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What Does My Lipid Panel Test Report Indicate?
Question: Hi
In 2014 I had Nonocclusive Plaque present in the right carotid artery bulb. I was doing really good with my heathy life style. I had my Lipo Panels check every 6 months and they were always good.
Then on Oct. 13 2016 They found Nonocclusive Plaque present in the right and left carotid artery bulb. My Lipid panel on Oct. 13 2016 was:
A1C 5.2-Non HDL Cholesterol 95-Lipidpro Protein LDL-P 1311-Lipidpro Insulin Resist LP-IR score 33-Lipidpro Disb Risk HDL Size 8.9-Lipidpro Diab Risk VLDLD Size VLDL levels not sufficient for VLDL size determination-Lipidpro Diab Risk Small LDL-P 612-Lipidpro Diab Risk Large VLDL_P 0.8-Lipo P Total HDL 29.7- Lipo P Small LDL 612-Lipo P Large HDL 3.9-HDL Cholesterol 46-Trig 53-LDL 85
What would you do? I am really unhappy because I try so hard for two years. I eat a plant base diet no meat just fish. Please let me know Thank You XXXXXXX
In 2014 I had Nonocclusive Plaque present in the right carotid artery bulb. I was doing really good with my heathy life style. I had my Lipo Panels check every 6 months and they were always good.
Then on Oct. 13 2016 They found Nonocclusive Plaque present in the right and left carotid artery bulb. My Lipid panel on Oct. 13 2016 was:
A1C 5.2-Non HDL Cholesterol 95-Lipidpro Protein LDL-P 1311-Lipidpro Insulin Resist LP-IR score 33-Lipidpro Disb Risk HDL Size 8.9-Lipidpro Diab Risk VLDLD Size VLDL levels not sufficient for VLDL size determination-Lipidpro Diab Risk Small LDL-P 612-Lipidpro Diab Risk Large VLDL_P 0.8-Lipo P Total HDL 29.7- Lipo P Small LDL 612-Lipo P Large HDL 3.9-HDL Cholesterol 46-Trig 53-LDL 85
What would you do? I am really unhappy because I try so hard for two years. I eat a plant base diet no meat just fish. Please let me know Thank You XXXXXXX
Brief Answer:
please provide more details
Detailed Answer:
Dear Sir
Before I elaborate more on your query, I would like you to provide a few more details.
1. Kindly provide exact detailed report of your carotid Doppler scan. Please provide a snapshot or PDF of your blood report, as it is somewhat confusing when you write it as a paragraph without exact units and reference range.
2. Please also provide your usual blood pressure. If you take medicines for diabetes, high blood pressure or any chronic illness. Do you smoke? Do you take statins? What is your weight and height.
Waiting for your reply
Sincerely
Sukhvinder
please provide more details
Detailed Answer:
Dear Sir
Before I elaborate more on your query, I would like you to provide a few more details.
1. Kindly provide exact detailed report of your carotid Doppler scan. Please provide a snapshot or PDF of your blood report, as it is somewhat confusing when you write it as a paragraph without exact units and reference range.
2. Please also provide your usual blood pressure. If you take medicines for diabetes, high blood pressure or any chronic illness. Do you smoke? Do you take statins? What is your weight and height.
Waiting for your reply
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hi, I exercise 6 days a week for approx. 1hr to 1 1/2 hr. at a time. My weight dropped from 195 and now I weigh 163lbs. I have never smoked! I do not drink any alcohol I never have! My blood pressure goes from 125/72 to 116/68. In 2014 my AC1 was 6.2 and now my AC1 is 5.2. I am not on any medication except Prilosec for silent gastritis. I am very active at work I never sit down walking the entire day and bending and reaching kind of a work out in itself. However I do run a business and it is very stressful, that is really what I believe my major downfall is. I have been in a Heart Program for the last two years and get my lipid panel checked every three months but now go every six months. I am extremely frustrated because I have been working so hard and why is this happening?
Two years ago my Doctor wanted to put me on LIPITOR® (atorvastatin 10mg and I refused and now I have it in my left carotid artery bulb and he said my right is slightly thicker than it was in 2014. He told me if I did not take it in 2014 that he would find more later. He says that is always the case. I was afraid because Lipitor has a lot of side effects and sometimes can make you get diabetes. And I do not want that, but if I would have listen to him maybe it would not be in my left carotid today. I forgot to tell you I take a multi vitamin and Nordic naturals omega-3 1280mg fish oil and 300mg coQ10 cholestoff plus 4 soft gels a day and 500 mg vitamin B12 with folic Acid and Biotin 5000mcg. He going to want to put me on the Lipitor for sure now so what would you do? Have you never heard of PTX sustain? DR. XXXXXXX Walters has this and his place is call http://wyyyyyyyyyyy.com/ and they do infusion therapy. I forgot to tell you I have thalassemia minor.
