The Good, the Bad and the Ugly – the Lipoprotein Story

You have heard of “good” cholesterol (HDL) and no doubt heard of “bad” cholesterol.  But have you heard of the “ugly” cholesterol (small dense LDL)?  Small dense LDL are one particular dangerous type of LDL.  Unfortunately their measurement is not captured in the regular cholesterol profile, or in the regular LDL measurement.  So you can have a PERFECTLY NORMAL, or even LOW LDL number, but have a high proportion of small dense LDL, and be at greatly increased risk for heart attack and stroke.  In fact, 50% of women who have heart attacks and strokes have normal, or even “great” cholesterol profiles.

Small dense LDL particles (I call it “ugly” cholesterol)  enter the artery wall (the “intima media”) and release inflammatory signals.  Regular LDL doesn’t do this, at least not nearly to the same extent.  Your immune system moves in to try to clean them up the low density LDL.  The immune cells “eat” (the official word is “phagocytose”) your small dense LDL particles.  This forms plaques in the arteries that can break off and travel upstream to cause heart disease and stroke.

For more information, have a look at this video for some new insights into the kind of cholesterol you need to be concerned about.

Thinking of your cholesterol number is like thinking of the cumulative score of a baseball game.  Say 32.  But you won?  It is much more important to know the score of each team.

The same applies to cholesterol.  The kinds of cholesterol that contain a protein called apo-lipoprotein A1 are good.  (Super!  A1!).  That’s because they circulate throughout the body picking up excess cholesterol, including the kind accidentally deposited in the blood vessel wall by small dense LDL, and take it back to the liver.  All types of cholesterol that contain a protein called apo-lipoprotein B-100 are bad, and are associated heart disease risk, but some much much more so than others.   This “bad” group includes VLDL (very low density lipoprotein), LDL (low density lipoprotein) and intermediate density lipoprotein (IDL).  Small dense LDL is the worst.  Downright ugly.  It is the most inflammatory, and plaque forming lipoprotein.

If your overall cholesterol “score” is 194, it would be considered “normal”.  However, if a high portion of that “score” is bad cholesterol (as measured by apo-lipoprotein B-100), and within that a high proportion is small density  LDL, you are still at high risk for heart disease.

Insulin resistance conditions, including polycystic ovarian syndrome, which we see so much of in our clinic, prediabetes and diabetes, all increase the proportion of these small dense LDL particles.  Small dense LDL is more likely with obesity, with metabolic syndrome and in patients with renal dysfunction.  Trans-fat increases the levels of small dense LDL (ugly cholesterol).

Although regular LDL (bad) cholesterol is not increased with diabetes, small dense LDL (ugly) cholesterol is.

Dr. Ravasia, Dr. Debra Ravasia, Debra Ravasia MD, Women's Health Connection, Spokane, cholesterol, small dense LDL, small LDL, heart disease, women, polycystic ovarian syndrome, PCOS

Why Small LDL is Dangerous (from www.antiaging.com)

Small dense LDL is highest before breakfast, and lowest after eating.  (Another important reason not to skip breakfast).

Small dense LDL is specifically reduced with certain structured lifestyle changes, and with smoking cessation, as well as treating insulin resistance.  Statins decrease overall cholesterol levels but do NOT alter the proportion of cholesterol that is “bad” and “ugly”.  In fact, statins actually INCREASE the proportion of small dense LDL particles (ugly)  relative to the other types of particles (good and bad), in some situations, such as when triglycerides (blood fats) are low.  Niacin and fenofibrates can change the proportions.

The structured lifestyle changes we are talking about are pretty specific.  Modified mediterranean diet, with a low glycemic index, to minimize insulin resistance, exercise, particularly the kind that builds lean body mass, stress reduction and smoking cessation are all helpful.  Metformin can be helpful as well.

Small density LDL needs a special test to measure it, called a “particle test”.  Common types include NMR, VAP, Berkeley labs, and a few others.  We use a lab which will bill your insurance, but will not ever bill you directly, even if your insurance doesn’t cover it, or cover all of it.

