My cholesterol was tested in September at 261 total, 160 LDL, 60 HDL. I have been on a diet / exercise program since and will have a follow up blood test soon. I have read about specific protein tests that are good indicators of heart disease but am confused about which test to request. Should I ask for an LPa test or a C-reactive protein test? What is the difference? What specific test should I have done in addition to the normal Lipid work-up? Finally, what are the pros and cons of Niacin therapy vs. Statins should I need medication? Thank you.
Although your HDL (good cholesterol) is high the LDL (bad cholesterol) is also high and depending on your other risk factors (age, family history, smoking, etc.) you may need to start medical therapy. For sure you should be on a low cholesterol diet. The goal for your LDL should be <130 or <100(again depending on risk factors). If you are still >160 you will probably need to start medications.
The tests you mention are markers of inflammation. Lp(a) [pronounced LP little a] is a subfraction of cholesterol that may be influence by inflammation and C-reative protein (CRP) is a marker of inflammation. Both these tests are more experimental than clinical but may help in determining your overall risk for cardiac disease.
As far as which medication to start if you need to start it the most 'popular' medication is a once-a-day statin (lipitor, leschol, mevacor, etc). These drugs lower LDL but may also lower HDL as well. The statins lower LDL and raise HDL but are more difficult to take. You need to be taking at least 1-2 gms of niacin a day to have beneficial effects on the cholesterol. Aspirin taken 1/2 hour prior helps decrease the flushing feeling and there is a new twice a day formulation. If it were me personally I would probably try niacin first and then if I couldn't tolerate it switch to a statin.
The main reason to take NIACIN is to raise HDL, but yours is already above normal. I personally think that the HDL reading is the best predictor of coronary artery disease. If you are below 40, watch out!
I would think that you would take a statin such as Lipitor to lower your LDL. If you don't have liver disease a low dose should do the job with no side effects. I tried a couple, but think that Lipitor is currently the best of breed.
I take three cholesterol drugs in combination: Niaspan, Lipitor, and Welchol. It's a great cocktail for reversing coronary artery disease, but definitely is rough on the gastro-intestinal balance.
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