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Personalized Program
The program involves three steps:
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Step 1 – basic risk assessment |
The first step in this risk assessment program follows the latest treatment guidelines of the Adult Treatment Panel of the National Cholesterol Education of the National Institutes of Health (step 1). This assessment is based on a comprehensive metabolic profile of 22 tests to rule out other problems (e.g. liver, kidney, thyroid disease, or gout), age, gender, systolic blood pressure, smoking history, diabetes history, heart disease history, and a further 3 measurements of fasting total blood cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol. Low density lipoprotein (LDL) cholesterol is then calculated (valid only if the triglyceride level is below 400 mg/dl) by the formula: LDL cholesterol = total cholesterol – HDL cholesterol - triglyceride/5. Non-HDL cholesterol is calculated using the formula: Non HDL Cholesterol = total cholesterol – HDL cholesterol.
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Step 2 – your history and specialized risk markers |
The second step of the program is based on your history and specialized direct measurement testing of twelve additional, very important, laboratory parameters of heart disease risk:
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direct LDL cholesterol |
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small dense LDL cholesterol |
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VLDL cholesterol |
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lipoprotein(a), Lp(a) |
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apolipoprotein (apo) A-I (the major protein of HDL) |
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apoB (the major protein of LDL and VLDL) |
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C- reactive protein, CRP |
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lipoprotein protein associated phospholipase or LpPLA2 |
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insulin |
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NT-proBNP or N-terminal pro-Brain natriuretic peptide |
Evidence has shown that these tests provide significant additional information about heart disease risk and allow for better risk assessment and treatment decisions.
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Step 3 – Specific heart disease risk assessment and treatment optimization |
The third tier of testing is designed specifically for patients who already have evidence of heart disease (heart attack, angioplasty, bypass, narrowing of coronary arteries, or a high heart CT calcium score), stroke, or peripheral vascular disease, or have diabetes, or are at very high risk of
heart disease (> 20% ten year heart disease risk).
This testing specifically examines HDL subpopulations which are important for removing cholesterol from the artery wall by a complex “2- Dimensional Gel Electrophoresis” method that separates your good HDL cholesterol into five sub fractions. This Boston Heart HDL MapTM technique allows us to optimize HDL raising treatment. This third tier of testing also measures markers of cholesterol production and absorption in the body, by gas liquid chromatography, which allows us to optimize LDL lowering treatment.
Finally, we also measure specific gene markers of heart disease risk and blot clot formation using genotyping. This testing is only done at Boston Heart Laboratory in Framingham, MA.
This third and final stage of testing is designed to optimize treatment in people at the highest level of risk, especially those who already have evidence of heart disease. Measuring these parameters allows us to help heart disease patients optimize their treatment with such agents as statins which inhibit cholesterol production, ezetimibe which inhibits cholesterol absorption, fenofibrate and gemfibrozil which enhance the breakdown and metabolism of triglyceride, niacin products which increase the production of HDL, and fish oil which decreases the production of triglycerides.
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