LDL high but HDL ok, Triglycerides low, VLDL low, should I be concerned?

[mcs]

The standard is not worthless.

All these more detailed/advanced blood test result is usually parallel with the standard test, thing like ApoB is fraction of LDL.

What's more important I believe is the ratio between HDL-C and LDL-C. Statin target is to bring down those LDL-C to be below 100 or lower than HDL if at all possible. Even lets say you have lpa issue, the treatment anyway is still the same.

Doc will give you statin, but func. medicine may give you even more meds, from Niacin to folic acid to reduce homocyesteine.

However folks have wrong idea just because you had statin you have reduced event which is not the same, statin is only for very long term prevention. It's blood thinner agent that reduce the actual event (from omega3 to Heparin)

even the best cardiologist in bay area ordered the standard test.

Not surprised either. I have found that even the "best" non-research cardiologists while great at disease intervention management, are way behind when it comes to disease prevention, continuing to practice obsolete science from when they were in med school. The standard tests can be entirely misleading, giving one a false sense of security - or the opposite, all depending on the LDL subfractions, Lp(a) levels, etc. relevant data, none of which are reflected in standard panels. For example, I just had recently updated 2 lipid tests both drawn at same day/time: STANDARD PANEL and the ADVANCED PANEL 1 (with ref ranges). As you can see, I look ok (other than low HDL) on my standard whereas on my advanced, I have elevated LDL particle and size as well as elevated Lp(a), CRP, APO-B, all markers of CAD risk. The only markers of relevance on a standard test are HDL and trigs. One's lipid status should never be judged on such misleading conventional measures as LDL or total cholesterol.

 

[Bubbs]

Not surprised either. I have found that even the "best" non-research cardiologists while great at disease intervention management, are way behind when it comes to disease prevention, continuing to practice obsolete science from when they were in med school. The standard tests can be entirely misleading, giving one a false sense of security - or the opposite, all depending on the LDL subfractions, Lp(a) levels, etc. relevant data, none of which are reflected in standard panels. For example, I just had recently updated 2 lipid tests both drawn at same day/time: STANDARD PANEL and the ADVANCED PANEL 1 (with ref ranges). As you can see, I look ok (other than low HDL) on my standard whereas on my advanced, I have elevated LDL particle and size as well as elevated Lp(a), CRP, APO-B, all markers of CAD risk. The only markers of relevance on a standard test are HDL and trigs. One's lipid status should never be judged on such misleading conventional measures as LDL or total cholesterol.

That is quite a difference between the panels, hopefully I get my results back soon and can update the thread

Apart from your HDL that all looked great in the standard test

Isn't large LDL particle size a good thing though?

 

[mcs]

That is quite a difference between the panels, hopefully I get my results back soon and can update the thread

Apart from your HDL that all looked great in the standard test

Isn't large LDL particle size a good thing though?

Yes, large, fluffy LDL is a good thing.

 

[Bubbs]

Got the results back, they didn't test for some markers I asked for unfortunately. How bad is this?

Cholesterol, Total
Your Value
195 mg/dL
Standard Range
100 - 199 mg/dL

LDL-C (NIH Calc)
Your Value
129 mg/dL
Standard Range
0 - 99 mg/dL
Flag
H

Optimal < 100
Above optimal 100 - 129
Borderline 130 - 159
High 160 - 189
Very high > 189

HDL-C
Your Value
56 mg/dL
Standard Range
>39 mg/dL

Triglycerides
Your Value
55 mg/dL
Standard Range
0 - 149 mg/dL

LDL-P
Your Value
1,423 nmol/L

Flag
H
Low < 1000
Moderate 1000 - 1299
Borderline-High 1300 - 1599
High 1600 - 2000
Very High > 2000


HDL-P (Total)
Your Value
30.8 umol/L
Standard Range
>=30.5 umol/L


Small LDL-P
Your Value
429 nmol/L

Standard Range
<=527 nmol/L


LDL Size
Your Value
21.3 nm
Standard Range
>20.5 nm


LP-IR Score
Your Value
<25
Standard Range
<=45

 

[Golfboy307]

Before commenting on the above values, have you had a calcium score (CAC) test to determine if and how much calcified plaque you have in your coronary arteries? You can usually get one set up yourself in most states for $150. That would go a long way to determine if these LDL values are truly impacting plaque buildup.

 

[Bubbs]

Before commenting on the above values, have you had a calcium score (CAC) test to determine if and how much calcified plaque you have in your coronary arteries? You can usually get one set up yourself in most states for $150. That would go a long way to determine if these LDL values are truly impacting plaque buildup.

My cardiologist wouldn't send me for calcium or CIMT tests, or a cardiac MRI

Hes scheduled me a carotid ultrasound which as I understand it is as useless as a stress test. I'll try to find a new Dr and get those tests. Although I've read the CT scan for the CAC test can be dangerous so I'd rather just get the CIMT to measure soft plaque

I'm going to start the crestor at 5mg 2x weekly and see if that drops me to normal, I asked for a vascepa script but no luck there so will keep taking the EPA supps

 

[Golfboy307]

A carotid ultrasound can be useful if it shows your IMT (thickness) of your artery walls. If the IMT is high it would indicate you likely have plaque buildup. There is strong correlation between IMT in your carotid artery and what you could expect in your coronary arteries. No radiation exposure with a this test vs. calcium score.

 

[Bubbs]

A carotid ultrasound can be useful if it shows your IMT (thickness) of your artery walls. If the IMT is high it would indicate you likely have plaque buildup. There is strong correlation between IMT in your carotid artery and what you could expect in your coronary arteries. No radiation exposure with a this test vs. calcium score.

His nurse said it wasn't the CIMT and was a standard carotid doppler ultrasound looking at blood flow through the carotid artery

I like the guy but he's very old school and thinks TRT is the worst thing you can do for your heart and prefers a vegetarian diet to keto

 

[Golfboy307]

Not going to get into the diet wars... but I get your comment about your doctor. Who does your TRT? My TRT doctor is more "whole body" medicine. He has no problem attacking root causes especially possible heart disease. He ordered the Boston Heart Study labs for me along with CAC. Maybe you need to switch..

 

[Bubbs]

Not going to get into the diet wars... but I get your comment about your doctor. Who does your TRT? My TRT doctor is more "whole body" medicine. He has no problem attacking root causes especially possible heart disease. He ordered the Boston Heart Study labs for me along with CAC. Maybe you need to switch..

TRT comes from a family doctor in a different state, he's much more willing to prescribe tests/ drugs/ anything I want and is the smartest TRT doc I've used (my old Dr was Karlis Ullis in LA and my current doc is just as knowledgeable)

 

[Bubbs]

Had a Carotid IMT ultrasound today, results were under 1.0mm

"Bilateral IMT measured < 1.0mm. Normal study There is no evidence of
hemodynamically significant stenosis in either carotid system. Antegrade
flow is present in both vertebral arteries."

Hopefully that means my arteries are in relatively good shape - which correlates to the idea that inflammation is what weaponizes LDL and I have very low levels of systemic inflammation

 

[Bubbs]

Since under 1.0mm is apparently meaningless I got clarity from my cardiologist on the numbers and my IMT is 0.59mm

Not ideal sadly, that puts my vascular age a few years older than I actually am.