“I see a lot of people being confused,’’ says Dr. Nieca Goldberg of New York University Langone Medical Center and the American Heart Association. Especially when they’re used on lower-risk people, “you don’t know how to make sense of the information.’’
Yet up to half of patients diagnosed with heart disease apparently had normal levels of LDL cholesterol, and some doctors say particle testing might help find some of them sooner.
“For most people, the standard lipid profile is fine,’’ says Dr. Michael Davidson of the University of Chicago. But “I get referred people who said, `My cholesterol was fine, why do I have heart disease?’ We’re showing them, well, because your particle number’s sky high and they were not aware that was a problem.’’
Davidson chaired a committee of the National Lipid Association which this month called the extra tests reasonable to assess which at-risk patients might need to start or intensify cholesterol treatment. That committee’s meeting was paid for by a grant from eight pharmaceutical companies, including some makers of particle tests.
Cholesterol isn’t the only factor behind heart disease. High blood pressure, smoking, obesity, diabetes or a strong family history of the disease can put someone in the high-risk category even if their cholesterol isn’t a red flag. Some doctors also are testing for inflammation in arteries that may play a role, too.
On the cholesterol front, doctors have long focused on three key numbers:
—Total cholesterol should be below 200.
—An LDL or “bad’’ cholesterol level below 130 is good for healthy people, but someone with heart disease or diabetes should aim for under 100.
—For HDL, the “good’’ cholesterol that helps control the bad kind, higher numbers are better — 60 is protective while below 40 is a risk.
