super high HDL

Dear Dr:
I posted this once on the expert form but didn't pay so here it is again.  This time I paid.,

I'm 52 yr. old female.  I'm at least 3 years into menopause and do not take hormones and am not overwieght.  I just got the results from my Berkeley Heart Test back.  The results are as follows:

Total Cholesterol:  300
LDL:  110 (mostly large buoyant particles but some small dense)
HDL:  182  (large particle)
Triglycerides:  40

The test also yields some specialized genetic information that I'm not real clear on but is as follows:
ApoE genotype 3/4
KIF6 genotype   719 Trp/Arg heterozygous

I also had a calcium score that was 0.

Anyway, my Dr. said he wasn't sure what to do, if anything, but was uncomfortable not treating a total cholesterol of 300.  His recommendation is for me to take a low dose of Lipitor.   I've always had high HDL, about 130, but it really shot up when I started taking fish oil, which I take for its general health benefits.   I've always heard that you want your HDL as high as you can get it.  Is that really true?   Should I stop taking fish oil?  By the way, I don't think I'm going to take Lipitor.  

[Lee Kirksey, MD]

The berkely heart panel is a tool to help generate a risk profile on a given patient when used in combination with individualized patient historical information including lifestyle and family history. It really should be ordered by a physician who is caring for you and then interpreting the information in light of your broad medical condition. In an ideal world if we all exercised for 30 minutes at least five times per week and ate a low fat plant based diet and did not smoke--the heart panel would merely help to identify people who had high risk genetic conditions which required aggressive medication treatments because lifestyle modification is not enough

In general tests like berkely heart panel are overused and make no significant impact on patient care because clinicians dont really understand how to interpret the statistical modeling

[Ruthiejb]

Hi greendor,
I know this is the Expert's Forum and I'm not an expert, but I recently had a cholesterol test done like you and learned some things since then.  I found out that I am, like you, APOE 3/4.  I didn't know what it meant so I looked it up and was upset to learn that if you are a 3/4 you are at higher risk for heart disease and for Alzheimer's.  APOE 4 isn't necessary or sufficient to develop Alzheimer's but 40-60% of people who have Alzheimers's have the 3/4 or 4/4 genotype (4/4 increases your risk even more than 3/4).  It has something to do with how your body processes cholesterol and fats.  Normal APOE genotype is 3/3 which is approx. 68% of the population; APOE 3/4 is approx. 15-20%.  I was very upset when I learned this as I never asked my doctor to do a DNA test on me and I didn't know he was having it done.  My fraternal twin developed coronary artery disease at age 59 (we're now 60), but I always thought it was because of her poor lifestye (sedentary and lack of exercise), but now I think she also may have the APOE 4 gene.  People with this genotype respond well to low fat diets and it's believed that they do not respond as well to statins as other genotypes except maybe for simvastatin (which I'm on).  Your calcium score is excellent and I recently learned that a calcium score is an excellent predictor for future heart problems, so you're in good shape there as well as your high HDL which is believed to be protective.  It's also great that you have mostly large & buoyant LDL.  After I got over the shock of learning my genotype, I became stricter with my diet; I read that carbs are not heart-healthy (even whole grains), so I've greatly lowered my carb intake (not sure if that's the right thing to do, though).  I don't know what the other genotype tests you had mean.  It bothers me very much that my doctor ordered this test without my knowledge, and when I asked him about it, he had no idea of the Alzheimer's link.  He only said it  tells him what meds to prescribe for me.  I'm still upset but trying my best.  I've also added 500 mg. Niacin to my regimen (to start), plus I've been taking baby aspirin and I've always exercised consistently.  No one in my family has ever had Alzheimer's and, again, this gene is neither necessary nor sufficient to develop AD, but it has been linked.  I hope this helps and that I haven't upset you.  I don't believe your doctor should have ordered this test without telling you exactly what it meant first.  The good news is also that you definitely can decrease your risk for heart disease and your numbers look pretty good to me.  I don't think doctors go by the total cholesterol number anymore anyway to determine heart disease risk; I think your calcium score of 0 and your high HDL mean much more.

[greendor]

I saw the Alzheimer's link on the internet too.  I'm more concerned about that than I am my cholestrol, epecially since my mother's father had Alzheimer's and and my mother has it now.  Berkeley Lab offers a patient education service.  They will call sometime this week to explain the result of the blood test to me.  I'm looking forward to it and hope they will give solid answers to my questions.  
Thanks for responding.