To battle the epidemic of south Asian heart disease current literature calls for all south Asians over the age of 25 years to begin routine screening with a traditional blood cholesterol (lipid) panel. However what is not common knowledge is that there are a few additional blood tests available, not included in most standard lipid panels, that may provide important additional information about a south Asian’s risk of developing cardiovascular disease. A traditional cholesterol panel include:
Total Cholesterol (TC), Low Density Lipoprotein (LDL), High Density Liprotein ( HDL) and Triglycerides ( TRG).
Ideal levels of these tests for south Asians are published in the South Asian Heart Disease Guidelines. While these data are very important and often sufficient to guide physicians on which patients should be started on cholesterol reducing drugs ( i.e. statins, niacin, fibrates, etc), for south Asians additional blood tests ( or biomarkers) may be obtained to better guide risk management. These biomarkers are associated with a complex multi-step process leading to the development of diffuse plaque buildup known as “Atherosclerosis“. Given south Asians have the highest proportion of heart disease compared to any other ethnicity, additional testing of such biomarkers may be indicated and worth further discussion with your physician.
IMPORTANT BIOMARKERS TO CONSIDER IN EVERY SOUTH ASIAN’S LIPID PANEL:
1. LIPOPROTEIN A, Lp(a): Normal value is < 20mg/dL. Lp(a) is a circulating protein that resembles LDL cholesterol but also consists of another glycoprotein called “Apo( a) “. Many studies have shown elevated Lp(a) levels to correlate with future cardiovascular events (i.e. heart attacks). Currently there is no drug that directly reduces Lp(a). Elevated Lp(a) levels may identify south Asians in need of more aggressive lifestyle and cholesterol reducing therapy.
2. HIGH SENSITIVITY C-Reactive Protein (hs-CRP): Normal value is < 3mg/L. CRP is a systemic inflammatory marker widely studied and proven to be a predictor of cardiovascular events in otherwise asymptomatic patients. It has been particularly found in South Asians to correlate with metabolic syndrome (a condition that leads to diabetes and heart disease). Elevated CRP may suggest south Asians in need of more aggressive lifestyle and cholesterol reducing therapy.
3. LDL PARTICLE SIZE: “The Bigger the Better” LDL cholesterol differs in size and density. There is the small and dense pattern vs. the large and non-dense pattern. The small and dense LDL cholesterol is associated with higher rates of cardiovascular events (i.e. heart attacks). It is also found with metabolic syndrome, diabetes, high triglycerides and lower HDL cholesterol levels. Small and dense LDL cholesterol may suggest south Asians in need of more aggressive lifestyle and cholesterol reducing therapy.
4. HOMOCYSTEINE: Normal value is < 13mmoL/L. Homoscysteine is a an amino acid. There is mixed data regarding its efficacy as a heart disease biomarker. Several studies have linked elevated homocysteine levels to heart disease, however other studies have found no correlation. Therefore at present time an elevated level of homocysteine may or may indicate the need for more aggressive lifestyle and cholesterol reducing therapy.