The NMR and Your Risk of Heart Disease
As science progresses the level of understanding of cardiac risk factors and special testing continues to improve. Many leading health experts believe that the Nuclear Magnetic Resonance Lipoprofile (NMR) test is the most sophisticated lab for understanding cholesterol numbers and heart disease risk.
Most physicians are quite familiar with standard lipid panels that look at lipoprotein ratios. Lipoproteins are protein based molecules that carry cholesterol to and from the liver and the various cells of the body. We have several different types of lipoproteins including low-density lipoprotein (LDL – C), high density lipoprotein (HDL – C) and very low lipoprotein (VLDL-C).
Good and Bad Cholesterol:
Most people associate LDL-C and VLDL-C as the “bad cholesterol” and HDL as the “good cholesterol” but this isn’t necessarily the case. These are all good cholesterols as they play vital roles in the hormone production, healing and cellular regeneration (1).
However, the LDL and VLDL subtypes are highly vulnerable to oxidative stress. When the body has chronic inflammatory processes these subtypes will be oxidized, leading to atherosclerosis of the arteries (2, 3, 4).
The NMR Versus Typical Lipid Panels:
The NMR uses advanced spectroscopy to uniquely provide rapid, simultaneous and direct measurement of LDL particle number and size of LDL particles, as well as a direct measurement of HDL and VLDL subclasses. This detailed lipoprotein particle information allows clinicians to make more effective individualized treatment decisions as compared to standard lipid panel testing (5).
This test looks at the standard lipid panel with LDL-C, HDL-C, triglycerides and total cholesterol levels. It also looks at the overall number of LDL particles (LDL-P). This test also breaks the LDL particle into two sizes of large and small LDL particles (6).
Different Types of LDL Particles:
Small, dense LDL particles have less anti-oxidants and are associated with a much higher risk of atherosclerosis. Large, boyant LDL particles are rich in anti-oxidants and present a much lower risk of oxidizing than the small, dense LDL’s (7, 8).
So the two major NMR numbers that are associated with atherosclerotic risk include the total LDL-P and the total small LDL particles. Someone may have high LDL on a standard lipid panel and yet have low LDL-P and small LDL particles giving them very low risk of cardiovascular disease.
On the flip side, someone may have normal or “healthy” LDL on the standard lipid panel but have high LDL-P and small LDL particles making them at high risk for cardiovascular disease.
How to Interpret the NMR Lipid Profile:
The most important number to assess on the NMR is the total LDL-P. The higher the total LDL-P and small LDL particles, the greater the risk for cardiovascular disease. Optimal levels of LDL-P on the NMR test are under 1000 nmol/L.
Near optimal: 1000 – 1299 nmol/L
Borderline – High Risk: 1300-1599 nmol/L
High Risk: 1600-2000 nmol/L
Very High Risk: Greater than 2000 nmol/L
The NMR also measures small and large LDL levels. Normal or healthy ranges for small LDL particles are under 750 nmol/L. Anything above this is a high risk. Anything above 1500 nmol/L is at extremely high risk. To understand the results look at this detailed report.
Like LDL, HDL has multiple subclasses. The most beneficial HDL molecule is “large” HDL which is called HDL2b. This molecule is responsible for reverse cholesterol transport in that it extracts cholesterol from arterial plaque. This is an important protective role for preventing atherosclerosis and heart disease.
Low HDL2b typically goes hand in hand with low HDL levels. People with HDL levels below 40 mg/dL will have low HDL2b while those with HDL above 60 mg/dL have a favorable quantity of large HDL. If levels are between 40-60 mg/dl the NMR test is helpful to determine the level of protective HDL (11, 12).
Intermediate Density Lipoprotein:
Most people are unaware of intermediate density lipoprotein (IDL) but it is a key factor on the NMR profile. IDL is a potent contributor to heart attack risk. When one has elevated IDL it is a sign that the body is struggling to clear fat from the blood after eating (13, 14).
The longer these lipoproteins persist in the blood, the more opportunity they have to become oxidized and create plaque. According to famed cardiologist Dr. William Davis, only about 10% of those with heart disease have elevated IDL levels.
Trigylcerides and VLDL Particles:
These are the most densely triglyceride packed lipoproteins. Triglycerides and VLDL particles typically have a direct relationship where when one is elevated the other will be too. However, there are times where triglycerides will be low and VLDL particles will be high.
VLDL circulates in the blood stream and interacts with LDL and HDL and forces triglycerides into the LDL and HDL particles. This is the initial step in the formation of undesirable small LDL and deficient large HDL.
Who Should Get an NMR Test:
One would use the NMR test because it provides a more accurate picture of cardiovascular (CVD) risk than the standard lipid panel. According to a major study, 50% of the people who suffered a heart attack had normal cholesterol levels. If you have any of the conditions listed below, the NMR LipoProfle test may be right for you:
- Previous heart attack
- Family history of heart attack
- High blood pressure
- Cardiometabolic risk
- Metabolic syndrome
- Low HDL (dyslipidemia)
- High triglycerides
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- St-Pierre AC, Bergeron J, Pirro M, Cantin B, Dagenais GR, Després JP, Lamarche B; Quebec Cardiovascular Study. Effect of plasma C-reactive protein levels in modulating the risk of coronary heart disease associated with small, dense, low-density lipoproteins in men (The Quebec Cardiovascular Study).Am J Cardiol. 2003 Mar 1;91(5):555-8. PMID: 12615259
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- Krauss RM, Dreon DM. Low-density-lipoprotein subclasses and response to a low-fat diet in healthy men. Am J Clin Nutr. 1995 Aug;62(2):478S-487S. PMID: 7625363
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