Latest / Your Daily Dose / A TEST THAT IS A BETTER WAY TO ASSESS CARDIOVASCULAR DISEASE

Transcript

A TEST THAT IS A BETTER WAY TO ASSESS CARDIOVASCULAR DISEASE · Your Daily Dose

• 0:00
  Speaker 1: Afternoon, everybody, and welcome. It is June sixteenth. I've been
• 0:04
  Speaker 1: off for a couple of days. I had the opportunity
• 0:07
  Speaker 1: of my son and his wife come and stay with
• 0:10
  Speaker 1: us for four or five days. It was wonderful, went
• 0:13
  Speaker 1: to the beach, went to a concert, did a bunch
• 0:15
  Speaker 1: of different things, and it was nice to reconnect. So
• 0:19
  Speaker 1: I was out of it. I didn't do any podcasts
• 0:21
  Speaker 1: during that time. I apologize, but we're going to get
• 0:23
  Speaker 1: back to it now. A new article came out today
• 0:26
  Speaker 1: talking about testing for cardiovascular disease problems, so we'll talk
• 0:33
  Speaker 1: today about a new test that may help you in
• 0:37
  Speaker 1: your battle with cardiovascar disease. Stay tuned, hi, and welcome
• 0:40
  Speaker 1: to Health Talk with Doctor Lynn. Your daily dose. The
• 0:43
  Speaker 1: information you hear on the show is informational. It's not
• 0:46
  Speaker 1: meant to diagnose or treat any disease. Any kind of
• 0:51
  Speaker 1: complete health conditions must be checked out and discussed with
• 0:55
  Speaker 1: your primary care physician. Get ready for the good news
• 0:58
  Speaker 1: of the day. God bless you, folks, and here is
• 1:02
  Speaker 1: doctor Lynn. Our daily devotional today comes from the Book
• 1:05
  Speaker 1: of Ephesians, Chapter two. Stay on the high road with me.
• 1:10
  Speaker 1: Many voices clamor for your attention, trying to divert you
• 1:13
  Speaker 1: to another path. But I've called you to walk over
• 1:16
  Speaker 1: so closely with me, soaking in my presence, living in
• 1:18
  Speaker 1: my peace. This is my unique design for you, planned
• 1:22
  Speaker 1: before the world began. I have called each of my
• 1:25
  Speaker 1: children to a different path, distinctly designed for that one.
• 1:30
  Speaker 1: Do not let anyone convince you that his path is
• 1:33
  Speaker 1: the only right way. Be careful not to extol your
• 1:36
  Speaker 1: path as superior to another's way. What I require of
• 1:41
  Speaker 1: you is to act justly, to love mercy, and to
• 1:45
  Speaker 1: walk humbly with me wherever I lead.
• 1:48
  Speaker 2: Stay tuned tin.
• 2:40
  Speaker 3: Seven two seven nine one six four two one five
• 3:07
  Speaker 3: to get a hold of me.
• 3:08
  Speaker 1: Off air. Cholesterol testing, we all get it done almost
• 3:14
  Speaker 1: on a regular basis. There's one test that very few
• 3:20
  Speaker 1: of you really get. It's been a part of the
• 3:22
  Speaker 1: Boston heart screening that I've been doing with patients now
• 3:25
  Speaker 1: for the last twenty years, and it's now coming to
• 3:29
  Speaker 1: the surface as one of the most widely recognized now
• 3:33
  Speaker 1: and maybe a better test than just testing your total cholesterol.
• 3:36
  Speaker 1: It's cap called apo lipoprotein B. Two people can have
• 3:43
  Speaker 1: the same cholesterol level but very different heart disease risk.
• 3:48
  Speaker 1: A simple test may explain why for some people a
• 3:51
  Speaker 1: normal cholesterol reading doesn't always mean there's something to worry about.