Two years ago my Doctor wanted to put me on LIPITOR® (atorvastatin 10mg and I refused and now I have it in my left carotid artery bulb and he said my right is slightly thicker than it was in 2014. He told me if I did not take it in 2014 that he would find more later. He says that is always the case. I was afraid because Lipitor has a lot of side effects and sometimes can make you get diabetes. And I do not want that, but if I would have listen to him maybe it would not be in my left carotid today. I forgot to tell you I take a multi vitamin and Nordic naturals omega-3 1280mg fish oil and 300mg coQ10 cholestoff plus 4 soft gels a day and 500 mg vitamin B12 with folic Acid and Biotin 5000mcg. He going to want to put me on the Lipitor for sure now so what would you do? Have you never heard of PTX sustain? DR. XXXXXXX Walters has this and his place is call http://wyyyyyyyyyyy.com/ and they do infusion therapy. I forgot to tell you I have thalassemia minor.
Brief Answer:
please see details.
Detailed Answer:
Dear Sir
1. You have provided a report of carotid scan of 2014. This is not a recent report.
2. You have not uploaded any blood report of your lipid profile as requested.
I have following observations to offer in this scenario.
a. Your LDL cholesterol is 85mg%, HDL cholesterol is 46mg% and VLDL is 10.6, non-HDL cholesterol is 95mg% and HbA1c is 5.2. Your LDL particle count is 1311.
b. You have a plaque in right carotid artery as per the report, the stenosis severity of which has not been mentioned. You have also developed a plaque in left carotid artery recently.
c. I do not agree with the statement that any plaque in carotid artery increases risk of future cardiovascular (CV) events i.e. heart attack or stroke by 2-4 times like diabetes. As per NCEP guidelines (ATP III, 2002), Only symptomatic carotid artery stenosis is considered a high risk condition. For your ready reference, I have copied the relevant paragraph of text below from the NCEP guidelines.
Identify presence of clinical atherosclerotic disease that confers high risk for coronary heart disease (CHD) events (CHD risk equivalent):
■ Clinical CHD ■ Symptomatic carotid artery disease ■ Peripheral arterial disease ■ Abdominal aortic aneurysm.
We consider Carotid artery disease to be significant if it causes more than 49% stenosis by diameter. Not all plaques confer same risk.
d. As per current ACC risk calculator your risk scores is 3.5%. I would have calculated your Qrisk score too but you have not provided your height as requested. The cut-off to start statins is a risk of >7.5%.
e. Recent guidelines including ACC 2013 and NCEP 2014 do not recommend use of omega3fatty acids, folic acid, bioton, Co-enzyme Q, Viamin B12 in management of dyslipidemia and we do not use them in any of our patients.
f. We do not start statins in this kind of lipid profile unless the obstruction in carotid arteries is more than 49%.
g. LDL particle count has not been a target in above mentioned guidelines. Only 2012 guidelines of XXXXXXX association of clinical endocrinologist mention about them but they state that role of statin in managing these particles needs to be evaluated and they should not be used for routine testing. We do not use them as targets as yet.
h. I do not know about PTX sustain but there is no role of Any kind of Chelation therapy in our current practice of cardiology. Some guideline recommend them for severely symptomatic patients who do not respond to standard therapy. But they have uncertain benefit. They are not found to effect natural history or decrease future events and they are not indicated for asymptomatic patients.
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
please see details.
Detailed Answer:
Dear Sir
1. You have provided a report of carotid scan of 2014. This is not a recent report.
2. You have not uploaded any blood report of your lipid profile as requested.
I have following observations to offer in this scenario.
a. Your LDL cholesterol is 85mg%, HDL cholesterol is 46mg% and VLDL is 10.6, non-HDL cholesterol is 95mg% and HbA1c is 5.2. Your LDL particle count is 1311.
b. You have a plaque in right carotid artery as per the report, the stenosis severity of which has not been mentioned. You have also developed a plaque in left carotid artery recently.
c. I do not agree with the statement that any plaque in carotid artery increases risk of future cardiovascular (CV) events i.e. heart attack or stroke by 2-4 times like diabetes. As per NCEP guidelines (ATP III, 2002), Only symptomatic carotid artery stenosis is considered a high risk condition. For your ready reference, I have copied the relevant paragraph of text below from the NCEP guidelines.
Identify presence of clinical atherosclerotic disease that confers high risk for coronary heart disease (CHD) events (CHD risk equivalent):
■ Clinical CHD ■ Symptomatic carotid artery disease ■ Peripheral arterial disease ■ Abdominal aortic aneurysm.
