Vail Daily health story: Mapping your blood
January 22, 2014
VAIL — I was not your typical candidate for high cholesterol.
I'm in my late 20s. I'm constantly biking, cross-country skiing, alpine skiing, rock climbing or running. I eat pretty healthy, aside from a debilitating weakness for chocolate and baked goods — but I try to keep it under control. I'm a healthy weight by almost any standard.
So you can imagine my surprise when the results of an intensive blood workup showed that I had a number of factors labeled "intermediate risk."
There was no need to go on medication or any need to panic over an imminent heart attack, but my numbers indicated there was room for improvement. With some tweaks to my lifestyle or diet, I could avoid potential problems down the road, said family physician Dr. Tim Kruse.
A typical lipid test you'll get at the doctor's office gives you four different numbers: total cholesterol, LDL, HDL and trigylcerides. For me, those numbers were very healthy. But this advanced blood workup further breaks down those numbers, giving you at least 10 other results that tell you what kind of HDL and LDL you have. That's where my results raised a number of yellow flags.
The test can also assess your risk for Type 2 diabetes, how you'll respond to certain medications as determined by your genetics, renal function, liver enzymes and how your blood clotting functions are doing.
Breaking it down
Kruse calls these in-depth tests premier prevention panels, but the in-depth cholesterol portion of these workups are commonly referred to as VAP (vertical auto profile) tests. They're becoming increasingly popular, although the jury is still out as to how the results should be interpreted.
"A normal blood workup would just look at your cholesterol numbers — it doesn't look at the details of the type of cholesterol. Some types of cholesterol are worse than others," said Kruse. "A typical physical will involve the basics. This goes several levels deeper."
LDL cholesterol goes cruising through your veins, and arteries and the larger type bump along without sticking to the walls, explained Kruse. It's the smaller particles that can get lodged in the sidewalls and create inflammation and blockage.
HDL, the "healthy" cholesterol, can help clear out LDL. While some of those numbers are determined by genetics, some can be raised or lowered through diet and exercise.
"Some people who have heart disease have normal cholesterol numbers (on the basic test). But you look closer at their inflammation levels, combine it with some bad genetics and it's a heart attack," Kruse said. "A lot of us march along when we're younger thinking we're invincible until we're 50 or 60, and suddenly you have these irreversible problems. I believe heart attacks can be prevented and that heart problems can be reversed."
A nutritionist recommended some diet changes that involved more healthy additions, rather than restricting any foods. She suggested adding certain foods that would help improve my healthy cholesterols, such as increasing my intake of omega-3 fatty acids and eating healthy fats such as those found in avocados and nuts.
With a fix that easy and good for my health in general, I wasn't going to argue.
And the diagnosis?
While Kruse prescribes the test for all of his patients as a matter of prevention, the jury is still out as to whether or not the in-depth lipid tests are helpful or how doctors should interpret the results.
Insurance doesn't cover the cost because there's no definitive research that making recommendations based on the results can prevent heart disease — yet. The cost isn't terrible: a regular lipid test costs less than $50, while most of the in-depth tests cost somewhere around $200. Kruse's all-encompassing panel that includes other results besides cholesterol costs somewhere around $300. Still, that's a price many patients are willing to pay for the information.
Dr. Dennis Lipton, general internist with Vail Valley Medical Center, said he orders the in-depth lipid test for patients who request it or for special case patients — for example someone who is a borderline high cholesterol case but doesn't want to go on medications.
Still, he said it's a promising idea and that he's very much in favor of preventative thinking.
"This test is good because it makes people think about it," Lipton said. "The earlier you intervene, the better. It's good to be aware, because if you follow the basic American diet, it's a recipe for a heart attack by the time you're in your 30s. But are we saving lives by checking this? At this point, the answer is 'No.' As of now, measuring these factors and intervening doesn't seem to prove that you can prevent a heart attack in the future."
Dr. Steven Yarberry, a Vail family medicine physician, called the in-depth tests "the wave of the future," but added that more information is needed before it will be widely accepted by physicians.
"Not everyone agrees the information is helpful. All of us use it to some extent as a new tool, but maybe not all the information about what the results mean has be gleaned," said Yarberry. "Not everyone agrees it's helpful. It might be in the future, we just don't know yet."
Assistant Managing Editor Melanie Wong can be reached at 970-748-2927 and firstname.lastname@example.org.