Pretty good news. Overall Cholesterol: 145, a figure that 20 years ago I never imagined I could achieve. LDL: 83, just a bit up from 77, but very favorable. The goal is to get it down to 70, but my doctor told me that I was essentially there. Triglycerides: 91. Great. The goal was to come in under 100. HDL: 46. Alas, this was a bit of a downer. I had increased my 500mg Niaspan to two a day and hoped that there would be a significant difference, but there was not. The VitalImaging goal is 60.
When I discussed this with my doctor, he was not optimistic about the possibility of getting all the way to 60. Using two 500mg Niaspan a day did not drive the HDL up. 3 or 4 might. 4 is maximum. I'm tolerating 2 and 3 a day and will go to 3 and hold that for the next profile which will be in about 3 months. I'm prepared to try 4 Niaspan/day -- that's 2 grams! Years ago, I OD'ed on Niacin and got an HDL of 55, but the Niacin played havoc with my liver enzymes. Luckily, my enzymes were okay this time: the AST at 33 (the high end is 35) and the ALT is 38 (high end 60). But the 55 HDL from the distant past give me some hope that I can approach the 60 goal.
While not optimistic, my doctor did say that anything over HDL 45 is very good. It's not clear that the extra 15 points are "needed". This gets us into marginal effectiveness levels. He said also that with LDL's down, the "small LDL trait" is less important. This is because there are many fewer of the small, gritty, dense LDL lipids to infiltrate into the crevices of my vascular system. He also thought that a calcium heart scan in a year is too early, especially in regard to treatment which he thought was about as aggressive as it could be now. I would welcome the reinforement, however, and may do it as orginally planned during the summer of 2011.
He did defend doing the thalium stress test to check for obstruction. He did not think that the calcium heart scan tests for this, though it does show both a predicted size and volume. But I would have known if I had had an obstruction in the hills of Oregon, so it was to confirm that really that it was prescribed.
The VAP test identifies the "Real LDL Size Pattern" on a spectrum of "Pattern B (left) to Pattern A (right)" I've inched from the far left to about 2/3 of the way to the absolute center (Pattern A/B) which I've reached once before. The position of this scale is supposed to be one of the best predictors of heart/vascular health. It is a refinement of the the LDL count which is a refinement of the overall Cholesterol count.
These are all indirect tests. Previous correlations show them to be good indicators. I'd feel better if I could get to Pattern A, though being there is no guarantee of anything. The 5mg of Crestor and the Niaspan affect this reading most directly.
The Trilipix affects the triglyceride reading and appears to be quite effective. The VitalImaging goal of lower than 100 is already met.
The VAP tests shows subclass information of my HDL lipids. My overall reading is 46. This consists of HDL-2 and HDL-3. HDL-2 is "large, buoyant". My count is 7 and is in the low range. It should be 10 mg/dL. My HDL-3 ("small, dense") is 39 and is in-range by being greater than 30 mg/dL. Together these two subclasses add up to 46. I'll see whether more niacin can increase the proportion of HDL-2 and bring the HDL-2 into the normal range. (A "2-fer").
I asked about doing a Berkeley Heart Lab Exam. My doctor's response was what I expected. The Berkeley tests would tell us more, but the medical response would be the same. We know there is a familial predisposition in my case. The Berkeley tests would confirm it, and perhaps say more about it, but wouldn't affect the recommended response.
There is the issue of habituation also. My HDL didn't go up even with twice the niacin and my LDL crept up from 77 to 83 with the same amount of statin. It would be interesting to try to determine the "increase rate" of medication to maintain a desired level of effect.
So I'm upping my Niaspan to 3 a day from 2 and hoping to see some marginal improvements at least in 3 months. For the record, I'm taking 5mg Crestor; 1 Trilipix; 4 Lovaza (Omega-3), 1 Zetia; also, 1 Trandolipril for blood pressure. And a baby aspirin.