cholesterol-particlesHow did we arrive at the conclusion that LDL cholesterol is the villain in heart disease?

Well…once again we see the mistakes made by researchers that lead us to think of LDL as the culprit.

A little history…

It had to do with a machine used in the laboratory, called an analytical centrifuge that created evidence that ultimately mislead researchers and clouded the issue of cholesterol sub-particles.

Invented in 1949 and used until 2004, this device was used to spin blood plasma samples at 40,000 rpm to separate out the cholesterol fractions such as HDL and LDL.

However this spinning process cannot separate the particles with the precision required to identify all of the sub-fractions of cholesterol that are present in the blood. It may have been state of the art when it was first used, but still fell far short in the accuracy required to actually identify all the sub-fractions of cholesterol.

This started the characterization of cholesterol particles as either good or bad cholesterol, depending on the particle density. This was a gross oversimplification that stuck in the minds of the public.

For many years this simplified version of a person’s risk of heart disease based on their ratio of good and bad cholesterol stood as the cutting edge of cholesterol testing and heart disease prevention.

This was accompanied by the now debunked view that saturated fats caused heart disease because of their association with cholesterol. People avoided saturated fats out of a fear that was not founded in good science.

They also consumed statins, the most prescribed class of drugs on Earth due to the same fear of cholesterol and it’s supposed relationship to heart attacks.

Americans have consumed some 14 billion dollars in cholesterol lowering drugs, which some health experts have advocated be given to people of all ages including children allegedly to prevent heart disease.

John Abramson argues in his book Overdosed America that lowering LDL cholesterol has inadvertently become the main focus of preventative medical care in the United States.

Cutting edge thinking about LDL cholesterol

Yet a more recent breakthrough utilizing a new technology called ion mobility analysis has shaken the traditional concept of cholesterol’s role in heart disease to the core, and called the entire LDL cholesterol theory into question.

Ronald M. Krauss, of the Children’s Hospital Oakland Research Institute, is using ion mobility analysis to count cholesterol particles such as LDL and HDL down to the smallest sub particle types using principles of physics.

Even though it’s extremely expensive and not widely available, this technology has helped to rewrite the rules on how we think about cholesterol and heart disease.

Rather than continuing to believe that LDL cholesterol is the bad cholesterol here, we now know that there are four types of LDL particles that factor into the risk of heart disease.

Some LDL particles are benign and others more dangerous. Thus it makes no sense to continue to base diet and drug recommendations on an outdated theory when the science regarding cholesterol particle types is far more precise now.

We could be using drugs that target the wrong particles, and making dietary recommendations that are doing more harm than good at this point, all while dramatically escalating health care costs and actually making treatment less effective!

Low Density Lipoproteins

LDL comes in four sizes:

  • Large (big fluffy particles)
  • Medium
  • Small
  • Very Small

As the LDL particle size decreases the particles become more dense, (and more dangerous). This is because the large fluffy particles can’t lodge in your artery walls as plaque, while smaller dense LDLs CAN!

High fat diets tend to increase the large fluffy LDL particles, while low-fat high carbohydrate diets increase the smaller more dense particles.

From this you can see why the standard medical advice about how we should eat to avoid heart disease is seriously flawed! It was all based on an oversimplified and outmoded concept of the nature of cholesterol particles.

Typical cholesterol tests can’t differentiate between large and small LDL particles. There are also genetic, environmental, and lifestyle factors that affect LDL particle size.

Enter “Ion Mobility Analysis”

Using ion mobility analysis, Dr. Krauss and his colleagues determined that there are some 11 different particles. This was done using a sample of 4,600 healthy men and women volunteers.

Eight percent of the test subjects went on to develop heart disease, and using statistical algorithms the researchers developed a series of three very accurate predictors for who would go on to develop heart disease.

Here are the correlations that Dr. Kraus’s team found:

    1. High levels of small and medium LDL particles with low HDL (called atherogenic lipoprotein phenotype) Also known as pattern B
    2. Low HDL levels
    3. High total LDL cholesterol

So as it turns out LDL cholesterol and the risk of heart disease is a complex relationship that standard cholesterol tests are almost useless to predict.

The PLAC Test

There is one test however that can give you a better idea of what your risk is. You can read about it in my article called “The PLAC Test.” This is the latest test that really utilizes our new knowledge of LDL to make more accurate predictions about what your real risk for heart disease is.

Using this test you can make better choices about lifestyle and diet, because they are based upon a more complete understanding of the science of cholesterol particles.

The PLAC test is a cutting edge medical screening test that identifies arterial The PLAC Testplaque that is in danger of rupturing. This test, used in conjunction with other cholesterol screening tests can pinpoint your risk of a sudden heart attack with a much greater degree of certainty.

The test actually measures levels of an enzyme in your blood known as lipoprotein phospholipase A2. This enzyme is responsible for a process that can cause damage to your endothelial layer and set the stage for atherosclerotic plaques which can rupture and trigger a heart attack.

When your levels of Lp-PLA2 are elevated, it indicates that you have plaque that can rupture and create a blood clot that results in a heart attack or stroke.

The most current information we have tells us that using cholesterol levels to determine your risk of heart attack is not very accurate. However medical science has identified a process where LDLs (low density lipoproteins) and Lp-PLA2 particles undergo oxidation by free radicals.

