As part of our new cardiovascular risk assessment (the VAP test) we are analyzing not just the amount of LDL or “lousy” cholesterol in the blood but also the pattern of the LDL. Pattern “A” refers to large fluffy particles which are less damaging to blood vessels vs pattern “B” which refers to smaller and denser particles that tend to stick around longer and are more damaging to blood vessels. If you have a pattern “B” then you are twice as prone to have a heart attack or die suddenly from your heart disease. Heredity plays a role in which pattern you have but the good news is that lifestyle changes such as increased exercise and weight loss can help move those with pattern “B” to pattern “A” Simple changes in diet as advised by our nutritionist Rick, and certain medications can all play a beneficial role.
Not a patient yet but wish to get our weekly e-mail medical news summary and be able to ask questions of the doctor? Click Here
How do you interpret the risk of cardio disease when one has low cholesterol, a decent ratio of HDL/LDL, but has a high LDL pattern B? What about the C reactive protein level?
Unfortunately, not all cardiovascular risk is captured by the traditional total cholesterol and HDL/LDL hence the impetus to develop other reliable risk factors such as LDL pattern and high sensitivity CRP. LDL pattern B and C reactive protein when high can play a tie breaker role when the need to go on a statin is unclear. Unfortunately we do not presently have tools that can easily integrate disparate high and low risk markers. This is why we still have a role for experienced doctors exercising clinical judgement on a case by case basis to guide us in our decision making.