Basic lipid profile, statin not enough

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Dear Pharmacist: I saw Dr. Oz interview a doctor on television about cholesterol. The guest said your total cholesterol doesn't matter and I read that in your book six years ago. Suzy, I take a statin, and do a lipid profile annually. Is this OK? — M.D., Austin, Texas

Dear M.D.: No, it's not OK, and I'm about to shock everyone (unless you've read my books). Recently I wrote a column about LDL and that we should not necessarily strive to lower it. We need to know the type and number of LDL particles. For example, Lipoprotein A, or Lp(a), and Apolipoprotein B, or Apo B, are two subtypes of LDL that are not measured in the basic lipid profile. These particular scores directly affect your cardiovascular risk.

Statins are not very effective in reducing LDL particle number or Apo B.

It's confusing because studies conclude statins reduce total LDL. And yes, they do reduce "total" LDL; they are also excellent anti-inflammatories so they are not completely without merit. But I'm bent on you reducing Lp(a) and Apo B, the subtypes known to raise heart attack and stroke risk.

I'll never submit myself for a routine lipid profile because it would waste my money. If your results show a low LDL (considered the bad particle), then you may assume you're OK. But a low total LDL score doesn't say much. Your triglycerides might be through the roof! You may have a huge concentration of dangerous Lp(a) and Apo B. Likewise, you may be happy with your high HDL cholesterol score (considered a good cholesterol), but what if you have the wrong kind of HDL particles? Yeah, some HDL is bad. Then you'd still be at very high risk.

The better tests, sometimes covered by insurance, measure particle size, type and sometimes the actual number of LDL and HDL particles. I urge you to ask your physician to order tests from Berkeley HeartLab, a leader in this field. There's also the VAP Test by Atherotech Diagnostics and the NMR LipoProfile by LipoScience.

This is not intended to treat, cure or diagnose your condition. Go to

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