Find out more by setting up an appointment with one of our providers at Women’s Health Connection.  Call (509) 465-8885, or visit our website at www.whconnection.com.

Posted in Cholesterol Management, Cholesterol Management, Cholesterol Management, Functional Medicine, Hypertension, Hypertension, Lifestyle Medicine, Polycystic Ovarian Syndrome, Preventative Care, Specialty Gynecologic Services | Tagged , , , , , , , , , , , , , , | Leave a comment

One very helpful patient iphone app…

The American Medical Association has a new iphone app that I love.  It offers a portable storage site for all your medical info.  Medications, allergy information, emergency contacts, your health care team, and your pharmacy. It makes information between patients and health care providers much easier, and further it enhances medication safety.

Best of all it’s a free app without any secondary sales motive or underlying agenda.  Hats off to the American Medical Association for developing this app!!  Click on the image below to access more information.  Bringing this information with you to your appointment is very helpful – we can help you update it when you are finished!

Women's Health Connection, Dr. Debra Ravasia, Spokane, WA, gynecology, urogynecology, primary care, bladder problems, urinary incontinence

My Medications iphone app by the American Medical Association

Posted in Bladder Problems, Functional Medicine, Lifestyle Medicine, Minimally Invasive Gynecological Surgery, Pelvic Prolapse, Preventative Care, Specialty Gynecologic Services | Tagged , , , , , , , , , , , , , | Leave a comment

Changes in Blood Pressure in Early 40s Affect Lifetime Risk of Stroke and Heart Attack in Women

“Oh it’s just up because I was in a rush to get here”

“Oh it’s just up because I took the stairs”

“Oh it’s just up because I’m feeling a little stressed”.

It is easy to try to rationalize a high blood pressure reading in the office.  Another common one I hear is “It’s only up in the office, never at home”.

Most of the studies that have been done tracking adverse effects of blood pressure have actually been based on a single  set of blood pressure readings in the office.

And stress does affect blood pressure in some people.  The question is “how much and how often are you stressed?”  If the stress of a doctor’s visit is enough to put your blood pressure up, what about pressures from family and children and work?  What
portion of the day is your blood pressure up as a result of stress?

The adverse effects of long term unaddressed blood pressure include blindness, kidney disease, stroke, heart attacks, peripheral vascular disease and many others.  Many people
with mild or intermittent hypertension with no symptoms  who are untreated or undertreated assume that those risks don’t pertain to them – that the risks apply to older people and people with more severe hypertension.

Now,  a recent study in Circulation goes one step beyond validating the importance of high blood pressure readings in the office  as being significant.  It shows that a single  set of normal readings in the office is not enough to rule out subtle changes in blood pressure that can be deadly and disabling in the longer term.  The study tracked blooPhysical Activityd pressure over 14 years beginning at age 41.

They found that women who developed hypertension between ages 41 and 55 had a 49% lifetime risk of heart attack or stroke, compared to those whose blood pressure remained normal, who have a 22% lifetime risk.

So it MATTERS if your blood pressure reading tends to increase easily when your stressed or in a rush.

This doesn’t mean you need to start medications right away, and in fact we usually don’t recommend that you do.  But it is VERY important to take it as a warning sign, and put your health first.

Hypertension is a killer, untreated.
Structured lifestyle changes, including a modified Mediterranean food plan, physical activity plan, sleep and stress management, careful supplement and medical food selection, are the initial first steps, and Women’s Health Connection can help.  If these measures do not make a substantial difference (ie bring blood pressure down to less than 140/90), then medications become necessary in addition to lifestyle changes, but ongoing lifestyle changes help reduce the amount of medication that is necessary.

At Women’s Health Connection, blood pressure is measured at rest, in both arms, at every visit, as recommended by the current guidelines on hypertension detection and treatment.

Call us at (509) 465-8885 to set up your preventative examination today, or to find out more about treating chronic medical conditions, such as hypertension with intensive lifestyle changes.

