What’s in Your Blood?

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It’s common knowledge these days that a crucial part of a physical checkup is a blood test. And for the prevention of heart disease, it’s important to know one’s cholesterol levels – how much LDL (low-density lipoprotein, or “bad”) cholesterol and HDL (high-density lipoprotein, or “good”) cholesterol is in the blood. Another significant measurement is the blood level of triglycerides, the major type of fat found in the body.

Recently, however, the American Diabetes Association and the American College of Cardiology Foundation convened a conference to examine the best way to manage levels of blood lipids (a category that includes cholesterol and triglycerides). The two organizations have a shared interest in this issue because of the high risk of that accompanies diabetes. The conference featured speakers and intensive discussions, and then a seven-member panel of experts released a consensus statement.

The panel members agreed that people with high HDL cholesterol levels tend to experience less heart disease, although they acknowledged the difficulty of determining whether just raising HDL cholesterol is enough to prevent cardiovascular disease. They also concurred that high LDL cholesterol is a major predictor of cardiovascular disease and that high LDL cholesterol may have even greater adverse effects in people with diabetes. The panel cautioned, however, that measuring HDL cholesterol can be tricky in some people and might not always accurately measure the likelihood that a person will form plaque in the lining of the arteries. So they looked at another blood marker, ApoB (apolipoprotein B, which is the protein part of LDL). After reviewing the evidence, the panel determined that measuring ApoB does have value for people with certain cardiovascular risk factors such as overweight, Type 2 diabetes, high cholesterol, and high blood pressure – especially those who are using statins to help lower their cholesterol. In addition, the panel said that ApoB levels can serve as a guide for managing and adjusting therapy.

Testing for ApoB involves a simple blood test and doesn’t even require fasting, although it’s usually included as part of a general blood test, so most people will fast before it anyway. But a separate blood test isn’t required just for ApoB. Now that these new recommendations are in place, your doctor might order a new lipid test beyond the usual ones for cholesterol and triglycerides.

Originally Published November 4, 2010

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