The NMR and Your Risk of Heart Disease - DrJockers.com

The NMR and Your Risk of Heart Disease

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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).

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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 (23, 4).

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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).

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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.

Researchers noted that elevated small LDL particle count alone can raise heart attack risk by up to 300% and heart attack risk is 600% higher when elevated C-reactive protein is also present (9, 10).

HDL Subclasses:

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).

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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.

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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.

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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:

  • Diabetes
  • Previous heart attack
  • Family history of heart attack
  • High blood pressure
  • Overweight/Obesity
  • Cardiometabolic risk
  • Metabolic syndrome
  • Low HDL (dyslipidemia)
  • High triglycerides

We have the NMR test as part of our CardioPower Testing which looks at major component of cardiovascular function.  You can also find this test on Health Labs here

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Sources For This Article Include:

  1. Berg JM, Tymoczko JL, Stryer L. Biochemistry. 5th edition. New York: W H Freeman; 2002. Section 26.4, Important Derivatives of Cholesterol Include Bile Salts and Steroid Hormones. Link Here
  2. Ballantyne CM, Hoogeveen RC, Bang H, Coresh J, Folsom AR, Heiss G, Sharrett AR.Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2004 Feb 24;109(7):837-42. PMID: 14757686
  3. 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
  4. Koba S, Hirano T, Kondo T, Shibata M, Suzuki H, Murakami M, Geshi E, Katagiri T. Significance of small dense low-density lipoproteins and other risk factors in patients with various types of coronary heart disease. Am Heart J. 2002 Dec;144(6):1026-35. PMID: 12486427
  5. Rankin NJ, Preiss D, Welsh P, Burgess KE, Nelson SM, Lawlor DA, Sattar N. The emergence of proton nuclear magnetic resonance metabolomics in the cardiovascular arena as viewed from a clinical perspective. Atherosclerosis. 2014 Nov;237(1):287-300. PMID: 25299963
  6. Soininen P, Kangas AJ, Würtz P, Suna T, Ala-Korpela M. Quantitative serum nuclear magnetic resonance metabolomics in cardiovascular epidemiology and genetics. Circ Cardiovasc Genet. 2015 Feb;8(1):192-206. PMID: 25691689
  7. Dreon DM, Fernstrom HA, Miller B, Krauss RM. Low-density lipoprotein subclass patterns and lipoprotein response to a reduced-fat diet in men. FASEB J. 1994 Jan;8(1):121-6. PMID: 8299884
  8. 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
  9. Lamarche B, Lemieux I, Després JP. The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects. Diabetes Metab. 1999 Sep;25(3):199-211. PMID: 10499189
  10. Tsimikas S, Willerson JT, Ridker PM. C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol. 2006 Apr 18;47(8 Suppl):C19-31. PMID: 16631506
  11. Colvin PL, Moriguchi E, Barrett PH, Parks JS, Rudel LL. Small HDL particles containing two apoA-I molecules are precursors in vivo to medium and large HDL particles containing three and four apoA-I molecules in nonhuman primates. J Lipid Res. 1999 Oct;40(10):1782-92. PMID: 10508197
  12. Colvin PL, Parks JS. Metabolism of high density lipoprotein subfractions. Curr Opin Lipidol. 1999 Aug;10(4):309-14. PMID: 10482133
  13. Tatami R, Mabuchi H, Ueda K, Ueda R, Haba T, Kametani T, Ito S, Koizumi J, Ohta M, Miyamoto S, Nakayama A, Kanaya H, Oiwake H, Genda A, Takeda R. Intermediate-density lipoprotein and cholesterol-rich very low density lipoprotein in angiographically determined coronary artery disease. Circulation. 1981 Dec;64(6):1174-84. PMID: 7296792
  14. Krauss RM. Relationship of intermediate and low-density lipoprotein subspecies to risk of coronary artery disease. Am Heart J. 1987 Feb;113(2 Pt 2):578-82. PMID: 3544774

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