The Irrelevant LDL

The more digging I do the more I become aware that the lipid test you get from your local GP is totally inadequate. Even the little information they offer is misinterpreted by most GP’s. The focus tends to be on LDL and keeping it low. It may surprise you that no research has been able to show a relationship between LDL levels as your doctor test shows and heart events. The size of LDL particles is relevant but this test is not offered. It may also surprise you to know that insurance companies in the USA do not even look at LDL levels when assessing your risk. They realise, better than our GP’s, that LDL levels are not relevant. A better indicator from the basic Lipid panel is Total Cholesterol / HDL ratio and it is this ratio that insurance companies focus on. The ideal ratio is below 3.5 for men, 3 would be even better.
So what test’s do offer a better indication.

1. Fibrinogen levels – Fibrinogen causes clotting and high levels are considered bad. A trial called Eurostroke divided participants into 4 categories based on Fibrinogen levels. There was a 50% rise in strokes for each increase in category. Arterial plaque has been found to contain Fibrinogen suggesting it plays a significant part in its formation. Desirable levels are less than 500 mg/dl

2. CRP – C Reactive Protein is a test your GP here in the UK will include. It is raised by inflamation within the body and with inflamation now considered the root cause of heart disease, high levels of CRP are certainly not desirable. One word of caution though general body inflamation can spike CRP, so if for example you have arthiritis or flu this may spike your CRP levels. Desirable levels < 0.5 mg/L

3. Microalbumin/Creatinine urine ratio (MACR) – Research from the Framlingham study showed that elevated ratios of Microalbumin to Creatinine had a 20% higher rate of CV events. Ideal ratios are lower than 7.5 for Women and lower than 4 for men.

4. LpPLA2 – This test measure the level of an enzyme Phospholipase attached to LDL. This level will be elevated when the arterial wall is inflamed. A danger sign that plaque could rupture and cause a heart attack. Levels less than 200 ng/ml were considered desirable according to a Mayo heart study.

5. ApoB / APO A1 ratio – These values show up on a Blue Horizon comprehensive test here in the UK. Research has shown the following indicators.

Men Low risk 0.4 – 0.69 Moderate risk 0.7 – 0.89 High risk 0.9 – 1.10
Women Low 0.3 – 0.59 Moderate 0.6 – 0.79 High 0.8 – 1.0

The ApoB/ApoA1 ratio (divide your ApoB value by your ApoA1 value) has been shown in numerous studies to be a better predictor of future heart attack events than both LDL alone and even the Total cholesterol / HDL ratio. Despite many doctors and researchers stating that this should be included in a standard lipid panel of results, you still have to go private to obtain it.

Maybe one day all these or at least more than one will be available at your local GP


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