FUDiabetes

Coronary Artery Calcium Scores

The NMR is the best, since it gives the particle diameter which is important.

Here are a couple of useful writeups:
http://mainheartclinic.com/2011/05/cholesterol-particle-size/

https://www.docsopinion.com/2013/10/20/ldl-cholesterol-particle-number-particle-size-made-easy/

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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 :frowning:

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.

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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!

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@Eric that’s a relief :slight_smile: 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?

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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.

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@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? https://en.wikipedia.org/wiki/CT_scan#Scan_dose

What are the risk/ reward, cost/benefit? To me, it is unclear if the calcium scoring is worthwhile.

Any thoughts?

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. :frowning:


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. :face_with_raised_eyebrow:


All that aside, personally I would just tell him you want both the NMR-LP and calcium score.

Great suggestion.

That’s being playful with the doctors. Some of them have no sense of humor, some are ok. :slight_smile:

I think it is a reasonable thing to do if you lay the cards on the table after and explain the reason. “I wanted to see if the recommendation would be different for a diabetic versus a non-diabetic. How much of this is because I am a diabetic?” etc.

The doc might not like it, but I think it is a valid question.

I have, it is a type of CT scan. My GP ask that I do it because it is painless and relatively inexpensive. Mine cost 99 dollars. Most insurance does not cover it. This test was of extreme value to me, it identified that I have some pretty hefty build up in my arteries. The down side was that it led to more testing.

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Thanks for the helpful feedback. Did you also have the NMR lipoprofile done? I think Eric’s suggestion that both be done is a prudent one. What additional testing was conducted, if you don’t mind my asking. I’d just like to be aware of what I’m getting myself into. And is the bottom line, statin medication, or could lifestyle changes positively impact the “hefty build up” in your arteries?

No I did not have the NMR lipoprofile done, it was not offered. My calcium score test came back extremely high. I also had a stress test and an arteriogram. No arteries met the requirements for intervention but a couple were close.

I know that statins can be a controversial subject. I had resisted the notion that if you are diabetic you should be on them but being faced with these test results I realized that I actually did need them. Lifestyle changes can work and was part of my plan but I am close to needing stents in two arteries, I need all the help I can get.

The calcium score test opened my eyes., it is a good screening tool.

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Thank you for the feedback. Are your numbers better now? Did a cardiologist work with you on ordering and interpreting the stress test and arteriogram or an endocrinologist? I will likely proceed with the calcium score and hopefully the NMR lipoprofile as previously suggested by Eric.

One nice thing to add about the NMR-LP, it tracks your history graphically. Instead of just seeing the numbers, every subsequent test shows which way you are going. I think that can be helpful.

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Bingo! I’m a firm believer that a single data point is far less helpful than seeing a trend, graph…etc.

Hey, from your HDL and ratio and tri numbers, it sounds like you are doing a lot correctly. Not sure where you are from an exercise standpoint, but if you need anything there, let me know.

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@Eric- yes! For “quite awhile” I was pretty motivated to exercise about twice weekly at a high level, cardio, weight/resistance training for up to an hour. Overall, minimum of 3x, 20 minutes.

Lately with the colder weather, I’ve been less motivated. I continue to work on large muscles, glutes, quads; less upper body workouts. “Workout” is about 3 sets of squats, side abductors, reverse lunges. Sometimes - 2 sets of 12 pushups. Is this “adequate”? FYI - I do not go to the gym, I’ve tried it, not my cup of tea. There is an outdoor fitness park where I live. I’ve used it since the fall, until the cold weather and I use it less frequently.

Your thoughts/recommendations?

I have posted before on why exercise is so helpful. This is just a quick list of the benefits:
why-should-i-exercise

The exercises you listed are certainly helpful to overall well-being. Keeping a strong core with those types of exercises is great for maintaining skeletal and muscular strength.

But do you know the most important muscle to exercise? Your heart, of course. Exercising your heart will also benefit your entire cardiovascular system (capillary density & mitochondria) and your lungs, as well as your heart.

And whenever you exercise your heart there is some area of muscles that is also getting a workout - arms, legs, or both.

The list of things you described are beneficial but are not enough to give your heart a sufficient workout. You need to maintain a higher heart rate for a period of time for your heart and cardio system to get enough benefit.

So there needs to be something you can do that gets your heart rate up consistently for a period of time. You can start slow with walking, or jogging. Or cycling, or a stationary bike. A rowing machine or swimming. You need to find something that you enjoy (or at least can tolerate) enough to keep you doing it consistently.

For the heart benefits there really aren’t any shortcuts. It takes a certain amount of time several times a week. It will take dedication.

We can get into specifics if you would like. Things like heart rate and duration and so forth. And you should discuss certain safety limits with the doctor you visit if you do a calcium score test.

The benefits are huge though. You can watch your insulin requirements drop and your insulin uptake speed increase, and if you are interested in weight loss that can happen too.

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