Some of the points to keep in mind are:
* LDL is usually a calculated number
* any increase in triglycerides results in a lower appearing LDL and a false sense of security
* any increase in triglycerides actually starting at about 100mg/dl is associated with an increase in small
dense LDL and increased risk of cardiovascular disease.
Is there a better way of evaluating LDL cholesterol ? Yes
* Measuring ApoB is the the easiest, least expensive most consistent way to evaluate LDL Cholesterol.
* there is one ApoB for each LDL particle regardless of the LDL parcel size.
Treatment guidelines goals
* American college of clinical endocrinologist ( AACE )
ACCE LIPID and Athersclerosis Guidelines
Endocr.Pract. 2012 ; 18 ( supplement 11: 1-78Apo B - < 90 mg /dl in people at risk for cardiovascular disease
< 80 mg/dl for people with "established" cardiovascular disease
< 80 mg/dl for patients with diabetes plus one or more " risk factors "
* American Diabetes Association consensus statement on lipid management
ApoB < 90 mg/dl - for people with diabetes and no other risk factors
- for people without diabetes without cardiovascular disease but with 2
"risk factors "
< 80 mg/dl - people with "known" cardiovascular disease
people with diabetes plus one or more additional risk factors
The official guidelines are catching up with what doctors have been doing for some time , using ApoB test to validate the the accuracy of LDL measurements in predicting risk for cardiovascular disease.
Who are those "people at risk for cardiovascular disease " and what are those "risk factors" ?
Have Fun , Be smart and ask for an ApoB test with your next Lab. evaluation. You do not have to fast for this test.
David Calder, MD
email me at firstname.lastname@example.org with questions or comments