Yesterday, I wrote about the basic premise of the June 2013
Men's Journal article "The New Guide to Heart Health" in which the author quotes a cardiologist making a recommendation to "Upgrade Your Cholesterol Test". The author suggests checking out your
ApoB,
VAP and/or
PLAC results. I'd put up
Berkeley Heart Lab against VAP as they both purport to provide more indepth analysis of your
LDL cholesterol. However, one of the basic ideas that we stress to our family medicine residents is to do something because it will make a difference, not just because you can.
So would I actually recommend any of these tests as first line diagnostics? Absolutely not! Why? If your LDL is high (above your goal as calculated by
Framingham,
Reynolds Risk, or
QRISK2), what additional information will these $50-100 tests give you/me? How will it change your management? You'll still need to change your
nutrition anyway. You'll still need to
exercise regularly anyway. Do you really need to pay $50-100 per blood test to tell you that? Do you really need an $800
coronary artery calcium scan to tell you to get off your
fat ass?
OK, so let's take it to the next level. Let's say that you're low risk for heart disease (less than 10% over the next 10 years) and you've managed to meet your goal LDL of less than 160mg/dL. Now what? Should you get one of the tests? I would posit that you should really aim for a goal LDL of less than 70mg/dL (considered optional for those at highest risk of heart disease). After all, why wait until you've finally had an event to tell you that your goal LDL
is now less than 70mg/dL. Only after you've reached that goal would I recommend additional testing.
In other words, if you know that
heart disease is the number one killer in both women & men, why would you accept a "good enough" LDL? And even though we accept that LDL is only part of the picture when it comes to heart disease, what will these $50-100 blood tests and $800 CAC scans tell us to do? Lower our LDL!!!
Stick around one more day as I answer the question: which statin is best?
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