We consider Carotid artery disease to be significant if it causes more than 49% stenosis by diameter. Not all plaques confer same risk.
d. As per current ACC risk calculator your risk scores is 3.5%. I would have calculated your Qrisk score too but you have not provided your height as requested. The cut-off to start statins is a risk of >7.5%.
e. Recent guidelines including ACC 2013 and NCEP 2014 do not recommend use of omega3fatty acids, folic acid, bioton, Co-enzyme Q, Viamin B12 in management of dyslipidemia and we do not use them in any of our patients.
f. We do not start statins in this kind of lipid profile unless the obstruction in carotid arteries is more than 49%.
g. LDL particle count has not been a target in above mentioned guidelines. Only 2012 guidelines of XXXXXXX association of clinical endocrinologist mention about them but they state that role of statin in managing these particles needs to be evaluated and they should not be used for routine testing. We do not use them as targets as yet.
h. I do not know about PTX sustain but there is no role of Any kind of Chelation therapy in our current practice of cardiology. Some guideline recommend them for severely symptomatic patients who do not respond to standard therapy. But they have uncertain benefit. They are not found to effect natural history or decrease future events and they are not indicated for asymptomatic patients.
Hope this helps.
Feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
No I gave you 2014 and 2016 and gave you all my blood work from Oct. 3 2016 Oct 7 2016 and Oct 13 2013 you are not reading everything!
Brief Answer:
observations are same.
Detailed Answer:
Dear Sir
My apologies for not scrolling the pages down in your report.
I have read the detailed report. However, there is no mention of exact percentage of plaque stenosis. If it is less than 50% as possibly meant by non-occlusive, my observations remain same.
Please feel free to discuss further.
Sincerely
Sukhvinder
observations are same.
Detailed Answer:
Dear Sir
My apologies for not scrolling the pages down in your report.
I have read the detailed report. However, there is no mention of exact percentage of plaque stenosis. If it is less than 50% as possibly meant by non-occlusive, my observations remain same.
Please feel free to discuss further.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Is my Lipo panel good? You did not say. I think it look ok, what do you think of my blood work and Lipo panel?
Please let me know
Thanks XXXXXXX
Please let me know
Thanks XXXXXXX
Brief Answer:
good lipid profile.
Detailed Answer:
Dear Sir
Please refer to XXXXXXX d and f of previous reply. Your lipid profile is very good looking at the conventional parameters. Although LDL particle (total and small) are out of range, the guidelines have not accepted them as targets and we do not know much about the benefit of therapy which can be used to specifically target them (as I discussed in detail previously).
If this glucose level of 105mg% is fasting, then it indicates impaired fasting glucose and you must watch your calorie intake and bod mass index. However, It does not seem alarming as your HbA1c is very good.
Hope this helps.
Sincerely
Sukhvinder
good lipid profile.
Detailed Answer:
Dear Sir
Please refer to XXXXXXX d and f of previous reply. Your lipid profile is very good looking at the conventional parameters. Although LDL particle (total and small) are out of range, the guidelines have not accepted them as targets and we do not know much about the benefit of therapy which can be used to specifically target them (as I discussed in detail previously).
If this glucose level of 105mg% is fasting, then it indicates impaired fasting glucose and you must watch your calorie intake and bod mass index. However, It does not seem alarming as your HbA1c is very good.
Hope this helps.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Why do USA Doctors always want to put you on statins? I don't know if got my info on my height which is 5'9 and my weight is 163lbs. How fast does plaque build up? I Lost 30lbs. I run everyday and I eat mostly plant base diet with fish. I have a little cheese and I drink almond milk. I just do not get it.
Please let me know.
Thanks XXXXXXX
Please let me know.
Thanks XXXXXXX
Brief Answer:
All is well. Talk to ultrasonologist.
Detailed Answer:
Dear Sir
1. I can not make a comment on choice of your physician.
2. Your Qrisk score is 5.5%. That means out of 1000 men with profile similar to yours, 55 will have heart attack or stroke in next 10 years. Mind it! it is an assumption based on previous data. Surprisingly this risk is lesser than aged match controls. The cut-off for starting statins on basis of this score is 10%. Hence, statins are not indicated.
3. I would request you to talk to your ultrasonologist who performed the carotid scan and get exact degree of stenosis caused by the plaque and also get his views on the statement that any plaque increases the risk of CV event 2-4 times.
4. There is no fixed rate of plaque building. Nor the size of plaque is only significant thing. Much more plaques which are below the limit of criticality (i.e. 70% stenosis for coronary arteries) rupture to cause heart attack then those with more than 70% stenosis. Still, medical therapy (aspirin and statins) for prevention is indicated for patients with plaques more than 50% stenosis only. In others, only aggressive life style modification and, if indicated otherwise, statins are recommended.{ These statements in this para pertain to plaques in coronaries (blood vessels of heart)}.
