Health column by Dr. Greg Feinsinger. Champion of Whole Food Plant Based Living and righteous person.
February is heart month. This is the third of a series of four columns about heart attack prevention. The first column was about the importance of screening for the disease that causes heart attacks—atherosclerosis (aka plaque or hardening of the arteries). Last week’s column was about looking for and treating the factors that cause atherosclerosis, if screening shows you have it. Today’s column will include an expanded discussion about cholesterol, and a discussion about the importance of advanced blood testing in successful heart attack prevention.
A “cholesterol test” usually refers to a lipid panel, which includes total cholesterol, HDL (good cholesterol), LDL (bad cholesterol), and triglycerides. Lipids, at normal levels, are important for human health, but abnormal levels are associated with atherosclerosis. Think of your LDL (L for lousy) as garbage in your arteries—too much garbage and you’ll develop plaque in your arteries. Think of HDL (H for healthy) as garbage trucks—you’ll also develop plaque if you don’t have enough garbage trucks. In general, a high level of HDL is protective, but sometimes HDL can be dysfunctional and cause instead of prevent problems (plenty of garbage trucks but they’re broken). High triglycerides and low HDL are usually associated with diabetes or pre-diabetes. Providers commonly tell their patients they don’t have to fast for a lipid test, but heart attack prevention doctors like their patients to fast for 6 hours (water only) because triglycerides are usually elevated in the non-fasting state.
Generally accepted guidelines for normal lipid values in the U.S. are total cholesterol < 200; LDL < 100 or if history of a heart attack < 70; HDL > 40 in a male or post-menopausal female, > 50 if pre-menopausal; and triglycerides < 150. The problem is that half of heart attacks occur in people with normal lipids based on these guidelines. Primarily this is because what we’re calling normal isn’t really normal—the guidelines are based levels in the average American, who eventually is going to die from a heart attack. What we should be calling normal are levels in people who never develop atherosclerosis, and are therefore heart attack-proof—such as the people in the five Blue Zones. These people, who are primarily plant-based, have total cholesterols of < 150, LDLs in the 30s and 40s, and triglycerides of < 70–levels present in human newborns, and in other adult mammals that don’t develop atherosclerosis.
Heart disease is not all about cholesterol—factors such as insulin resistance and inflammation play a major role. Brad Bale, M.D. and Amy Doneen, R.N., PhD, developed the respected Bale-Doneen Method of heart attack prevention and wrote the book “Beat the Heart Attack Gene.” They, and other heart attack prevention doctors, order “advanced” blood tests that go beyond the usual lipid profile. These include tests such as the following:
- Lp(a), which is a particularly harmful type of LDL. Elevated Lp(a) often runs in families with a high incidence of heart disease at an early age, and elevation is present in a third of all heart attack victims. Elevated Lp(a) does not respond to statins—only to plant-based nutrition and to niacin. When Lp(a) is elevated, it’s very important to achieve low LDL levels (well under 70).
- LDL on the usual lipid panel measures the LEVEL of bad cholesterol, but what is more important is the number of LDL particles per unit of blood—called the LDL particle number.
- The size of LDL particles is important—small, dense LDL particles are more harmful than large, fluffy ones.
- LP-IR is a test that measures insulin resistance—the cause of 70 percent of atherosclerosis in America.
- F2 isoprostane is a marker of oxidative stress—increased oxidation increases the risk of accelerated aging, cancer, and cardiovascular disease. Elevation occurs in people with unhealthy lifestyles and in over-exercisers (such as ultra-marathoners).
- Microalbumin/creatinine ratio is a urine test that measures the health of the endothelial lining of the arteries in your kidneys. It should be less than 7.5 in women and 4.0 in men.
- Lp-PLA2 is an enzyme that when elevated contributes to formation of arterial plaque. Elevation also occurs when plaque becomes inflamed—the driver of plaque rupture, the actual cause of heart attacks and most strokes.
- MPO is an enzyme that when elevated makes ALL types of cholesterol (even HDL) inflammatory.
How much do these tests cost? If done through the Cleveland Heart Lab, Medicare and most insurances pay. If you are uninsured or have a high deductible, the cost is in the $100 range—about the same cost as a regular lipid panel in most labs. Yet, unfortunately, most providers don’t order these valuable tests, unless they are well-versed in heart attack prevention.