Advanced Lipid Testing

Dr. Kroll is a specialist in cardiovascular prevention and is certified in clinical lipidology. Cardiovascular disease, including myocardial infarction (heart attack) and stroke, are the leading causes of death in the United States.

Cardiovascular disease, including myocardial infarction (heart attack) and stroke, are the leading causes of death in the United States. It is estimated that more than 80 million Americans carry a diagnosis of heart disease. There have been remarkable advances in the field of cardiovascular prevention over the last several decades to treat heart disease. Most of these treatments, including balloon angioplasty, stenting, coronary artery bypass and peripheral vascular surgery are necessary when patients are not appropriately managed. The advances in medical management and prevention are even more remarkable and a patient interested in such prevention needs to use the knowledge of an expert in this field. .

Despite these advances, there still remains a very high residual risk of having a cardiac event, with more than 400,000 people each year dying from cardiac-related disorders. While coronary artery disease takes a lifetime to develop, many of the current therapies are started late in life only after cardiac events have occurred or heart disease has been diagnosed.

The Cholesterol Treatment Center aims to prevent the onset or recurrence of heart disease by identifying and aggressively treating cardiovascular risk factors. The program's multidisciplinary staff of Dr. Kroll, his nurses, and and other allied health professionals committed to providing leading-edge care in heart disease and stroke prevention.

Our program provides a comprehensive and detailed cardiac risk assessment and treatment of patients with a number of cardiovascular risk factors, including:

Abnormal cholesterol
High blood pressure
Family history of early heart disease
Metabolic syndrome or diabetes
Obesity
Smoking history

Patients will receive an individualized and customized treatment plan tailored to their risk profile and may include recommendations on lifestyle interventions and medications targeted at optimizing risk factors. Special program services will include:

Advanced lipid testing and novel serum cardiac risk biomarkers
Non-invasive imaging of plaque build-up (atherosclerosis)
Cardiovascular genetic testing
Counseling and education on lifestyle
On staff psychotherapist and nutritionist
Access to clinical trials and university based treatment protocols.

Advanced Lipid TestingStandard lipid tests may demonstrate a normal LDL and total cholesterol level in patients with a risk of atherosclerotic disease. Moreover, patients with significant reduction in LDL cholesterol following lipid lowering therapy may still develop coronary heart disease. Thus, standard lipid testing, which measures total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides, is not sufficient to predict the overall risk for heart attack and strokes.
Advanced lipid testing provides information on additional risk factors to help evaluate the cardiovascular risk more effectively and monitor the effects of lipid lowering therapy. Two of the most common risk factors measured in advanced lipid testing include apolipoprotein B (ApoB) and LDL-particle number (LDL-P).
ApoB: It measures the total bad cholesterol or atherogenic lipoproteins in blood, which has the potential to cause cardiovascular disease (CVD). The components of bad cholesterol include very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL), large buoyant-low density lipoprotein (LDL) and small dense LDL. One ApoB molecule is present in each of these bad cholesterol components. Therefore, the total number of ApoB indicates the total quantity of bad cholesterol. High levels of ApoB indicate an increased risk of CVD, even with normal LDL cholesterol levels.
LDL particles: High LDL cholesterol level increases the risk of heart disease. LDL can occur as large buoyant LDL particle, or as small dense LDL particles with less cholesterol per particle. Thus, even for normal levels of LDL, there can be large numbers of small dense LDL particles per liter of plasma. Moreover, these small dense LDL particles are more atherogenic than large buoyant LDL particles and more easily invade the walls of the arteries, increasing the risk of plaque formation.
Advanced lipid testing evaluates the actual number of LDL particles that carry LDL cholesterol per liter of plasma and the size of these particles as well. sdLDL stands for small dense LDL and high levels of sdLDL indicate increased risk of CVD. The presence of large numbers of sdLDL particles may be secondary to insulin resistance, which may indicate a risk of developing diabetes.
Advanced lipid testing may also include Lipoprotein (a) or Lp (a) and ApoA1.
Lipoprotein (a): Levels of lipoprotein (a) are genetically determined, and are not affected by changes in lifestyle or drugs. High levels of this lipoprotein indicate increased risk of CVD and cerebrovascular disease. Lipoprotein (a) estimation is recommended in individuals with a strong family history of premature CVD.
ApoA1: This measures the total number of good cholesterol in blood. High levels of ApoA1 indicate a decreased risk of CVD. This test may be ordered along with ApoB to determine the ratio of ApoB/ApoA1, which indicates the balance between potentially atherogenic and atheroprotective cholesterol, which is a better predictor of risk than either parameter alone.
ApoB, ApoA1, lipo (a) and LDL-particle are all simple blood tests. Advanced lipid testing may be recommended at the initial visit and also at regular intervals during treatment. Sometimes, it is recommended, only after successful achievement of the LDL cholesterol and non-HDL cholesterol goals, to check the effectiveness of the lipid-lowering therapy (a combination of healthy lifestyle and cholesterol lowering medication).

Dr. Kroll is board-certified in the field of lipidology and advanced cholesterol management by the American Board of Clinical Lipidology.