These oxidized particles then attack the blood vessel wall causing damage and making the plaque deposits hard and brittle. This oxidized brittle plaque can then break off and cause life threatening problems such as a heart attack or stroke.

Lp-PLA2 is actually created in atherosclerotic plaques and thus can serve as a marker for inflammation in the artery wall. People who have heart disease show high levels of this marker (Lp-PLA2) which not only indicates they have plaque buildup, but also that the plaque is oxidized and can cause severe cardiovascular events.

Autopsies on patients who died suddenly of heart attacks showed ruptured plaques and high levels of Lp-PLA2 in their arteries.

This has also been see in patients who undergo surgery for carotid artery atherosclerosis. They show the same high levels of Lp-PLA2 that indicates a danger of rupturing plaque.

Those people who showed atherosclerosis of the carotid artery but did not show symptoms had much lower levels of Lp_PLA2. It’s clear from this evidence that this is a very significant and useful marker for predicting sudden cardiovascular events.

Studies done at the May Clinic also found that Lp-PLA2 was a specific indicator of dangerous plaques even in the absence of other risk factors. This indicates that it is inflammation and not merely cholesterol levels that create the risk of sudden heart attacks and stokes, so it is inflammation that we should address in our efforts to prevent heart disease.

Advantages of the PLAC test:

  • The test more accurately predicts the risk of sudden heart attack or stroke than other lipid screening tests.
  • The test directly measure lipoprotein phospholipase levels, a very accurate inflammation marker.
  • The PLAC test is the only medical screening approved by the FDA that indicates both heart attack and stroke risk in patients.
  • The test is relatively inexpensive and convenient.
  • The test can also be used to monitor a patients response to treatment and lifestyle changes.
  • The test is covered by Medicare and private insurance companies.
  • The test does not have to be taken in a fasting state.
  • The test can be used in patients that are currently using Pravachol, Benadryl, and Tylenol

Who should get the PLAC test and when?

Experts recommend a formula for determining who should get the test based on other risk factors and their estimate risk of sudden heart attack within a ten year period. This makes no sense to me at all. We have a test that can specifically identify people who are a high risk for a heart attack or stroke, before this actually happens and give them a chance to lower their risk.

I believe the PLAC test should be used as a standard cardiovascular screen test, because it targets the process that is actually dangerous, rather than cholesterol levels which don’t really give an accurate measure of your risk. Once the test has been done, all that’s left is to determine how to go about lowering the risk, by reducing the inflammation in your arteries.

As to who should have it done, it makes sense to me that anyone approaching middle age would be a candidate for it. Autopsies of US soldiers killed during the Korean War showed atherosclerotic plaques in the arteries of young men in their 20’s. Based on this it seems reasonable that the test could even be done on people in their early 20’s as a way of identifying people who may be at risk and giving them plenty of time to make the lifestyle changes needed to protect themselves.

People with metabolic syndrome which consists of the following:

  • obesity
  • abnormal blood lipid profile
  • elevated blood sugar
  • high blood pressure

are prime candidates for the PLAC test, as it is known that metabolic syndrome involves inflammation and thus raises the risk of heart disease.

The test can be done at followup intervals to verify the success of lifestyle changes and other interventions in terms of lowering the patient’s risk. While I claim no medical expertise, common sense suggests that this test be done early and the person then adapt their lifestyle, nutritional and exercise habits to mitigate this risk. That approach makes the most sense.

How to interpret the test results:

Even though the Lp-PLA2 test is much different than cholesterol screening tests, the levels are somewhat similar:

The 3 risk levels are:

Low:   under 200 ng/mL

Borderline:  200 to 235 ng/mL

High:  over 235 ng/mL.

Lp-PLA2 levels over 200 to 220 ng/mL indicate a very high risk of endothelial damage which in turn presents a very high risk of atherosclerosis.

Medical Interventions:

The PLAC test can be used to identify the magnitude of risk and also to determine how well the treatments used to combat it are working. This is why followup tests are important.

Statin drugs are said to provide a 20-30% reduction in Lp-PLA2 levels. The risk to benefit ration of statins is something you will have to discuss with your doctor.

Niacin used in combination with statins is reported to provide an additional 5 to 20% further reduction of the Lp-PLA2 enzyme.

Angiotensin-converting enzyme (ACE) inhibitors are also reported to lower Lp-PLA2 levels, and medical scientists have speculated that the effectiveness of all cardiovascular drugs may actually depend on their ability to successfully lower Lp-PLA2 levels

Niacin and omega 3 fatty acids (fish oil) also show an ability to reduce levels of Lp-PLA2.

Tumeric spice (also called circumin) has been found to reduce a form of phospholipase in animals, and thus may be of value to humans in reducing Lp-PLA2 levels, but the study results are not in on this yet. My guess is however that turmeric is most probably of value in human as well.

Conclusion:

Since heart disease is the nation’s number one killer, preventing it is vitally important to a long and health life. Medical screening tests such as blood pressure and cholesterol are not enough to accurately predict who is a risk for a heart attack or stroke.

The PLAC test is relatively inexpensive, non invasive, and very accurate in predicting who is at high risk for a sudden cardiac event like a heart attack or stroke. It really represents a cutting edge approach to identifying people at high risk and helping them make the changes that can save their lives.