Hello Ms XXXXX,
Thank you for the query.

I understand that you have high hsCRP, homocysteine and lipoprotein levels. You have not mentioned the type of lipoprotien. You have not mentioned the exact levels either. Both are important for estimation of risk. I also understand that you have had elevated cholesterol levels in the past. Again, the values of the subtypes are not available.

From the details given, it is apparent that you are at an increased risk relatively for cardiovascular, cerebrovascular or peripheral arterial atherosclerotic disease. This is a relative risk, not really an absolute risk. The level of risk would also depend on the exact levels of these parameters as well as other co-existing risk factors like diabetes, hypertension, dyslipidemia, exposure to smoke, family history of atherosclerotic disease, diet, sedentary lifestyle, obesity, etc.

hsCRP can be increased whenever there is any inflammation or infection. Homocysteine levels are influenced by food. There are different types of lipoproteins and the risk will vary depending on the exact type that is increased.

Hence, you can see that the interpretation of these results has to be taken in relation with the clinical history, family background, physical examination and the other relevant investigations. Only then can an appropriate risk estimation be done.

The treatment of these conditions would depend on the levels of the parameters and can be easily accomplished with diet, exercise and certain simple medicines, which can be prescribed by your physician after a thorough evaluation. Follow-up estimation of these levels while on treatment will ensure that control has been achieved.

I hope this answers your query. Feel free to ask me for any further, specific clarifications.

Thanking you,
Yours sincerely,

Dr Raja Sekhar Varma, MD, DM
Conultant Interventional Cardiologist

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Hello,
Thank you for the reply and the details of the results.

On examining the values, it is found that the hsCRP, Homocysteine and lipoprotein (a) values are indeed mildly elevated.

hsCRP levels >0.3mg/dl is considered high risk. Your value is lesser than this. Also, this parameter is taken in conjunction with the lipid parameters which are all normal in your case. Hence, all that you need to do now is to follow a low-fat diet and monitor lipid levels once in 3 months. Statins like rosuvastatin or atorvastatin would have been indicated if the LDL values were more than 100mg/dl, or if you had established atherosclerotic disease. AS of now, probably, they are not indicated.

Homocysteine values more than 15micromol/L are abnormal. Again, if you are a pure vegetarian or even otherwise, the first step should be to assess serum vitamin B12 levels. If this is abnormal, it should be corrected appropriately. In the absence of other major risk factors and disease, all you need to do to correct this marginal elevation of homocysteine is to take a diet that is XXXXXXX in folic acid, vit B6 and vit B12 like fruits and vegetables, especially legumes. Vit B12 may need supplementation for most vegans. After one month, a repeat value of serum homocysteine levels should be obtained and if the values are persistently high, Vitamin pills may be taken to correct the same. There are specific formulations of vitamins designed to reduce homocysteine levels.

Lipoprotein (a) is also mildly elevated. Again, this is not a major elevation and the lipid parameters are normal. In fact, the target of treatment itself is to reduce the level to less than 50 mg/dl. In the absence of elevation of conventional lipid parameters, family history of atherosclerotic disease, established coronary/cerebrovascular disease, and no other prominent risk factors, treatment of lipoprotein (a) may not be indicated and may not achieve much benefit. If required, extended release niacin may be used. Statins also might help. There are other drugs, but they remain experimental and are not indicated now.

I hope this answers your query.
With regards,
DR Raja Sekhar Varma, MD, DM
Consultant Interventional Cardiologist

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