Cholesterol Testing Not Enough for Some

Test for Protein Called ApoB Better Measure of Heart Attack, Stroke Risk
By Salynn Boyles
WebMD Medical News
Reviewed by Elizabeth Klodas, MD

March 27, 2008 -- People at high risk for heart attacks and strokes may need even more aggressive cholesterol control than is currently recommended, experts now say.

In a joint statement released Thursday by the American Diabetes Association (ADA) and the American College of Cardiology (ACC), the experts concluded that measuring LDL, or bad, cholesterol may no longer be the best measure of heart health in these patients.

The panel found that once LDL cholesterol is lowered to recommended levels in high-risk patients, testing for the protein ApoB may more accurately identify those still at risk for cardiovascular events.

If ApoB levels are high, patients may need more aggressive lifestyle interventions or larger doses of lipid-lowering statin drugs, even if LDL cholesterol levels are within normal range, the panel concluded.

"LDL measurement is still very important," ADA Vice President of Clinical Affairs Sue Kirkman, MD, tells WebMD. "But for high-risk people who are on statin therapy it may not be enough to get LDL down below 100 or even 70."
LDL and ApoB

Achieving an LDL of below 100 milligrams/deciliter is now widely recommended for patients with two or more risk factors for heart disease and for those with diabetes but no other major heart disease risk factors.

Guidelines call for a target LDL at or below 70 for patients with established heart disease or diabetes with additional risk factors for heart disease.

These risk factors include high blood pressure, tobacco use, and family history of heart disease.

While aggressive cholesterol treatment has contributed to reductions in heart attacks and strokes, these events are still common among high-risk patients who reach the target goals, Kirkman says. This could occur if other cholesterol particles that contribute to risk are still elevated.

ApoB is a molecule that is present in all the cholesterol particles that significantly contribute to the development of atherosclerosis (also known as plaque or hardening of the arteries). The hope is that measuring ApoB will help patients and their doctors better gauge actual risk because ApoB will be a more accurate measure of the total number of all artery-clogging particles (not just LDL). There is growing evidence that ApoB levels are a better indicator of heart risk than total cholesterol or LDL.

For this reason, the joint panel recommends a target ApoB level of less than 90 for high-risk patients without established heart disease and less than 80 for the highest-risk patients with heart disease or with diabetes and other cardiovascular risk factors.
Statins and Lifestyle

The report could lead to more aggressive treatment of high-risk patients with lipid-lowering statins, but the panel concluded that more research is needed to confirm the benefits of this approach.

The group also called for public health initiatives aimed at promoting lifestyle changes that reduce cardiovascular risk.

Kirkman says patients and their doctors often focus on drug treatments, forgetting that lifestyle changes can also have a big impact on risk.

"It is important to remember that lifestyle is a big part of this," Kirkman says. "Getting patients to improve their diets, stop smoking, and exercise are all critical. It isn't all about drugs."

Healthy Habit No. 13: Plan

There is, perhaps, no better word in the English language to better illustrate how you can incorporate healthy habits into your everyday life.

"A little planning goes a long way," says Johnson. "Eating healthy never happens by accident."

For the most part, neither do good fitness, skin protection, healthy teeth, weight loss, and social ties. Many of these habits take effort that need to be scheduled into busy lives.

To eat healthy, for example, it would help to set aside time to draft a menu, make a grocery list, go to the store, prepare meals, and pack breakfast and lunch.

Healthy Habit No. 12: Take a Daily Walk

We already mentioned the merits of exercise in habit No. 5. Now, here's a tip on how to incorporate physical activity into your daily life: WALK.

We're not talking about taking the time out of your busy schedule to work out -- that's important, too -- but infusing life- and limb-saving movement into your waking hours.

"Just move. Pace during phone calls, while you're brushing your teeth, while watching your son's soccer game," says Bryant, noting that every 20 steps a person takes is 1 calorie burned.

An eight-year study of 13,000 people also showed that people who walked 30 minutes daily had a significantly reduced chance of premature death compared with those who rarely exercised, reports the American Council on Exercise.

And there are plenty of opportunities to move those legs:

* Take the stairs instead of the elevator.
* Walk to the store.
* Window shop at the mall.
* Leave your desk and visit your co-worker instead of sending him an email.
* Walk and talk with friends instead of meeting for a meal.

Healthy Habit No. 11: Drink Tea

"Decaffeinated tea is better," says Fleming, noting that the caffeinated variety can be dehydrating, and sugary drinks can lead to weight gain.

There is some evidence that tea may help in improving memory, and preventing cavities, cancer, and heart disease. Fleming says, though, that the overall research is still inconclusive.

"There may well be some beneficial effects of tea, particularly the potential antioxidant effect, but we don't have great data on that right now that is that specific."

However, there's no doubt that a cool iced tea can be a refreshing treat during hot days. Try flavoring your tea with juices, fruits, cinnamon sticks, ginger, and other condiments.