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Done fasting blood test. No family history of diabetes. Should I be concerned about IR score or cardiovascular risk?

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My last fasting blood test showed an insulin-resistance score of 44 and a blood-glucose level of 89. I have no biological family history of diabetes. Should I be concerned about the IR score of 44 or my cardiovascular risk? I have a family history or early heart disease. Below is more information.

My LDL was 94 (down from two years ago), my HDL was 47 (up). Trigl: 108 (down)

LDL particle count (around) 1450...high range
LDL size: (around) 470 ...normal range

No thyroid problems shown in blood test.

My weight is 164, height 5'10''. I have recently lost over 40 lbs in just under a year. My blood pressure has also dropped and averages at between 95 and 110 OVER 55 to 75.
Posted Wed, 5 Sep 2012 in Hypertension and Heart Disease
Answered by Dr. Michelle Gibson James 2 hours later

There is a syndrome called metabolic syndrome which is present , increases your risk for heart disease, stroke and full blown diabetes. It is used to assess cardiovascular risk.
Metabolic syndrome is basically just some risk factors that are put together and a person is said to have it if they have at least 3 of the factors.
The risk factors are as follows:

1)insulin resistance ( your body is fighting its own insulin, this may present with prediabetes where a person does not have diabetes but has a tendency towards it. This is diagnosed if your fasting blood sugar is greater than 100.
A person is also said to be positive for this factor is they are actually being treated for diabetes.
Your blood sugar is 89 which means you do not have this risk factor.

(2) elevated blood pressure (greater than 130/85) or treatment for hypertension. Your readings are lower than this, so this risk factor is also absent.

(3)triglycerides greater than 150mg/dl or receiving treatment for high triglycerides. Your value at 106 is good and also means this risk factor is absent.

(4) HDL level of less than 40 in men (less than 50 in women) or receiving treatment for low HDL. Your value is 47 and therefore above what is required, so good.

(5)waist circumference greater than 102 cm in men ( if the male is of asian descent greater than 95 cm). I am unsure about this one though you mentioned that you had loss some weight recently.

So for sure you do not have at least 4 of the risk factors and cannot be diagnosed with metabolic syndrome which implies that your cardiovascular risk is not elevated at present.

In terms of the LDL values , an LDL of 94 is excellent and a normal LDL particle size is good because the smaller they are , the more XXXXXXX

In summary, at this present time , you are doing well with low risk, keep it up, its difficult for alot of other people.

I hope this answers your questions, feel free to ask any additional questions
Above answer was peer-reviewed by
Follow-up: Done fasting blood test. No family history of diabetes. Should I be concerned about IR score or cardiovascular risk? 30 minutes later
Is it true that the LDL particle count doesn't matter as much as long as the particle size is large? In other words, can I "blow off" a moderately-high/borderline LDL particle count if the size appears to be essentially large? Though, not to be complacent.
Answered by Dr. Michelle Gibson James 1 hour later

LDL particle size and number are two of the relatively new methods used to assess cardiovascular risk.
They are particularly useful in persons who are thought to be at high risk for cardiovascular disease. This is determined by the risk factors mentioned above, there are also additional risk factors that can be checked for completeness.
I didn't mention them before because you were negative for the major ones.

These are [1] determined by the presence of cardiovascular disease like peripheral vascular disease ,diabetes or abdominal aneurysm- where the aorta which is one of the largest blood vessels has cholesterol plaques and may weaken and burst [2]the age of the person- greater than 45 yrs for men [3]smoking [4] high blood pressure [5] an HDL less than 40.
These factors are also used when interpreting cholesterol results to determine if the person is high risk, moderate risk or low risk. The total number of factors present are calculated then if the person has a history cardiovascular disease - they are called high risk.
If they don't have a history of cardiovascular disease and have 2 or more risk factors then a special scale (called Framingham) is used to calculate 10 yr risk of a cardiovascular event. These persons need to aim for an LDL of less than 130
If you have o to 1 risk factors then the LDL should be less than 160.

The American diabetic association and the American College of Cardiology are unsure if the importance of the LDL particle size vrs number. They believe the number is probably important but they think that more research is needed on particle size.
So the count is important as well.
LDL particle number results can differ from the LDL cholesterol result because each LDL particle can carrry a different amount of cholesterol.
Even though your LDL particle size is in the higher range , the fact that the other risk factors are either absent or low is protective and indicates low risk.

LDL particle number can be lowered by using a diet low in saturated and trans fat, increase the use of healthy fats (mono and polyunsaturated), using alot of fruits and vegetables and physical activity. In some cases medication may be used.

Feel free to ask anything else
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