• 3:55
  Speaker 1: For about the price of a dinner out. A simple
• 3:58
  Speaker 1: blood test can reveal a hidden layer of heart disease
• 4:00
  Speaker 1: risk that standard cholesterol tests miss, Yet it isn't part
• 4:04
  Speaker 1: of routine cholesterol screening, so most doctors don't order because
• 4:09
  Speaker 1: they don't have a drug for it. The test measures
• 4:12
  Speaker 1: apo lipoprotein B or APO B, a protein that sits
• 4:16
  Speaker 1: on every particle that carries cholesterol through the bloodstream, sort
• 4:20
  Speaker 1: of like a little truck. Unlike standard cholesterol tests, which
• 4:23
  Speaker 1: measure how much cholesterol is circulating, ApoB counts the actual
• 4:27
  Speaker 1: number of those harmful particles. Two people can have the
• 4:31
  Speaker 1: same LDL or bad cholesterol level, but the one with
• 4:34
  Speaker 1: more APO B containing particles are at our higher cardiovascular risk,
• 4:39
  Speaker 1: said doctor Zang Zhang At, assistant professor at Columbia University.
• 4:45
  Speaker 1: Standard cholesterol tests focus largely on LDL, the so called
• 4:48
  Speaker 1: bad cholesterol, along with high density lipoprotein HDL. Higher levels
• 4:53
  Speaker 1: of LDL and the blood are linked to an increased
• 4:55
  Speaker 1: risk of heart attack and strokes, and for decades clinicians
• 4:59
  Speaker 1: have used LDL L is their only and primary guide
• 5:02
  Speaker 1: for treatment. Whoever, Heart disease risk is not about the
• 5:06
  Speaker 1: amount of cholesterol present. It also depends on the number
• 5:09
  Speaker 1: of cholesterol carriers. The number matters because these particles are
• 5:15
  Speaker 1: not the same size. Smaller LDL particles can produce LDL readings,
• 5:22
  Speaker 1: but a higher total number of harmful particles overall, a
• 5:25
  Speaker 1: pattern associated with increased athoskerotic cardiovascar disease. An APPOB test
• 5:32
  Speaker 1: closes that gap because each particle carries exactly one ApoB
• 5:37
  Speaker 1: protein attached to it. Measuring ApoB gives you a direct
• 5:41
  Speaker 1: count of how many harmful or atherogenic particles those capable
• 5:48
  Speaker 1: burrowing into artery walls and depositing plaque, are circulating in
• 5:52
  Speaker 1: the blood. When ApoB levels are higher than expected relative
• 5:56
  Speaker 1: to your LDL levels, this mismatch is called discordance. Remember
• 6:00
  Speaker 1: that name discordance. In these cases, low or normal cholesterol
• 6:07
  Speaker 1: measures maydical reassuring, but they can give a false sense
• 6:11
  Speaker 1: of security. More particles circulating the blood means more opportunities
• 6:15
  Speaker 1: for them to contribute to plaque build up. Over time.
• 6:18
  Speaker 1: These plaques eventually restrict blood flow and can lead to
• 6:21
  Speaker 1: heart attacker strokes. Alternatively, having lower normal APPO B levels
• 6:27
  Speaker 1: even in people with high LDL predicts a lower likelihood
• 6:30
  Speaker 1: of plaque build up and a lower risk of athos choruses.
• 6:33
  Speaker 1: So you can have a high LDL, have been a
• 6:36
  Speaker 1: normal APPO B and not be at a cardiovascidar risk
• 6:40
  Speaker 1: if you have a family history of early heart disease,
• 6:43
  Speaker 1: of B CITY or other metabolic risk factors. Apo B
• 6:46
  Speaker 1: may offer additional information beyond standard LDL cholesterol tests. Beyond
• 6:51
  Speaker 1: helping to identify risks that might otherwise be missed, APPO
• 6:54
  Speaker 1: B can also help doctors decide how aggressively to treat
• 6:58
  Speaker 1: that risk. As a study published in JAMA, computer model
• 7:04
  Speaker 1: stimulate simulating about two hundred and fifty thousand US adults
• 7:08
  Speaker 1: eligible for statins compared three ways of guiding cholesterol lowering
• 7:12
  Speaker 1: treatment by LDL cholesterol, by non HDL cholesterol, or ApoB.
