The most sophisticated lab for understanding cholesterol and heart disease risk

As science progresses, the level of understanding of cardiac risk factors and special testing continues to improve. Many leading health experts believe that the Nuclear Magnetic Resonance Lipoprofile (NMR) test is the most sophisticated lab for understanding cholesterol numbers and heart disease risk.

Most physicians are quite familiar with standard lipid panels that look at lipoprotein ratios. Lipoproteins are protein based molecules that carry cholesterol to and from the liver and the various cells of the body. We have several different types of lipoproteins including low-density lipoprotein (LDL - C), high density lipoprotein (HDL - C) and very low lipoprotein (VLDL-C).

Most people associate LDL-C and VLDL-C as the "bad cholesterol" and HDL as the "good cholesterol" but this isn't necessarily the case. These are all good cholesterols as they play vital roles in hormone production, healing and cellular regeneration. However, the LDL and VLDL subtypes are highly vulnerable to oxidative stress. When the body has chronic inflammatory processes these subtypes will be oxidized, leading to atherosclerosis of the arteries.

The NMR versus typical lipid panels

The NMR uses advanced spectroscopy to uniquely provide rapid, simultaneous and direct measurement of LDL particle number and size, as well as a direct measurement of HDL and VLDL subclasses. This detailed lipoprotein particle information allows clinicians to make more effective individualized treatment decisions as compared to standard lipid panel testing.

This test looks at the standard lipid panel with LDL-C, HDL-C, triglycerides and total cholesterol levels. It also looks at the overall number of LDL particles (LDL-P). This test also breaks the LDL particle into two sizes of large and small LDL particles.

Small, dense LDL particles have fewer anti-oxidants and are associated with a much higher risk of atherosclerosis. Large, boyant LDL particles are rich in anti-oxidants and present a much lower risk of oxidizing than the small, dense LDLs.

So the two major NMR numbers that are associated with atherosclerotic risk include the total LDL-P and the total small LDL particles. Someone may have high LDL on a standard lipid panel and yet have low LDL-P and small LDL particles giving them very low risk of cardiovascular disease. On the flip side, someone may have normal or "healthy" LDL on the standard lipid panel but have high LDL-P and small LDL particles making them at high risk for cardiovascular disease.

How to interpret the NMR lipid profile

The most important number to assess on the NMR is the total LDL-P. The higher the total LDL-P and small LDL particles, the greater the risk for cardiovascular disease. Optimal levels of LDL-P on the NMR test are under 1000 nmol/L.

Near optimal: 1000 - 1299 nmol/L
Borderline - High Risk: 1300-1599 nmol/L
High Risk: 1600-2000 nmol/L
Very High Risk: Greater than 2000 nmol/L

The NMR also measures small and large LDL levels. Normal or healthy ranges for small LDL particles are under 750 nmol/L. Anything above this is a high risk. Anything above 1500 nmol/L is at extremely high risk. Researchers noted that elevated small LDL particle count alone can raise heart attack risk by up to 300 percent and heart attack risk is 600 percent higher when elevated C-reactive protein is also present.

Who should get an NMR test

One would use the NMR test because it provides a more accurate picture of cardiovascular (CVD) risk than the standard lipid panel. According to a major study, 50 percent of the people who suffered a heart attack had normal cholesterol levels. If you have any of the conditions listed below, the NMR LipoProfle test may be right for you:

• Diabetes
• Previous heart attack
• Family history of heart attack
• High blood pressure
• Overweight/Obesity
• Cardiometabolic risk
• Metabolic syndrome
• Low HDL (dyslipidemia)
• High triglycerides