Lipids and Cardiovascular Risk

At 7x7 Health, we go beyond the traditional lipid panel of total cholesterol, LDL, HDL, and triglycerides. While these can be very useful, they either only tell part of the story or are not interpreted in the most optimal way. We believe that apolipoprotein B (apoB) levels should accompany all lipid tests levels and that all patients should be screened for elevations of lipoprotein a (LPa). This data can also be combined with measures of inflammation, a known cause of blood vessel damage. Taken together, with a detailed personal and family history, we create much clearer picture of individuals’ risk of heart disease, stroke, and other vascular diseases.

Lipid and Cardiac Tests

  • LDL has traditionally been called the “bad” cholesterol, while HDL is considered to be “good” or protective. This is an oversimplification of the true mechanisms by which lipids cause damage to blood vessels. It turns out that the compound that actually causes the thickening and hardening of the blood vessel walls through buildup of plaques (atherosclerosis) is called apolipoprotein B (apoB). In human bodies, the majority of apoB is bound to LDL - in this way, measuring LDL levels is an indirect way of measuring the apoB concentration I the blood. HDL, by comparison, carries apolipoprotein A (apoA), which helps remove cholesterol from the blood vessels and reduce inflammation and damage.

  • Because apoB is directly implicated in the development of atherosclerosis in the blood vessels of the heart, brain, and other organs, we think it is a superior biomarker to LDL cholesterol. Reducing apoB, either through diet or cholesterol-lowering medications, is known to reduce the risk of death from cardiovascular causes.

  • Lp(a) is a unique form of LDL which is known to be especially damaging to arteries and valves of the heart. It has a linear association with heart attack, stroke, and aortic valve stenosis (the higher the level of Lp(a), the higher the risk of those diseases). Approximately 20% of people have elevated Lp(a) levels, which is known to be genetically inherited. Lp(a) levels don’t fluctuate much and while there are clinical trials underway for medications to reduce it, currently there is no approved treatment to lower it for prevention. Patients should have this test done once during their life, and, if elevated, take steps to optimize all other parameters of cardiovascular risk.

  • It has long been understood that the damage caused by lipids in the arteries is related to the inflammation that they cause - immune cells trying to repair the damage, cause inflammation and scaring, resulting in plaques that can narrow and occlude critical arteries. We combine tests for inflammation such as high-sensitivity C-reactive protein (hs-CRP) and homocysteine alongside lipid tests.