The Cholesterol Conundrum
Oct 09, 2009 by Bill Rawls, M.D.
Abnormal cholesterol levels present a real quandary for wellness-based physicians. Representing only one indicator of risk, cholesterol levels do not define the problem at the root of many heart attacks and strokes— the degree of arterial stiffness (hardening of the arteries).
Elevated cholesterol contributes to plaque formation, which in turn causes arterial stiffness, but elevated cholesterol is far from the sole cause of plaque formation. Many individuals with moderate elevations in cholesterol do not have significant plaque formation, and some people with normal cholesterol do have significant plaque formation. Therefore, the standard lipid panel, which measures only the amount of cholesterol and triglycerides in the blood, does not always provide sufficient data to warrant the use of statins and fully assess cardiovascular risk. More informed decisions can be made by combining this standard cholesterol test with other screening tools. Two such screening tools are omega-3 testing and pulse wave analysis, a measurement of arterial stiffness and central blood pressure.
Preliminary research suggests that omega-3 testing shows promise. As a big believer in the benefits of fish oil, this measurement of the ratio of omega-3 fatty acids (‘good’ fat) to omega-6 fatty acids (‘bad’ fat) is one test that I would like to see go mainstream; the actual concentration of these important fatty acids in the body is valuable information. The essential omega-3 fatty acids found in fish oil can block or reduce all factors that lead to plaque formation, and the degree of saturation of these fatty acids in the body not only appears to be a good predictor of heart attack and stroke but possibly also of cancer. Though most anyone can benefit from taking an omega-3 supplement, absorption is variable from person to person. Several labs offer omega-3 testing, although at this time the test is not completely standardized, and most insurance companies do not cover it. When more data becomes available, these factors may change.
While a standard lipid panel and omega-3 testing do measure factors indicating risk for heart disease, neither test answers the million-dollar question: “What is the patient’s cardiovascular risk from the actual degree of arterial stiffness already present?” Performed with the SphygmoCor system, a measurement called pulse wave analysis answers this question by showing the physician and patient the effect of arterial stiffness on central blood pressure. Arterial stiffness is a direct measure of the degree of plaque formation. Central blood pressure, which is always different from blood pressure at the arm, is the pressure the heart and other organs actually experience.
Providing data previously available only through monitoring with a catheter placed in the aorta, the pulse wave analysis is completely noninvasive and takes only minutes to perform, with results immediately available. Featured in hundreds of published studies, it is well established at major medical centers in the U.S. and Europe and is beginning to make its way into smaller communities.
The analysis is performed by pressing a sensor against the strongest pulse point on the patient’s wrist. The SphygmoCor system displays the pressure wave form as it exists in the ascending aorta (the large vessel leading from the heart) and also produces a wealth of data, including central blood pressure and numerous measurements of arterial stiffness. In short, the pulse wave analysis provides information that directly correlates to the risk of heart attack and stroke and enables physicians to make more informed treatment decisions.
Categories: Cardiovascular Health, Disease Prevention,
Tags(s): Cholesterol, Omega-3 Fatty Acids, Statins,
Previous Comments
Larry Hammond- Oct 19, 2009
I am interested in the SphygmoCor testing. How can I locate a testing center?
Dr. Rawls- Oct 19, 2009
Larry, thank you for reading and expressing interest in this unique testing. My medical office, Soundside Healthcare in Morehead City NC, will be hosting a trial of the SphygmoCor system during the months of November and December. Please call 252-808-2500 for more information. You can also contact the SphygmoCor office directly for more information on hospitals & practices where their system is available. Best wishes, Dr. Rawls
Jan Alden- Jul 18, 2010
Dr. Rawls, reading this well after your post, how satisfied were you with the overall results of the SphygmoCor testing at your facility based on your knowledge of your patients, and will you be offering this test again? Thanks for all that you do for us! Jan
