As most of you know I love thinking about cholesterol disorders and using nutrition to improve health. Over the years I’ve explored options in testing that provide a deeper look into a patient’s risk for heart disease. This is considered a non-standard approach by some of the national guidelines, but I’m frustrated by the “Take your medicine and stop asking questions” attitude I find in these publications. I believe having more data helps patients and doctors make better decisions about their lives.
I break down these additional studies into three categories. First, advanced cardiovascular bio-markers can help us understand the number of risky particles floating around in the blood stream. Tests like LDL particle number (LDL-P), Lp(a), and Apolipoprotein B are some examples. These particles have been shown to be more reliable in assessing risk than the standard LDL-C measurement across a range of patients, although in certain situations the LDL-C which is found in the standard lipid panel is still a reliable surrogate. In addition to the particle numbers, there are several tests available to measure the amount of inflammation that could be attributable to plaque formation in the arterial wall. Lp-Pla2 is a test that helps to narrow the range of inflammation assessment to just that which is coming from the arteries and plaque build up.
I’m excited to announce that we’ve recently partnered with Boston Health Diagnostics to bring these labs to our patients at a more affordable price point. As with all our other labs in Trinity DPC, I offer these labs at a discount which can be as much as 60-90% off the retail price. These tests are used as needed for each individual patient and not every patient needs the testing.
Second, I use an ultrasound study of the carotid arteries called a Carotid Intima-Medial Thickness (CIMT) test. This shows the soft and hard plaque building up in the arterial wall. If the blockage is big enough it shows the reduction of blood flow to the brain also. This test is available on a monthly basis for $150.
Lastly, a Coronary Calcium score is a CT scan of the beating heart that shows calcium build up, or plaque, in the coronary arteries. A score of zero means that no calcium was seen. This is the best result. As the number climbs so does the amount of plaque in the arteries. Zero scores correlate with low risk of heart attack and strokes in certain populations. These tests are $99 at local imaging centers in town.
It’s always amazing to me to consider how inexpensive testing becomes when you exclude insurance from the situation. Think about getting a CT scan of the beating heart for under $100 while a CT scan of the stationary kidney is $2500 just because the insurance company interferes with the pricing by dictating reimbursement.
If you’re interested in your risk and finding out when these tests would be good for you to have done, just let me know next time you’re in the office. As I said, I love talking about lipid disorders, assessing patients’ risk, and reversing problems with the three pillars of good health: good nutrition, good exercise, and good sleep.