TV Checkup: Alex Trebek: Hearts in Jeopardy

I understand that Alex Trebek, the host of the television show Jeopardy, had a heart attack last night and that he apparently had no risk factors for Coronary Artery Disease.

Is it true that he did not have any of the 5 major risk factors for heart disease? The major risk factors for Coronary Heart Disease are Smoking, Diabetes, Hypertension(high blood pressure), Age, and High Cholesterol. I believe that he did not have the first three, but we all age so that is indeed a risk factor.

Most importantly, did he really have normal cholesterol levels? On his regular lipid panel done by his doctor, I am sure it was "normal" but there is so much more to the story. I will give you something to think about. Last year there were 125 million lipid panels done in the US but the number of patients with Coronary Heart Disease continues to rise.

Also, the CDC states that 50% of people who have heart attacks have "normal" cholesterol at the time of their heart attack. Was Alex Trebek one of the 50% ? My guess was that he was in that group.

Although I am a heart surgeon, I have dedicated my practice to preventing Cardiovascular Disease by opening up The Center for Cholesterol Management in Los Angeles where I perform advanced lipid testing on all my patients. There is more to lipid management than measuring "good" and "bad" cholesterol. Most of today's tests do NOT tell the whole story. In fact many times heart attacks can occur without any warning signs. I will try and describe advanced cholesterol testing in simple terms.

We all know that oil and water do not mix. Well, blood is like water and cholesterol is an oily substance. When too much cholesterol is deposited in one of the Coronary Arteries, a narrowing results which can lead to a heart attack.

Since blood and cholesterol do not mix, the cholesterol has to be transported through the body by particles and these particles include HDL(the good cholesterol) and LDL( the bad cholesterol). Think of these lipoprotein particles as cars on a highway and ask yourself, is it the number of cars that cause a traffic jam or the number of passengers in the cars? We all know that it is the number of cars.

Unfortunately, the cholesterol testing that is done by 99.9% of the physicians in the US measures the numbers of passengers in the cars when it has been show that it is the number of LDL particles(the cars) that cause Atherosclerosis. I perform LDL particle testing on all my patients and measure the number of LDL particles in the blood stream.

This type of testing misses no one with high cholesterol, which can lead to Atherosclerosis, heart attack, and death while conventional lipid testing can miss up to 50-60% of people with high cholesterol but their test shows it to be "normal".

Simply put, the more LDL particles one has, the greater the risk of Cardiovascular disease. An example would be this: Let's say on your cholesterol test at your doctor's office your LDL cholesterol is 120mg/dl. This is considered normal in a low-risk patient. How do I know if you have two big cars(LDL particles) carrying 60 people in each one or 120 small cars (LDL particles) with one person?

It is impossible to know without doing LDL particle testing. The first person has a LDL cholesterol level of 120mg/dl and this is transported through the blood in two big particles. This person is not going to get Atherosclerosis. The second person has exactly the same "normal" LDL cholesterol of 120mg/dl, but it is transported through the blood in 120 small LDL particles. There is no doubt that the second person has had untreated high cholesterol for years because the patient and the physician thought it was "normal".

Years of untreated high cholesterol (high LDL particle number) leads to Atherosclerosis and ultimately Cardiovascular Disease and maybe even death. For a more in depth discussion, you can go to my website at http://www.lipidcenter.com/ and click on the power point presentation titled Advanced Cholesterol Testing - A Basic Understanding.

Dr. Richman also writes about issues related to cholesterol management and testing on his Cholesterol Management 101 blog.

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