Advanced Lipid testing for the Assessment of Cardiac Risk

1. Advanced Lipid testing for the Assessment of Cardiac Risk Tara Dall, MD Advanced Lipidology Delafield, Wisconsin Diplomate, American Board of Clinical Lipidology July 17. 2008

3. Picture perfect Health Normal lipid panel Normal BP, no identifiable heart disease risk factors Meet Barb age 55 Body for Life Champion

4. But she had “Normal Cholesterol”, BP, no heart disease risk factors The question is: did she have the right test? Barb Suffered aMassive Heart Attack at age 59

5. 75th 75th 50th 50th 25th 25th Large VLDL-P Medium VLDL-P Small VLDL-P IDL-P Large LDL-P Small LDL-P Large HDL-P Medium HDL-P Small HDL-P LDL Particle Numbers Near or above optimal nmol/L Optimal Borderline-high High Very High LDL particle 2148 Optimal is <1000 She appears to have had a risk factor after all LDL-P 1600 - 2000 2148 <1000 1000 - 1299 1300 - 1599 >2000 nmol/L Optimal Moderate Borderline-high High Small LDL-P 1522 <1200 600 - 849 850 - 1200 <600 Lipids Near or above optimal mg/dL Optimal Borderline-high High Very High LDL-C 125 <100 101-129 130 - 159 160 - 200 >200 mg/dL mg/dL mg/dL Total Cholesterol HDL-C Triglycerides 46 78 187 Subclass Particle Numbers VLDL Subclasses LDL Subclasses HDL Subclasses P E R C E N T I L E

6. D.S. Low HDLFirst NMR LipoProfile test LDL-P = 2219 (optimal <1000 nmol/L) Small LDL p 2049 All three lipoprotein indicators of metabolic syndrome present Risk Identified

7. D.S. Low HDL Follow Up NMR LipoProfile test 3 months later LDL-P was 2219 nmol/L (optimal <1000 nmol/L) + Advicor 1000/40 mg LDL-P now is 1044 nmol/L Risk Managed

8. LDLparticle 3002