performed. The initial Cardiac/Metabolic Syndrome panel is in the ballpark of $200 and when you consider the amount of information you get from this testing it ends up being a pretty good deal. This panel is covered by insurance.

PM me and I'll send you the PDF which goes into much more detail.

[E61Silver]

Where can you get the tests on the east coast and what is its name?

[MrLabGuy]

Originally Posted by x54.4blue

Where can you get the tests on the east coast and what is its name?

Many of these tests are available through some of the larger Laboratories in the US such as Quest Diagnostics and LabCorp. They may send some of these to reference labs such as Specialty Labs or ARUP if not performed "in house". Some of the tests are proprietary but if you are in the Boston area you can look up Boston Heart Lab who performs this entire spectrum of testing and is considered to be on the cutting edge of cardiac testing. Our lab is located in Bay Area of California. We are fairly new and making a name for ourselves in the area of advanced testing and connectivity in terms into interfacing into practice management systems.

The Metabolic Syndrome tests are quite common and most adults have had these tests run in some form or another.

The tests everyone with a family history of stroke or lipid disorders should look into having are:

Lp-PLA2
hs-CRP
Homocysteine
Lioprotein (a)
Apo B
sd-LDL

Our method of measuring the sd-LDL (small dense LDL) is a new procedure which replaces the older less accurate salt density gradient ultracentrifugation in favor of a combination of iodixanol density gradient centrifugation and digital photography.