July 13, 2011

Heart Disease and Cholesterol!

Jul 13
Cholesterol is such a buzz word these days! Everyone is worried about it but truth be told, no one really understands it all that much. There are so many misconceptions and myths surrounding cholesterol’s role in heart disease that it’s mind boggling. So let’s get started on clearing up a few of these misconceptions! Myth One: “High cholesterol is the number one cause of heart disease.” WRONG! This is merely just among one of the many risk factors. In fact, less than 30 out of 100 people with heart disease have high cholesterol.  In actuality, the most prevalent risk factor is low HDL along with small LDL particles, which commonly occur together. Between 60 – 70 out of a 100 people diagnosed with heart disease have low HDL and small LDL particles. You might be confused right about now and wondering what exactly small LDL particles refers to?! Small LDL particles aren’t on the everyday cholesterol panel and need to be measured specifically. The typical cholesterol panel will measure your HDL, LDL, triglycerides, and total cholesterol. Unfortunately, this doesn’t really tell you much at all. Relying on these four tests alone to assess cardiovascular risk is a serious limitation especially when research has shown that these tests only help identify a mere 40% of people with coronary artery disease. Myth Two: “If I take a statin agent, I won’t have a heart attack.” WRONG! Lowering cholesterol may reduce but does not eliminate the risk of heart attacks. There are just too many other factors at play. Other variables such as small LDL particles, low HDL, high fibrinogen, high homocysteine, and high insulin are all important factors to consider. In fact, the very common occurrence of metabolic syndrome (low HDL, high triglycerides, high blood pressure, excess abdominal fat) substantially heightens the risk of heart disease, even in the presence of low cholesterol levels. That is why taking a statin drug simply isn’t going to cut it in terms of reducing the risk of heart disease. Myth Three: “I feel fine and my stress test was normal. My doctor says I don’t have heart disease.” WRONG! Most heart disease is silent – without symptoms and undetectable by conventional means such as electrocardiograms and cholesterol testing. Second, stress testing is a miserable failure for screening asymptomatic people. Most future deaths and heart attacks occur in people with normal stress tests (when symptoms are not present). The net result of this misconception is that most future heart attack victims are walking around feeling fine and unaware of their risk. The basic premise that I’m trying to get to is that cholesterol alone is not a very good indication of heart disease. People need to be aware that they may be at risk for heart disease even when their cholesterol is normal. There are other tests out there that much better ascertain your risk of such disease. With Functional Medicine, the use of more advanced tests becomes standard. One of the tests used in Functional Medicine is the VAP test – this test breaks up the lipoprotein LDL and HDL into their subgroups, which vary in particle size and density.  Knowing that a patient’s LDL is above 140 mg/dl is simply not enough! This tells you nothing about whether the relative ratios of the different particles will increase or decrease the risk for heart disease. One important red flag is if a patient has more clusters of small, dense LDL as this greatly increases the risk of cardiovascular disease. Another consideration is that large particles of HDL (HDL2) are much more potent in extracting cholesterol from the cells whereas small particles (HDL3) are pretty much useless and provide no protection. The VAP test, along with other tests such as inflammatory markers and the standard panel, provide a more complete picture. More than 1.3 million Canadians are currently diagnosed as having heart disease and these numbers are going up all the time. In 2004, cardiovascular heart disease was the number one killer in Canada! However, the MOST important thing to note is that the risk of developing heart disease can be significantly reduced! The important thing is to first assess your risk factors and then work towards reducing them. Having a false sense of security will not help you and can prove fatal. It is much, much easier to take steps to prevent heart disease than it is to live with it. I guarantee it!