Heart Disease is More Than High Cholesterol
By Abida Wali, ND

A new national study published in the January issue of American Heart Journal has shown that nearly 50 percent of patients hospitalized for a heart attack had “normal” cholesterol levels.  Evaluating your risk for heart disease measured by routine cholesterol tests may not be enough.

You may be at risk for heart disease if you have:

• Triglycerides greater than 150
• HDL lower than 40
• LDL greater than 130
• Total Cholesterol greater than 200
• A family history of heart disease or cardiac events
• Diabetes or family history of diabetes
• High blood pressure
• Thyroid problems
• Abdominal obesity

The routine cholesterol test only reports 4 lipid components.  However, a more comprehensive test called the VAP® (Vertical Auto Profile) panel that more accurately measures LDL (Bad Cholesterol) and provides measurements for 15 lipid components should be used.  VAP® Tests also help identify early detection of the metabolic syndrome which leads to diabetes and heart disease.

Comparison of the VAP test and Routine cholesterol test is summarized below:

Cholesterol Measurements                    VAP Test                  Routine Test
                                 LDL                       Direct Measurement         Calculated
                                HDL                            included                     included
                  Triglycerides                           included                     included
            Total Cholesterol                           included                    included
                              VLDL                           included                 
                       Non-HDL                           included
                        apB100                           included
Lp(a)                           included
IDL                           included
LDL-R                           included
    LDL-R Subclass Pattern                           included
     Remnant Lipoproteins                           included
        Metabolic Syndrome                           included
                              HDL2                           included
                              HDL1                           included

The VAP test breaks down cholesterol beyond HDL (high-density lipoprotein, the "good" cholesterol), LDL (low-density lipoprotein, the "bad" cholesterol), and triglycerides and provides new information that can help better assess and treat your heart disease risk. Risks of both Heart Disease and Diabetes can be reduced with the right preventative treatments, which is why more accurate diagnosis is critical.

In addition to The VAP® Test, other diagnostic tests that aid in the early identification and treatment of heart disease include:

• hsCRP: High sensitivity C-Reactive Protein (hsCRP) is a general marker of inflammation and has been recognized for its ability to predict future coronary events in apparently healthy individuals.

• Homocysteine: Homocysteine is an amino acid needed for normal health.  However, at high levels homocysteine is a major risk factor for cardiovascular disease.

Once your risk factor(s) has been identified based on your VAP results and other risk factors according to National Cholesterol Education Program Adult Treament Panel- III Report (ATP-III), natural and/or pharmaceutical treatments can be used to lower your risk factors.

Therapeutic Lifestyle Changes (TLC) that includes diet, weight management, and increased physical activity is the first therapeutic modality listed in the ATP-III guideline for the proper management of cholesterol and cholesterol components.  TLC and other natural treatments to reduce cholesterol and other risk factors associated for developing heart disease are summarized below:

• Lifestyle changes that focus on stress reduction, smoking cessation and weight management.
• Exercise: At a minimum 45-50 minutes of Cardio with Target Heart rate of 60% to 80% of maximum heart rate.
• Diet:
• Adopt a Mediterranean Style diet
• Decrease consumption of saturated and trans-fats to <7% of daily calories. 
• Decrease consumption of simple and refined carbohydrates.
• Increase consumption of soluble fiber found in fruits and vegetables.
• Increase consumption of omega-3 fatty acids found in fish such as mackerel, lake trout, herring, sardines, albacore tuna and salmon to 2 servings a week.  If you are pregnant, talk to your healthcare practitioner for the best form of omega-3 fatty acids that is right for you.

• Dietary Supplements:
• Omega-3-fatty acids found in fish oil: A potent anti-inflammatory agent that reduces triglycerides and increases “good” HDL cholesterol.
• Plant Sterols: Binds to dietary cholesterol in the intestinal tract.
• Niacin: Also known as Vitamin-B3 helps in increasing your HDL “good” cholesterol. Three forms of OTC niacin are available: Immediate Release, sustained release, and no-flush niacin.  Liver toxicity has been associated with the sustained release niacin.  Before using OTC niacin, talk to your natural healthcare provider regarding the right dosage, side effects and liver toxicity monitoring.
• Red Yeast Rice: Same mechanism as statins as it inhibits the rate limiting enzyme in the production of cholesterol.
• Soluble Fiber: Reduces cholesterol by binding to dietary cholesterol in the intestinal tract.

Pharmaceutical Treatment for Lowering Cholesterol

• Statins: Inhibits the rate-limiting enzyme in the internal production of cholesterol. 
• Fiberates: Inhibits triglyceride synthesis and stimulates breakdown of triglycerides rich lipoproteins.
• Prescription Niacin: Also known as Vitamin-B3, helps in increasing your HDL “good” cholesterol.  Two forms are available: Niaspan® ER ( Extended-release)  and NIACOR® IR (immediate release).
• Combination of therapies listed above.  However, combination therapy has been shown to increase the potential for adverse effects.  For the best combination that is right for you, discuss the benefits and risks with your healthcare provider.

If you have identified several risk factors for developing heart disease from the list above, talk to your healthcare provider on how to lower your risk. Early identification of your risk factors will give you a better opportunity to take preventive measures toward a happy and healthy heart.

Dr. Wali can be reached at Ocean Pacific Integrative Health Center in Carlsbad. Please call 760-944-9300.

Links of Interest:
1- www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
2- www.atherotech.com
3- www.thevaptest.com