5. Medical sciences have not found out a test as yet which can predict occurrence of heart attack because as yet we can not predict that which plaque will rupture and when. You have good lipid profile, normal weight for your height and good exercise habits. Keep it up.
Sincerely
Sukhvinder
All is well. Talk to ultrasonologist.
Detailed Answer:
Dear Sir
1. I can not make a comment on choice of your physician.
2. Your Qrisk score is 5.5%. That means out of 1000 men with profile similar to yours, 55 will have heart attack or stroke in next 10 years. Mind it! it is an assumption based on previous data. Surprisingly this risk is lesser than aged match controls. The cut-off for starting statins on basis of this score is 10%. Hence, statins are not indicated.
3. I would request you to talk to your ultrasonologist who performed the carotid scan and get exact degree of stenosis caused by the plaque and also get his views on the statement that any plaque increases the risk of CV event 2-4 times.
4. There is no fixed rate of plaque building. Nor the size of plaque is only significant thing. Much more plaques which are below the limit of criticality (i.e. 70% stenosis for coronary arteries) rupture to cause heart attack then those with more than 70% stenosis. Still, medical therapy (aspirin and statins) for prevention is indicated for patients with plaques more than 50% stenosis only. In others, only aggressive life style modification and, if indicated otherwise, statins are recommended.{ These statements in this para pertain to plaques in coronaries (blood vessels of heart)}.
5. Medical sciences have not found out a test as yet which can predict occurrence of heart attack because as yet we can not predict that which plaque will rupture and when. You have good lipid profile, normal weight for your height and good exercise habits. Keep it up.
Sincerely
Sukhvinder
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Dr. Sukhvinder XXXXXXX
I have Nonocclusive plaque present in the right and left carotid artery bulbs. My Doctor says it would be good to go on atorvastatin 10mg for prevention so it will not get bigger. Two years ago I only had it in my right carotid artery bulb and now two years later I have it in my left carotid artery bulb. That is why he thinks it a good idea to go on atorvastatin 10mg. What do you think?
Please let me know
Thank you XXXXXXX
I have Nonocclusive plaque present in the right and left carotid artery bulbs. My Doctor says it would be good to go on atorvastatin 10mg for prevention so it will not get bigger. Two years ago I only had it in my right carotid artery bulb and now two years later I have it in my left carotid artery bulb. That is why he thinks it a good idea to go on atorvastatin 10mg. What do you think?
Please let me know
Thank you XXXXXXX
Brief Answer:
please see details below
Detailed Answer:
Dear Sir
A preventive measure has to be based not upon the simple logic but also upon the medical evidence. There are so many changes in body which take place with time. Some of them may lead to disease but we do not take medication for all of them. Like our aortic valve gets thickened with age and may lead to significant obstruction requiring replacement. But we do not do anything for it unless there is serious obstruction. Our prostate size also increases with age but we do not take medications or undergo surgery unless there are symptoms. Nor we take medications to control its size unless there is evidence of obstruction.
Guidelines say that STATINS should be given for symptomatic carotid artery disease or they can be given for prevention, once obstruction in carotid artery is >50% by diameter stenosis. We do not have a recommendation to start it below that cut-off. Neither there is evidence that it will be beneficial. Because none knows that if a given obstruction of say 10% will ever reach level of significance or not. Hence the person can not subjected to disadvantages (side effects and economic burden) of drug without proven benefit of therapy.
I hope I am clear in my stand.
Sincerely
Sukhvinder
please see details below
Detailed Answer:
Dear Sir
A preventive measure has to be based not upon the simple logic but also upon the medical evidence. There are so many changes in body which take place with time. Some of them may lead to disease but we do not take medication for all of them. Like our aortic valve gets thickened with age and may lead to significant obstruction requiring replacement. But we do not do anything for it unless there is serious obstruction. Our prostate size also increases with age but we do not take medications or undergo surgery unless there are symptoms. Nor we take medications to control its size unless there is evidence of obstruction.
Guidelines say that STATINS should be given for symptomatic carotid artery disease or they can be given for prevention, once obstruction in carotid artery is >50% by diameter stenosis. We do not have a recommendation to start it below that cut-off. Neither there is evidence that it will be beneficial. Because none knows that if a given obstruction of say 10% will ever reach level of significance or not. Hence the person can not subjected to disadvantages (side effects and economic burden) of drug without proven benefit of therapy.
I hope I am clear in my stand.
Sincerely
Sukhvinder
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. REMY KOSHY
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