• 7:19
  Speaker 1: They found that by using APPO B to guide treatment
• 7:23
  Speaker 1: decisions gave the greatest overall benefit. Let me read that again.
• 7:26
  Speaker 1: They found that using APPO B to guide treatment decisions
• 7:30
  Speaker 1: gave the greatest overall benefit. ApoB tests may be especially
• 7:35
  Speaker 1: useful for assessing heart disease risk in younger adults. In
• 7:39
  Speaker 1: another study published in JAMA Network, they followed ten thousand
• 7:43
  Speaker 1: adults for roughly two decades. Drawing on data from three
• 7:46
  Speaker 1: large US cohort studies. They examined how well different cholesterol
• 7:51
  Speaker 1: markers predicted future heart attacks and strokes. Higher APPO B
• 7:55
  Speaker 1: levels were associated with the greater heart disease risk and
• 7:59
  Speaker 1: stroke across all age groups. However, the marker was especially
• 8:05
  Speaker 1: informative in younger adults aged eight to thirty nine, with
• 8:08
  Speaker 1: a risk gap between the high and low apo B
• 8:11
  Speaker 1: levels was four times greater than in older adults. We
• 8:14
  Speaker 1: found that APPO B may be more informative in younger adults.
• 8:18
  Speaker 1: Adding APPO B to standard risk equations modestly improve the
• 8:22
  Speaker 1: quality and the ability to identify which younger adults would
• 8:26
  Speaker 1: go on to develop party of ascer disease. APPO B
• 8:30
  Speaker 1: tests are relatively inexpensive, usually around sixty bucks through most
• 8:35
  Speaker 1: major lab providers, but they are still not part of
• 8:38
  Speaker 1: a routine cholesterol screening. One reason is practical, The test
• 8:42
  Speaker 1: usually has to be ordered separately rather than included in
• 8:46
  Speaker 1: a standard lipid panel, and doctors are lazy. It's also
• 8:50
  Speaker 1: the question of habit. For decades, clinicians of a rite
• 8:53
  Speaker 1: relied on LDL cholesterol assess risk and guide treatment, and
• 8:57
  Speaker 1: shifting to a different approach can take time, even as
• 9:00
  Speaker 1: evidence continues to build that may be starting to change.
• 9:04
  Speaker 1: Current US guidelines still use the LDL cholesterol thresholds of
• 9:08
  Speaker 1: less than one hundred for borderlined intermediate risk, less than
• 9:11
  Speaker 1: seventy for high risk, less than fifty five for people
• 9:14
  Speaker 1: with very high heart disease risk. However, health organizations, including
• 9:20
  Speaker 1: the American Heart Association, increasingly emphasizing earlier diventions and new
• 9:24
  Speaker 1: cardiovascular risk tools, are beginning to take a broader view
• 9:28
  Speaker 1: of risk beyond LDL cholesterol alone. LDL and non HDL
• 9:34
  Speaker 1: cholesterol still provide useful information, but APPOB is more directly
• 9:38
  Speaker 1: tied to heart attack risk because it reflects the number
• 9:41
  Speaker 1: of harmful cholesterol particles in the blood. For some people,
• 9:45
  Speaker 1: especially those with diabetes, fatty liver disease, or obesity. That
• 9:49
  Speaker 1: added clarity helps doctor decide window start treatment before it
• 9:52
  Speaker 1: turns into something harder to reverse. You want more information
• 9:57
  Speaker 1: on that, give you a call. We can schedule that
• 9:59
  Speaker 1: for you. APPO lipoprotein B and now you know the
• 10:04
  Speaker 1: rest of the story have a great one. Folks, God
• 10:06
  Speaker 1: bless c Us.