Friday, May 11, 2012

A better way to evaluate LDL cholesterol

This is a follow up of yesterday post and request that you calculate your LDL cholesterol from your own test results.  My reason for asking you to do the math exercise was to put attention on the fickle nature of the LDL test result  used to evaluate our risk for Cardiovascular disease.

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: 1-78
          Apo 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


Comment:
   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" ?
 more tomorrow
                                                 
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 info@diabetesofficevisit.com with questions or comments
                     

1 comment:

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    LDL cholesterol

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Your comments and questions are appreciated. David Calder,MD