Monday, September 6, 2010


Cholesterol is only part of the story. Most heart attacks occur in folks who have not only normal cholesterol, but decent levels of its subtypes, HDL (Healthy Dynamite Lipids) and LDL (Lousy Darn Lipids). Also some who have elevated cholesterol and LDL with a low HDL have no cardiovascular disease. Actually it is the oxidized LDL that is the villain. But there is more to the tale. There have been new, more comprehensive lipid tests available to doctors in the last 10 years and most don’t even know about, let alone use them. There are two Labs that do these: the VAP test (short for Vertical Auto Profile), developed at the University of Alabama, Birmingham (UAB) Medical Center, and the LPP (Lipoprotein Particle Profile) test offered by SpectraCell Laboratories in Houston. 

These tests are a boon for doctors and better for their patients who do not want to be just treated for heart disease, but rather prevent it. More information is needed if we are to utilize blood lipids as a reliable risk assessment. Thanks to medical science, we now have better studies that can break down the many components of cholesterol, and most importantly, single out the most dangerous fractions. You can now get a much more accurate picture of what may or may not be a cholesterol problem. 

Here are just a few of the key readings these tests give you that the old ones do not. Your LDLs are considered to increase the risk of heart attack and necessitate treatment. But LDL, for the most part, is really a good guy-a sheep slapped with a wolf's reputation. Your basic cholesterol is mostly LDL, a fatty substance produced in the liver and wrapped in a protein coating (Lipoprotein) that allows it to circulate in the bloodstream. Cholesterol is essential in the body as a raw material. Enzymes convert it to vitamin D, steroid hormones (like estrogen, progesterone, testosterone, and cortisol), bile acids needed for digestion and as part of our cells membranes. It also makes up 28% of our Brain!

LDL can be bad or good. The new tests identify if your LDL is bad or not. LDL becomes dangerous when it is oxidized or overly present as a small dense particle as opposed to a larger, fluffy more "buoyant" particle (Pattern A}. 
The small dense LDL is nefarious and if too many is labled Pattern B. B for Bad!! This is because the smaller Beebe like particles are more easily able to penetrate the endothelium. There also is a Pattern I, for intermediate, IDL and indicates that most LDL particles are very close in size to the normal gaps in the endothelium (26 nm).

The tests also indicates a subtype of LDL called Lp(a). When this substance rises abnormally in the bloodstream, the result of genetics, it can increase the risk of heart attack up to 25 times. This is a highly inflammatory and thrombotic molecule. There is no conventional medication for Lp(a), but niacin (vitamin B3), high dose vitamin C with Proline, and N-Acytel Cysteine (NAC) may help. When using Niacin beware that Homocysteine, another risk factor in the blood does not build up and hence should also be monitered. I also recommend a small dose of aspirin and acetomenaphin as a blood thinner. 

A high level of HDL-the so-called good cholesterol-is generally associated with protection against heart attack. We now know that HDL is further classed into HDL2 and HDL3. The difference between the two is HDL2 is far superior to HDL3 in providing protection for the heart. Triglyceride level, are of course measured too and anything above 100 (fasting) is considered abnormal. With these tests, various triglycerides are singled out.

The one to be concerned about is called VLDL3, the most inflammatory triglyceride, considered a prime indicator for coronary artery disease progression, insulin resistance, and type II diabetes. Triglycerides are fat globules in the bloodstream. In a concentrated form, they create the fatty "love handles" around your midsection. This then increass HsCRP that “rusts” our arteries. A better test incorprated in the VAP is the PLAC-2, which, more specifically, reveals not only how much plaque we have, but how stable it is. Unstable plaques rupture causing a sudden heart attack or what is even worse, A STROKE !!


  1. Doctor Block, I might make a good medical school case study. I am a non-compliant 67-year-old obese male, with diabetes, low HDL cholesterol, and hypertension. I have had two mild strokes and two transient ischemic attacks. I have had both big toes amputated because of diabetic ulcers, and I had my gallbladder removed years ago.

    I am non-compliant, refusing to take any medications because I don't think our bodies evolved to take the latest blockbuster chemicals from BigPharma.

    Here's one example of my non-compliance: In March of this year, I was hospitalized to have my right leg amputated because of severe diabetic foot ulcers. A steady procession of doctors came through my hospital room, telling me that my leg could not be saved and that it needed to be amputated immediately in order to save my life. I refused to have the amputation, and I still have my leg, which has healed up very nicely. Being non-compliant means that I still have both legs.

    Here's another example of my non-compliance: A few months ago, I was hospitalized with chest pains and shortness of breath, and cardiologists recommended stents or bypasses. I again refused those procedures, and I am working aggressively on diet and exercise, trying to develop collateral circulation, or "natural bypasses." So far, so good, and the symptoms of chest pain and shortness of breath are getting better.

    My doctors say I am non-compliant and crazy.

    I may be crazy, but I still have both my legs and I have fewer cardiac symptoms, all without drugs or surgery.

    So, if I were your patient, would you put up with my preference for diet and exercise, instead of drugs and surgery?