At my recent endo visit, it was brought up that I may benefit from cardiac calcium scoring. My risk factors are LDL cholesterol (135) outside of normal limits and total cholesterol (263) outside of normal limits, and of course, diabetes. BP is low, A1C 6, not bad- could be better. My diet is not LCHF; it’s moderate carb (~80 g daily with fats and protein).
How many of you have changed your diet and noticed a reduction in LDL and total cholesterol?
How many of you have changed your exercise routine and noticed improvements in your lipid profile?
Has anyone ever had the procedure, carduac calcium scoring, done? I have yet to wade through the literature on calcium scoring. If any of you have had experience, I’d be curious to hear your thoughts.
To get your cholesterol ratio, divide total cholesterol by HDL. Ideally, you want it to be less than 3.5-to-1. So even if your LDL and total are somewhat high, if your HDL is also high that helps.
My HDL is 117; my ratio is 263/117=2.25. Historically, my GP, endo were not concerned; the ratio has been good. The total cholesterol was barely above 200. Lately, it’s been closer to the mid 200’s. My triglycerides are 55. I recall reading somewhere that it was postulated that triglycerides levels are the better “predictors” of CVD, not cholesterol. The endo explained that the ratio and HDL theory is no longer the present thinking, and that watching the LDL level is very important.
There is a more precise test that is better. It measures the size of the LDL.
Having mostly small and dense particles is worse than when they are the large and fluffy particles. You can ask for an NMR (Nuclear Magnetic Resonance) Lipoprofile test.
According to https://en.wikipedia.org/wiki/Low-density_lipoprotein “Direct LDL particle measurement by NMR was mentioned by the ADA and ACC, in a 28 March 2008 joint consensus statement,[33] as having advantages for predicting individual risk of atherosclerosis disease events, but the statement noted that the test is less widely available, is more expensive [about $13.00 US (2015 without insurance coverage) from some labs which use the Vantera Analyzer[34]” $13 does not seem very expensive to me.
It was stated in the wikipedia article that:
“In 2008, the ADA and ACC recognized direct LDL particle measurement by NMR as superior for assessing individual risk of cardiovascular events.[15]” and
“Blood tests commonly report LDL-C: the amount of cholesterol which is estimated to be contained with LDL particles, on average, using a formula, the Friedewald equation. In clinical context, mathematically calculated estimates of LDL-C are commonly used as an estimate of how much low density lipoproteins are driving progression of atherosclerosis. The problem with this approach is that LDL-C values are commonly discordant with both direct measurements of LDL-particles and actual rates of atherosclerosis progression.”
The NMR is a direct measurement, whereas, the blood tests are indirect estimates. Which method would you prefer? I think it’s a no brainer.
Is the NMR test non routine and therefore difficult to obtain? My endo, (I have had to change because of insurance change) dismissed my request for the NMR lipoprofile and is recommending the cardiac calcium scoring
The former, I would imagine consists of obtaining a blood sample and performing NMR spectroscopy on the blood sample. The latter, a CT scan. I think the former is simpler than a CT scan.
I got my test results back. It’s interesting. I am glad I got it done.
One thing in there was a LP-IR score. The LP-IR score is an index they developed that has been associated with insulin resistance risk of getting type 2 diabetes.
Anyway, it was good news for me. Anything less than 27 is considered low, and I was < 25. My risk of getting Type 2 is practically nothing!
@Eric that’s a relief On a more serious note, if one were not Type1 or Type 2 yet, someone could obtain helpful information about risk; but what about those who are already Type 1 or Type 2?
The LP-IR is just an adjunct to the test. That part might be helpful for a non-diabetic. For me it was just interesting to see that they correctly calculated me as insulin-sensitive, because I really don’t use much insulin. So they got it right.
But the actual NMR lipo profile test itself is extremely useful for any adult diabetic. Since you probably get a lipo profile test anyway - since diabetics are an at-risk group - getting the NMR lipo is much better. It doesn’t just give numbers of LDL and HDL, but particle size. A much more precise measure of risk.
Since you have to give up the vial of blood for your endo anyway, to me it is a no-brainer, get the better test!
I highly recommend this for any adult who would be getting a lipo profile anyway.
@Eric, for reasons not made clear to me, my endo stated that I don’t need the NMR lipoprofile test, but instead the cardiac calcium score test. ( frustrated face)
That’s a completely different test of course, but there is no reason you couldn’t have both. It doesn’t have to be one or the other. Are you opposed to getting that test also?
Can you say you will do calcium scoring if he also writes the NMR-LP? Remind him he works for you.
The reason I support the NMR-LP is because it is only a vial of blood, there isn’t any downside for the person.
I agree- it’s easy, and most likely, not expensive. The calcium scoring seems like it would be a CT scan. Why would I want to subject myself to that? CT scan - Wikipedia
What are the risk/ reward, cost/benefit? To me, it is unclear if the calcium scoring is worthwhile.
It can be a useful test, but it depends on why your doctor wants you to do it. If there is a family history of heart disease or if he is worried about your cholesterol or things like that.
In your OP it looks like your LDL and total is a bit high. But your HDL and ratio are good, and your triglycerides are good.
Why is he pushing for this test?
Because he’s an endo, not a cardiologist. He knows that PWD’s have higher risk of heart disease. And your LDL and total are higher than ideal. And he deals with diabetics with heart problems all day long.
There is not a lot of risk to it. There is not a lot of radiation, if that is what your are worried about. It’s fairy simple.
I would tell him you’ll get it if you also can get an NMR-LP. Or get referred to a cardiologist and speak with him. But the cardiologist might also dump you into the “diabetic” bucket immediately.
If you are feeling somewhat rebellious and want to see how much diabetes is playing into this, you can go to a cardiologist, skip mention of diabetes completely on the forms (and don’t give your endo’s name as your primary care doctor), and after he advises you, then you tell him you are a diabetic, and see if it changes his recommendation.
All that aside, personally I would just tell him you want both the NMR-LP and calcium score.
On a more serious note, if one were not Type1 or Type 2 yet, someone could obtain helpful information about risk; but what about those who are already Type 1 or Type 2?
