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Lipid profile test showed high levels. But treadmill test showed normal. Started diet adjustment. Which indication is right?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
Recently I've done my lipid profile test. Following are the result
Cholestrol - 308, Triglycerides - 390, LDL - 155 , HDL - 41
cholestorl/HDL ratio - 7.5, LDL /HDL - 3.8
Since the levels are high, I've done Tread mill test as well but it was very normal. My age is 37 and my father had mild heart attack at the age of 55 yrs.
Doctor has advised me to go for TONACT-TG for 2 months and do a test after that.
I've started on the diet adjustment and regular excercise as well. Please advice me whether I've a high risk of getting cardiac problems . Do I need to continue statin medicine even if the test after 2 months gives positive results ? If tread mill test shows normal results , what does it indicate ?
Posted Tue, 22 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 10 hours later
Hello Mr GV Tharakan,
Thank you for your query.

As you have rightly pointed out, the total cholesterol, triglycerides and the LDL cholesterol levels are all high. HDL cholesterol level (the good cholesterol) is acceptable.

The target values are as follows:

Total Cholesterol < 200mg/dl
Triglycerides <150mg/dl
LDL cholesterol <130 mg/dl
(If you are a diabetic, the LDL cholesterol should be less than 100 mg/dl, and if there are multiple cardiac risk factors, unstable Coronary Artery Disease, kidney disease and very high cardiac risk, then the value should be less than 75mg/dl. There are experts who strongly believe that Indians as a race are strongly predisposed to heart disease and thus, stricter LDL limit of < 75mg/dl is better!)

Since you have a family history of heart disease and since you are an Indian male with high cholesterol levels, you are at a higher than normal risk for developing coronary artery disease, cerebrovascular disease and peripheral vascular disease.

Treatment should consist of dietary regulation, daily exercise and drugs. You also need to monitor and control your blood sugar, BP, weight and avoid exposure to smoking (active and passive).

Tonact TG is a good drug which combines atorvastatin and fenofibrate to control LDL cholesterol (bad cholesterol) and triglycerides.

You need to repeat a fasting lipid profile towards the end of two months, while still on the drug. Based on the values, the drug dosage will need to be adjusted further. You will probably need to continue the medicine for a longer period of time. The important thing is to keep the cholesterol values as low as possible and within the target values to prevent disease later on.

A negative treadmill test indicates that you have a low probability of having significant obstructive coronary artery disease. Significant disease is usually defined as having major blocks of more than 70% severity.

It does not predict the probability of heart attacks (which can occur with even 40% to 60% blocks, when blood clots suddenly after coming into contact with cholesterol deposits after a break in the inner lining of the coronary artery).

Unfortunately, there is no practical test at the moment to identify these "vulnerable plaques" that can produce heart attacks. Prediction of heart attacks and strokes are currently based on risk estimation depending on age, gender, race, smoking, diabetes, hypertension, lipid abnormalities and family history. The best way to reduce risk is a multi-pronged approach focussing on diet, exercise, drugs and lifestyle modification to target the "modifiable" risk factors. (You obviously cannot prevent getting older, being a male, change your genes or your parents!!)

I hope this answers your query. Feel free to ask me any clarifications that you may require.

With regards,
Dr Raja Sekhar Varma, MD, DM,
Consultant Interventional Cardiologist
Above answer was peer-reviewed by
Follow-up: Lipid profile test showed high levels. But treadmill test showed normal. Started diet adjustment. Which indication is right? 13 hours later
One another observation is that when I did a blood test 3 months before for taking up an term insurance , the report showed less Triglyceride value (178 )and low fasting sugar value ( 88) and higher HDL value ( 58), total cholestrol ( 281). Can these values vary like this . Before taking the lipid profile do I need to 15 hrs of fasting ( even without water ). Can you clarify whether I need to go one more lipid profile.

Also I want to know whether I need to go for Echo or CT ?
Answered by Dr. Raja Sekhar Varma 19 hours later
Thank you for the query.

The lipid profile has to be done on a fasting basis. Ideally, around 10 hours of fasting is enough (usually, overnight fasting after dinner, and blood test done the next day morning). It is better to have absolute fasting, though sips of water will not matter.

Diet can influence the triglyceride levels a lot. These changes can come within 3 months also.

Needless to say, the test should be done properly in a good, standard lab using direct estimation of lipid levels. Some labs measure only total cholesterol, triglycerides and HDL cholesterol and calculate the estimated LDL and VLDL levels. This can be erroneous.

It is also known that there is a lot of variability in the test results depending on the weather (in the cold season, you may get lower values), gender, liver function, thyroid function, blood sugar levels, etc.

Thus, it becomes necessary to perform the test at a standard, quality-conscious lab with good accreditation and internal/external quality control. Fasting is important. Blood sampling and processing should be standardized. There should not be technical errors in loading the auto-analyzer. The kits used should have been standardized and machines calibrated properly. There should not be too much delay in processing the sample.

Since the total cholesterol and LDL appear to be high in both the reports, and since you have started on medication, it is better to wait for 2 months and then recheck your lipid profile. Do not stop the medication prematurely. The medicine will need to be modified/dosage adjusted after the lipid profile result.

Sine the treadmill test is negative, there is no immediate necessity of doing an echo or CT angiogram, unless there is strong clinical suspicion of heart disease, other uncontrolled cardiac risk factors and symptoms of chest pain, breathlessness on exertion, palpitations or giddiness. Since the echo is a non-invasive, cheap and harmless investigation, there is no harm in doing an echo either. But angiogram, whether conventional or CT, is reserved for those with appropriate symptoms, strong, multiple uncontrolled risk factors and positive stress test.

I hope this answers your query.
Please accept my answer if there are no further clarifications.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
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