Thursday, January 25, 2007

The Great Cholesterol Testing Scam

We have probably all been to see our doctors on multiple occasions to have blood drawn for a "lipid panel" particularly those with diagnosed heart disease. Few probably suspected that their LDL Cholesterol was off by as much as 100%. You might think, "How can that be, this test has been adminstered for decades and seems to be accepted everywhere." Unbelieveable as it may seem, here is the sordid truth!

The standard test for cholesterol, the one in use in the overwhelming majority of clinical medical practices was developed in the 60's by a lipid researcher named Dr. Friedewald. It measured Total Cholesterol, HDL and Triglycerides and then LDL was ESTIMATED (your doctor will say "calculated" but this suggests accuracy that just isn't there) by this formula:

LDL = Totol Cholesterol - HDL - Triglycerides/5

It was already acknowledged that this estimate would be off if the subject had high triclycerides (above 400) or failed to fast before the test (which many patients lie about - come on, admit it).

This was great in the 60's before the advent of newer technologies but, as you will hear me repeat early and often, medical practice typically lags technology by a decade or more. Just add up the numbers: 4 years of medical school plus 3 years of internship and residency, plus the time it takes for modern technology to reach the text books means your doctor is already years behind modern technology the day he starts his practice.

Let's look at a real life example. I recently had a lipoprotein analysis done via one of the latest technologies, Nuclear Magnetic Resonance Spectroscopy. It showed my LDL to be 55 (and subdivided it into 3 more components by size and gave an exact particle count). I then repeated the test using the old method which reported my LDL to be 25, off by more than 100% (depending on how you stack the comparison). For me, you might say, "Damn, 55 0r 25 what's the difference, they are both low." and you would be close to the truth. But let's say my real LDL was 200 but the test said 100. That is the difference between a diagnosis of "no treatment needed" and "let's get you on a statin ASAP!" Get the picture? Yes, the older way is cheaper. But tell me, suppose you go skydiving. You want a cheap parachute that works "most of the time" or an expensive one that works all the time? Hey, it's your life!

Which leaves me where I often end a rant. Most doctors (and hospitals and insurance companies) are hopelessly behind the curve. If you want to do everything you can to ensure you get the most modern treatment, you have to get involved, do your homework, and question everything.

Remember, only you can prevent blissful ignorance,

HeartHawk (with apologies to Smokey the Bear)


JJC said...

and be prepared to pay for the tests yourself. My primary Dr. doesn't want to give me any tests that he doesn't understand and there is a lot that he doesn't understand. The cardiologists in his group are all gung-ho surgeons. The most "progressive" told me that heart-scans are obsolete. Now I am looking for a cardiologist outside my medical plan.


by the way, the anonymous posts don't work for me

neil said...

Hi All,

While I have found many on-line places to order a self VAP test, I have only found this one to order a NMR profile...

Has anyone found another site?


JJC said...

No I haven't. I called Liposcience and they couldn't come up with an alternative either. Its a 100 mile drive for me to get to one of the drawing stations for lab-safe.


Anonymous said...

LabCorp direct lab. services NMR LipoProfile

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