Cardiovascular Disease Uncovered Beyond the Lipid Panel – Part One

June 17, 2022

Cardiovascular Disease Revealed – Part One

Cardiovascular disease is the number one killer in all age groups and yet a typical workup for any patient for cardiovascular disease is only a Lipid Panel. In fact, there are many other factors to consider when determining cardiovascular disease risk other than just the lipid panel.

A large study found 50% of people who suffered a heart attack had normal cholesterol levels.1

In Pittsburgh, an advanced blood test called the Cardio IQ Panel was put together at Quest labs revealing other cardiovascular markers giving a broader and more accurate picture of cardiovascular risk in individuals than the standard lipid panel. This panel is done on all patients at RMC.

What are the cardiovascular risk factors revealed in Cardio IQ?

What do the results mean?

How does it compare to the standard lipid panel?

These questions will be answered in the next series of blogs.

Standard Lipid Panel Explained

You may have seen HDL and LDL on your lipid panel. HDL is commonly known as the “good” cholesterol and LDL the “bad” cholesterol. Also seen on the standard panel are total triglycerides and total cholesterol. To assess cardiovascular risk, your doctor may use your cholesterol numbers along with age, blood pressure, evidence of diabetes, and lifestyle factors to determine your cardiovascular risk. Although many are told they are “low risk” still carry on to experience adverse and even premature cardiovascular events. Why?

The standard lipid panel does not take into consideration the size or the number of cholesterol particles. All cholesterol is not created equal!

HDL and LDL Particle Size

Though LDL is known as “bad” and HDL “good,” they both come in good and bad forms based on their size. The bigger an LDL or HDL particle, the better. Small particles are more concerning and have an easier time passing through, getting stuck and taking up residence in the walls of your blood vessels causing irritation, whereas larger particles are less likely to do so.

HDL Cholesterol

While many believe they are in the clear because their HDL level is high, this is not always the case. If you have a high HDL level and the particle size of HDL is small, this is a cardiovascular risk. Therefore, it is not good for people with small particle size HDL to have a high HDL number.

Shown in the following image, small particle size HDL has been associated with increased cardiovascular risk, therefore turning the “good” into bad.2,3

LDL Cholesterol

This concept is also shown in the following image4 of four people with the same levels of LDL cholesterol, but the particles for each are a different size:

Each person has high LDL cholesterol but because Jerry’s particle size is the largest, he is at the lowest risk for cardiovascular events, whereas Maria is at the highest risk because she has many small LDL particles moving through her blood vessels that are prone to becoming stuck.

As demonstrated here, the risk is not LDL cholesterol or even cholesterol itself; the risk is the particle size. How do we assess this risk based on particle size?

Particle size on Cardio IQ Lipid Panel

To assess the particle size of cholesterol, the advanced lipid test called Cardio IQ comes into play. This helps identify individuals with an underlying hidden risk that would not have been found on the standard panel.

Shown in the following image5 is a portion of a sample Cardio IQ test report. As you can see in the top portion is the “Lipid Panel,” which coincides with the standard lipid panel you may have. Below that is “Lipoprotein Subfractions,” where you see a breakdown of the particle size. Now that we have determined the problem is not LDL cholesterol itself but rather the size and number, we can further deduce your risk.

Based on this result, if you only had the results of the “Lipid Panel” portion, you and your doctor may determine you are very low risk for heart attack or stroke. This is what typically occurs with the standard lipid panel. The addition of the “Lipoprotein Subfractions” shows us that there is a hidden risk, and it is high. The breakdown of particles puts you at high risk, which would have never been discovered on the standard panel.

More Insights on Cardio IQ

The key takeaway here is that “normal cholesterol” on the standard lipid panel does not give the full story. This in-depth analysis of cholesterol particle size gives us an edge to address early risk factors and prevent cardiovascular events, but this is still not the full story! In addition to the breakdown of cholesterol particle size, Cardio IQ also includes other important markers that provide major insights into cardiovascular risk.

The next blog post will dive deeper into Cardio IQ and the additional markers included in the panel that offer a global picture of your health and an even greater edge in preventing adverse outcomes.

Have an awesome day! Dr D

Posted in Cardiovascular Disease