The Lipid Panel-Robert St. Amant, MD, FAAFP
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Transcript The Lipid Panel-Robert St. Amant, MD, FAAFP
THE LIPID PANEL
What are we missing?
Robert St. Amant, MD, FAAFP
Diplomate, American Board of Clinical Lipidology
Baton Rouge General
Medical Director, Lipid Center
Womack Heart Center
Conflict of Interest Statement:
Speakers Bureau for the following companies:
•
•
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Abbott Laboratories
CardioDx
Kowa/Lilly
Berkeley HeartLab
Clinical Investigator:
• CardioDx
Audience Objectives:
Have a better understanding of the standard lipid
panel and cardiovascular disease risks.
Be able to discuss the relationship between
cholesterol and lipoproteins and why patients with
normal lipid panels have cardiovascular events.
Explore more advanced cholesterol, biomarker,
and genetic tests available to enhance
cardiovascular disease risk assessment.
The Lipid Panel
Total Cholesterol
Triglycerides
HDLc
LDLc
…….What’s missing?
Cholesterol
Cell structure
Sex hormones
Bile acids
Vitamin D
Total Cholesterol
Structure
Sources
NCEP goal?
Triglycerides
Structure
Sources
Purpose
NCEP target
HDL cholesterol
Structure
Sources
Purpose
NCEP target
LDL cholesterol
Structure
Sources
Purpose
Primary NCEP ATPIII goal
Non-HDL Cholesterol
What???
“New” 5th lipid fraction
ALL BAD cholesterol, not just LDLc.
Atherogenic lipoprotein particles
Residual risk
Secondary NCEP goal: 30mg/dL above LDLc goal
NCEP ATPIII LDLc Goals:
CHD/CHD risk equivalents
Moderate CHD risk
Low CHD risk
Non-HDLc goal
TG primary goal
CVD Risk Factors
Smoking
Age >/=45M, 55F
HPT >/=140/90
Low HDL <40*
Family Hx CAD
Age <55M, <65F
* HDL >/= 60 is a
negative risk factor
Lipoproteins
Insolubility
Lipid trafficking vehicles
ApoA and ApoB
Interheart Study
ApoB/ApoA
ApoB Lipoproteins
Size
Composition
Atherogenic
Discordance
LDLc, LDLp, MIs
ApoA Lipoproteins
Protective
HDL cholesterol
Functions
Quantity vs Quality
HDLc vs HDLp
Protein Cargo
Atherosclerosis
Complex process
Progressive
Inflammatory
Endothelial dysfunction
Atheroma burden
Plaque rupture
Risk Factors
Lifestyles
Non-modifiable
Modifiable
Insulin resistance
Insulin Resistance
Definition
Diagnosis
Prevalence
70% of MIs
Treatment
Metabolic Syndrome
5 Criteria
3/5 = diagnosis
1/3 adults
Screening
CAD & DM risks
Looking Beyond the Lipid Panel
Using Selected Biomarkers
Not for low risk patients
Diligent risk evaluation
Residual risk on statin therapy
Advanced Cholesterol Testing
Beyond the lipid panel
Not for everyone
Intermediate and high risk patients
Affordable
Part of “What’s Missing?”
Lp(a)
LDL particle with an apo(a) protein
Very atherogenic
Disrupts process of fibrinolysis
MI/stroke risk
CV events with normal lipids
Lp-PLA2
Enzyme on LDLp
Rapid plaque formation
Prone to rupture
MI / stroke risk
Treat BP/meds
SLCO1B1 Genotype
Gene variation for OATP
Increased level statin drug
Myalgia risk
Statin “intolerance”
Thank You!
Questions?