Frequently Asked Questions

Cholesterol is a waxy, fat-like substance that is produced in the body by the liver. Cholesterol forms part of every cell in the body and serves many important functions. For example, our bodies need cholesterol to:

• Maintain healthy cell walls
• Make hormones (the body's chemical messengers)
• Make Vitamin D
• Produce bile acids, which aid in fat digestion

However sometimes, through either genetic or lifestyle factors, our bodies make more cholesterol than we really need, and this excess cholesterol circulates through the bloodstream. High levels of cholesterol in the blood can clog blood vessels and increase the risk for heart disease and stroke. Primarily, it travels in the blood as two compounds: low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

In practice, HDL cholesterol is often called the 'good' cholesterol and LDL cholesterol is called the 'bad' cholesterol. The reason for this is that HDLs help transport cholesterol in the body to the liver where the body then prepares to excrete it. LDLs, on the other hand, actually transport cholesterol from the liver to cells in the body. Once the body's cells have all of the cholesterol they need, the extra cholesterol can build up along blood vessel walls in the form of plaque. People with high total cholesterol to HDL cholesterol ratios are at increased risk for heart disease, because in general, they are transporting more cholesterol to cells than they need.

Thanks to new research, we now understand that heart disease, or blocking of arteries, is caused by lipoprotein particles and not by cholesterol. Made of lipids, and various proteins, lipoprotein particles are the principal way lipids like cholesterol are transported in the blood. These are the particles that can build up in a person's arteries and cause heart attacks.

Lipoprotein particles have two parts:

• An inner core region of cholesterol and triglyceride
• An outer shell

Cholesterol and triglyceride cannot move through the artery wall unless it is carried inside a lipoprotein particle. Lipoprotein particles serve as the vehicles that transport cholesterol in the blood. As lipoprotein particles move through the blood, they can enter the wall of an artery. As the number of lipoprotein particles increases in the blood, more particles move into the walls of arteries. Once inside the artery wall, lipoprotein particles undergo changes that lead to the formation of blockages inside the artery wall. These blockages grow over time leading to increased risk of heart attack; this is why lipoproteins are so important. Recent studies show it is the number of lipoprotein particles that cause heart disease.

Triglycerides (TG) are complex molecules that carry fat (fatty acids) in the blood from the intestine and liver to muscles and fat tissue. Elevated triglyceride is an independent risk factor for atherosclerosis (build up cholesterol in the heart and other arteries. After the fats are eaten and absorbed into the intestine, they are packaged along with intestinal cholesterol into a special lipoprotein called a chylomicron. After bringing the TG to muscles and fat tissues, chylomicrons carry their remaining lipid (cholesterol) to the liver where it is processed. The liver can also send out TG to muscles and fat cells in very low-density lipoproteins (VLDL). Once the VLDL delivers its TG, it carries mostly cholesterol and is either cleared by the liver, enters the arteries (if too many are present) or is converted to a primarily cholesterol-carrying lipoprotein called low density lipoproteins (LDL) which are either cleared by the liver or enter the artery. If TG are high, too many VLDLs are made and released and soon there will be to many LDL particles (LDL-P), which is a major coronary risk factor.

Statins are a class of drugs that work by blocking the most important step in the formation of cholesterol. The result is the removal of LDL (bad cholesterol) from the blood.

While they all have the same mechanism of action, the answer is no. Though statins in general lower LDL-C (bad cholesterol) significantly, different statins have different effects on the HDL-C (good cholesterol) and triglycerides.

The choice comes down to the doctor's preference for one drug over another. Most doctors are comfortable with only one drug among a certain class of drugs. This is why it is important to seek the advice of an expert in lipid (cholesterol) management so that you can be placed on the most appropriate drug and corresponding treatment program for your particular situation.

The simplest way is to ask informed questions. In general, preventive cardiologists, some cardiothoracic surgeons, and any doctor with some lipid management training, should have a good knowledge base in which to address difficult problems in cholesterol management. However, to be certain you are receiving the best care, you should visit a physician who is dedicated to cholesterol treatment and management.

Yes, most certainly. Your doctor should know the way all the different drugs should be used separately, or in combination, to lower the bad cholesterol, raise the good cholesterol and lower triglycerides. In addition to medication, it's important to form a program around your particular situation, to ensure best outcomes. Again, to be sure you're getting the best treatment available; you should visit a physician who specializes in cholesterol management.

We do know that increased levels of HDL reduce the risk of heart disease. Believe it or not, there is very little data from clinical trials that show increasing the HDL makes the HDL function better. There is no magic number for the HDL. In fact, the National Cholesterol Education Panel (the panel that sets treatment guidelines) does not have raising HDL as a treatment goal in cholesterol management. The basic principle is that the LDL (bad cholesterol) should be lowered as much as possible to lower the risk of heart and other vascular disease.

The well-established risk factors for coronary artery disease include age, smoking, hypertension, high cholesterol and diabetes. You also may be at risk if heart disease runs in your family.

The Center for Cholesterol Management is the only free-standing facility in Southern California to deliver state-of-the-art diagnosis and treatment of lipid disorders using nuclear magnetic resonance (NMR) based lipoprotein testing - the only kind of testing that provides both traditional lipids and the number of atherogenic particles to better identify and manage patients at risk for coronary heart disease. The philosophy behind the Center is to employ a multi-disciplinary approach to lipid treatment and cholesterol testing. The Center uses a cross-section of experts and physicians, nurses, dietitians and physical therapists to develop individualized, preventative care and management programs for patients with high cholesterol, heart disease and those at risk for developing coronary artery disease. Using this best-practices approach, the professionals at the Center will develop a cholesterol management and treatment program that is customized to your needs. This includes a medication, diet, and exercise program for each patient.

When patients visit the center, they can expect a pre-test consultation with Dr. Michael Richman. He will discuss the patient's current health, risk factors and explain the test. The patient's blood is drawn and a follow-up appointment is scheduled within 5-7 days to go over the results.

Most appointments take 30-45 minutes. After a sample of blood is drawn, tests are sent to a lab, analyzed and we will call you with the results shortly thereafter. Armed with the results of this breakthrough test, Dr. Richman and his team can design a more focused and effective treatment plan for fighting heart disease.

No. Patients don't need to fast because lipoprotein particles have a set life in the body like blood cells. That is three days for LDL. Since the test measures the lipoprotein concentration instead of the lipid concentration, fasting is not necessary. However, some of the other testing done for your particular problem may require fasting for several hours so check with your doctor prior to your visit.

The only feeling is that of a tiny pin prick when the needle is inserted to collect the blood sample.

The NMR LipoProfile test costs around $100. Medicare covers the cost of the test and most private insurance providers cover a portion, as well. (Note: O n your first visit, additional tests may be performed to check for risk factor markers, liver function, etc. In this case, an additional cost will incur.)

Every patient is different. Dr. Richman will customize a program for you, based on your individual needs. However, for patients who present with a high LDL-P number, it's a good idea to have the test done every six weeks, especially if medication is prescribed or changed - to monitor progress. Typically, the next test is at three months, and then recommended every 6 to 12 months thereafter.

Again, you may have "high cholesterol" (aka: a high LDL number) and not actually be at risk for heart disease. It's the LDL-P that matters, so it's important to take NMR-based lipoprotein testing to determine that number, to see if you're at risk. While there's no cure for high cholesterol, there are ways to treat the condition through a program designed for your specific needs. This includes a healthy diet, exercise and cholesterol-lowering medication. Call the Center for Cholesterol Management today for more information.