Reply To: 55 yo f, High HDL, low LDL Central adiposity thx heart disease
- 55 yo f, High HDL, low LDL Central adiposity thx heart disease
- Reply To: 55 yo f, High HDL, low LDL Central adiposity thx heart disease
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Stratifying an individual’s CV risk is a complicated task and different organisations have different policy statements and lipid targets. Furthermore, they seem to change every year. I am a United States physician, so I will discuss our lipid targets. To simplify matters, I will not go into great depth about particle size or number as it is beyond the scope of this discussion, except for three useful tests that will provide a lot of information. Those tests are Lp(a) (pronounced lipoprotein little a), the PLAC test, also known as Lp-PLA2 (lipoprotein-associated phospholipase A2), high sensitivity C-reactive protein (hs-CRP) and GGT (gamma-glutamyl transpeptidase/transferase).
PLAC test info: http://tinyurl.com/8knyhe2
Emerging Risk Factors Collaboration. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009;302(4):412. (http://tinyurl.com/9f7nzsh).
Pearson TA, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499. (http://tinyurl.com/8myr48f).
Lee DS et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2007 Jan;27(1):127-33. Epub 2006 Nov 9. (http://tinyurl.com/9av7nra).
A breakdown of the numbers:
Total cholesterol: below 5.2 mmol/L
LDL: below 1.8 mmol/L (optimal), below 2.6 for those at increased risk for CVD, 2.6-3.3 (near ideal)
HDL: 1.3-1.5 mmol/L (women) (better), 1.6 and above (best)
Triglycerides (TG’s): below 1.7 mmol/L (desirable), 1.7-2.2 (borderline high)
The above values are taken from the Mayo Clinic (http://tinyurl.com/5fseyz).
Total cholesterol includes both “good” high-density lipoprotein (HDL) cholesterol, and the “bad” varieties, chiefly low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL). HDL makes up approximately 20%–30% of total cholesterol, LDL makes up approximately 60%–70% of total cholesterol and VLDL makes up about 10%–15% of total cholesterol. (http://tinyurl.com/8ot2yun).
From a naturopathic point of view (and a physiological one), most cholesterol is made in the liver. That is one of the reasons why many statins are prescribed and work better when taken at bedtime, because most of the cholesterol is made during the night while we sleep. Since we make most of our cholesterol STC is not affected by fasting, nor are LDL’s and HDL’s (some of the sub-particulars of LDL’s and HDL’s are affected). Only TG’s are affected by fasting. Therefore, treatment strategies aimed at improving liver function, in my experience, normally improve values.
Maddox TM. Cholesterol Management Health Center. WebMD. 2012. (http://tinyurl.com/5rbuy2).
Your next question about the ratios and do they matter, are poignant. According to the American Heart Association, the goal is to keep your cholesterol ratio 5-to-1 or lower. An optimum ratio is 3.5-to-1. A higher ratio indicates a higher risk of heart disease; a lower ratio indicates a lower risk. (http://tinyurl.com/d775k4e).
If you and/or your client were interested in gathering more info, Doctor’s Data has two tests that might prove to be useful. They are the CV Risk Profile (http://tinyurl.com/8bzbrse) and the Comprehensive CV Risk Profile (http://tinyurl.com/8gg8uep). These are available via Regenerus Labs in the UK – email: firstname.lastname@example.org
High serum HDL-cholesterol (>60 mg/dL [1.6 mmol/L]) is associated with a lower risk of coronary heart disease (CHD), implying that an elevated LDL-cholesterol level may be less important in this setting. This pattern is most likely to occur in women. However, the AFCAPS/TexCAPS trial, which is the only primary prevention study that included women, all of whom were postmenopausal, specifically excluded women and men with serum HDL-cholesterol above 47 and 45 mg/dL (1.2 mmol/L), respectively.
Rahilly-Tierney CR, et al. Relation between high-density lipoprotein cholesterol and survival to age 85 years in men (from the VA normative aging study). Am J Cardiol. 2011;107(8):1173. (http://tinyurl.com/aotzjnx).
The reason(s) for this association is not well understood. HDL-cholesterol levels are positively associated with HDL particle size, and these same individuals most often have large LDL particles.
A separate issue is whether the HDL particles are functional in patients with high HDL-cholesterol levels such as your friend has. In one series of patients with elevated HDL-cholesterol levels who had coronary artery disease, it was found that the HDL particles were functionally impaired with regard to anti-oxidant and anti-inflammatory activities. In the future, it is anticipated that HDL biology will extend beyond static measures of concentration to functional measures of their anti-atherothrombotic properties.
Ansell B, et al. Inflammatory/anti-inflammatory properties of high-density lipoprotein distinguish patients from control subjects better than high-density lipoprotein cholesterol levels and are favorably affected by simvastatin treatment. Circulation. 2003;108(22):2751. (http://tinyurl.com/axy4tmp).
Rosenson RS. Functional assessment of HDL: Moving beyond static measures for risk assessment. Cardiovasc Drugs Ther. 2010;24(1):71. (http://tinyurl.com/ah8tp2x).
I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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