Lipid Levels

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The standard lipid panel provides information about plasma concentrations of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and very low-density lipoprotein (VLDL) cholesterol. However, a patient who scores within the "average" ranges for these parameters should take little comfort because being average, in this case, means a greater than 50% likelihood of dying of heart disease.

Other lipids and lipid-related cardiovascular risk factors include Apolipoprotein A-1, Apolipoprotein B, and lipoprotein(a). Apolipoprotein A-1 is the major protein constituent of HDL cholesterol and is responsible for the activation of two enzymes that are necessary for the formation of HDL. This may be an important factor in the relationship between HDL levels and the incidence of atherosclerosis. Apolipoprotein B is the major protein found in LDL cholesterol. Studies suggest that this protein plays an important role in targeting the selective uptake of LDL by the liver. In a study examining lipids, lipoproteins, and apolipoproteins in individuals with angiographic evidence of coronary artery disease (CAD) and healthy patients, the strongest association with coronary artery disease was the ratio of apolipoptotein B:apo-lipoprotein A-1 (apo B=apo A-I).4 In a similar study, lipid parameters were evaluated in a lower-risk population with and without coronary artery stenosis to investigate the risk factors associated with increased risk of CAD. Total cholesterol and apo B=apo A-I ratio were significantly different between groups with and without CAD in men. In women, triglyceride, HDL, and apo B=apo A-I ratio were significantly different between the two groups. In the lowest quartile of total cholesterol, triglycerides and LDL, and the highest quartile of HDL, only apo B=apo A-I ratio was associated with CAD in both men and women; thus the only variable showing a significant difference between patients in men and women with and without CAD was the apo B=apo A-I ratio.5 Lipoprotein(a) isacomplex of Apolipoprotein A and LDL, and elevated levels are associated with an increased risk for atherosclerosis and cardiovascular disease. Lipoprotein(a) is similar to that of LDL in the development of atherosclerosis; it is localized in the blood vessel walls, then oxidized, and forms foam cells associated with atherosclerotic plaques. Lipoprotein(a) is also pro-thrombotic, a result of its inhibition of plasminogen activation along with its ability to stimulate secretion of plasminogen activator inhibitor-1 (PAI-1).

According to the recommendations of the National Cholesterol Education Program, these laboratory tests provide useful parameters for evaluating risk status for coronary heart disease (CHD). Both individual and stand-alone values and comparison ratios between individual components of the lipid panel provide information for classifying patients into low, medium, and high-risk categories. With regard to risk, so-called "normal" levels are derived from groups of patients with no obvious evidence of CVD and this, in itself, is inaccurate because such patients may have preclinical CVD and therefore do not reflect a true "no-risk" population. Cholesterol levels undergo considerable variation among individuals, with day-to-day values fluctuating by as much as 15%, while an 8% difference can be identified within the same day. Even positional changes can alter these values; recumbency can decrease cholesterol values by 15%.6 Although cholesterol is no longer considered to be such a significant culprit in CVD as much as in the past, great emphasis is still directed at reducing cholesterol blood levels. However, current research is aimed at examining the increased risk of having small LDL particles and a greater number of LDL particles, rather than look at the total weight of LDL, HDL, and total cholesterol. Also, examining the role of oxidized LDL has also taken on increased significance in assessing overall cardiovascular risk.

Alternative and complementary (ACM) practitioners utilize the lipid panel in much the same way as standard medical practitioners, but ACM practitioners utilize natural-based medicines with minimal side effects that are effective for lowering cholesterol, LDL, and VLDL, while elevating HDL over time. In addition, ACM practitioners have a larger arsenal for treating and preventing heart disease, which provides even greater benefit when combined with traditional statin drug therapy. The following plant-derived medicines are used to treat suboptimal cholesterol, HDL, LDL, VLDL, and triglyceride levels. It is essential from a clinical perspective to remember that cholesterol serves many essential purposes in the body as a pro-hormone building block for estrogen, progesterone, testosterone, corticosteroids, and vitamin D, and is incorporated in each of the cells within the human body. Cholesterol is certainly a risk factor yet, it should not be made the sole culprit since it is guilty in large part through association with other risk factors.

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