How Healthy Is Your Heart?
Should You Get the apoB Heart Test?
ApoB testing isn't for everyone. "We measure particle size only in carefully selected patients," says Ladies' Home Journal medical adviser Marianne J. Legato, MD, director of the Partnership for Gender-Specific Medicine at New York City's Columbia University. "It's often done when you have someone who's at relatively low risk of heart disease in all respects except that she has a high total cholesterol and/or LDL level." For people with borderline or high cholesterol but no other risk factors and no family history of early heart disease (under the age of 55 for men, 65 for women), finding out that their LDL particles are the large kind can be reassuring news (even though LDL levels over 130, regardless of particle size, are always cause for concern). However, you may be given the test even if your LDL isn't high but you have other cardiovascular risk factors, such as high blood pressure or metabolic syndrome.
The American Heart Association does not currently recommend routine apoB testing because researchers have not yet come up with guidelines for interpreting test results across the general population. You're not likely to come across the blood test at your annual physical but may get it if your internist refers you to a cardiologist for a more thorough risk assessment. ApoB is often used as part of cholesterol screening at heart centers such as the famed Cleveland Clinic. "The standard lipid profile -- a count of total cholesterol, HDL and LDL -- is sufficient for most people, but we use apoB for patients with high triglycerides for whom the standard test may not be adequate," explains Byron Hoogwerf, MD, an endocrinologist in the Cleveland Clinic's preventive cardiology and rehabilitation section.Some Doctors Question the apoB Test
To complicate matters further for patients, some doctors challenge the value of apoB tests and cholesterol lowering in general. Nortin M. Hadler, MD, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, cautions that high cholesterol ups your lifetime heart-disease risk by only 1 to 2 percent and feels it isn't a meaningful threat unless you have a family history of early heart attacks. He believes that the evidence for taking steps to lower cholesterol (either with diet, exercise, or drugs) is weak and that these measures make no real difference in preventing heart attacks. Others, such as John Abramson, MD, a family physician and clinical instructor at Harvard Medical School and author of Overdosed America, question the value of cholesterol testing when the resulting treatment -- statins -- has not been shown to actually prevent heart disease in otherwise-healthy women. A 2004 Journal of the American Medical Association review of 13 studies on statins found that they reduce the risk of heart attacks only for patients who already have heart disease.
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