Lipids: LDL-P & VLDL
I’ve never been concerned with my cholesterol numbers. All my numbers have been in the acceptable range; total 193, HDL 81, Tri 80, LDL 94, Non-HDL 112, Chol/HDL-C 2.4, TG/HDL-C 1.0 were the results from my last screening. However, after my previous doctor retired, my new doctor ran additional tests under the category of “Lipoprotein Fractionation, NMR” which included two results that were outside the acceptable ranges: LDL-P 978 (<935 “optimal”) and VLDL Size 47.5 (<47.1 “optimal”). Because of those two outliers, I was prescribed a CAC test which yielded a greater than zero reading of 90. At age 56 and after decades of endurance activities, probably no surprise to have a greater than zero result. This prompted my doctor to prescribe a stress test of all things. This test went fine; peak blood pressure during test 166/82, max hear rate 144, exercise capacity 13.7 METs., nothing abnormal.
Bottomline: my concern is that this new doctor has prescribed a 5 mg dose of Rosuvastatin because of those two readings out of range along with the CAC score. On the one hand, I do not believe that the CAC reading should have been a reason for prescribing a statin. On the other hand, I do not know the relevance of LDL-P & VLDL screens; are they measurements worth looking at? Also, since statins don’t seem to have any major side effects for most people, and since taking the statin my LDL has dropped all the way down to 55, maybe no harm to foul?
Hi there,
Those baseline numbers do indeed look good. In a small proportion of individuals there can be a “discordance” between cholesterol-based metrics (like those measured on a standard lipid panel) and particle-based metrics (like LDL-P or apoB), such that people can be at higher risk even with standard labs that look good.
However, even your advanced measurement numbers are not especially concerning. I am not sure where the reference range (“normal”) values came from on those additional tests, however I would not be too concerned with those results. Based on what you’ve described here I would not have recommended the advanced testing at all in your case, nor would I have recommended a stress test (particularly if you have no symptoms or issues with training).
Regarding where you go from here: those two measurements on their own would not automatically justify a statin in my mind. Some clinicians might base their statin decisions on a CAC score, however your situation may be a bit different if you have been very healthy throughout your life and this is moreso attributable to high volume endurance exercise (although this isn’t really possible to definitively prove in any given individual). I would still be considering other risk factors (e.g. family history, blood pressure, smoking history, other lab data), and coming to a shared decision with the patient. It’s hard to say how likely you are to benefit from this treatment over the long term, but if you would prefer to absolutely minimize your risk and have no issues taking the 5 mg dose, you are right that there’s nothing wrong with that.
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