 

Posted in Hypertension, Hypertension, Lifestyle Medicine, Preventative Care | Tagged , , , , , , , , , , , , , , , , , , , , | Leave a comment

Emergency Contraception Should be Available for Adolescents (Plan B)

 

What is the most commonly performed gynecologic procedure in the USA?  No it’s not a hysterectomy.  And no, not an ablation.  It’s therapeutic abortion.  By a long shot.  Over 1.3 million abortions occur every year in the USA.  In fact that makes it the most common surgery performed overall.

More than 50% are obtained by women under age 25, and almost half of these by women under age 20.  The peak age is 18.  80% are unmarried.  American teenagers are especially dependent on abortion compared to their European counterparts, who are better educated about sex, and who use contraception more effectively.

More than half of teenage girls are sexually active prior to age 17.  Most of the time the first sexual encounter is unplanned and has not been thought out or prepared for.

Now, these are just facts, and this blog does not pretend to be “for” or “against” abortion.  I realize that the issue is complicated, and like most Americans, I’m not polarized on this.

But no matter what side of the fence you lean towards, you have to agree this is not good.  We need to get our head out of the sand.  We need responsible prevention, as a government policy, as a society.

Yet, we seem to be stepping further backwards as a country.  This week, the Food and Drug Association (FDA) was about to announce that Plan B was safe and effective without a prescription for adolescents aged 11 to 17, after extensive study and was approved for this use.  Kathleen Sebelius, Health and Human Service Secretary, made a recent shocking decision to override the FDA’s decision three days before they announced it publically.  This naïve approach will no doubt be responsible for many more therapeutic abortions than would have needed to occur among our girls ages 11 to 17.

Women's Health Connection, Dr. Debra Ravasia, contraception, Spokane, WA

Kathleen Sebelius, Source: www.whorunsgov.com

Plan B is safe and effective for over the counter use for adolescents.  This unilateral decision by Kathleen Sebelius to override the FDA is regrettable.

Plan B is easier than ever to use.  See http://www.planbonestep.com/ .  If you would like more information about Plan B, or other forms of contraception, reversible or permanent, please call us to set up an appointment at (509) 465-8885.

The following is a list of pharmacies in Spokane that provide Plan B:

North Spokane

FRED MEYER
12120 N DIVISION ST
SPOKANE, WA 99218
(509) 465-4433

PAYLESS LONGTERM PHARMACY
1224 E WESTVIEW CT
SPOKANE, WA 99218
(509) 467-3250

SAFEWAY PHARMACY
10100 N NEWPORT HWY
SPOKANE, WA 99218
(509) 465-3676

WALGREENS DISTRICT OFFICE
10220 N NEVADA ST # 270
SPOKANE, WA 99218
(509) 465-4775

TARGET
9770 N NEWPORT HWY
SPOKANE, WA 99218
(509) 466-3006

SHOPKO
9520 N NEWPORT HWY
SPOKANE, WA 99218
(509) 466-2449

ROSAUERS SUPERMARKETS INC
9414 N DIVISION ST
SPOKANE, WA 99218
(509) 467-6812

SAV-ON PHARMACY
12312 N DIVISION ST
SPOKANE, WA 99218
(509) 466-0357

WALGREENS PHARMACIES
12315 N DIVISION ST
SPOKANE, WA 99218
(509) 466-7461

RITE AID
12420 N DIVISION ST
SPOKANE, WA 99218
(509) 466-1946

RITE AID
9120 N DIVISION ST
SPOKANE, WA 99218
(509) 464-4480

WALGREENS PHARMACIES
7905 N DIVISION ST
SPOKANE, WA 99208
(509) 467-8361

KMART
6606 N DIVISION ST
SPOKANE, WA 99208
(509) 489-0320

SAV-ON PHARMACY
6520 N NEVADA ST
SPOKANE, WA 99208
(509) 489-5287

FRED MEYER PHARMACY
525 E FRANCIS AVE
SPOKANE, WA 99208
(509) 482-5033

SAFEWAY PHARMACY
902 W FRANCIS AVE
SPOKANE, WA 99205
(509) 327-6114

LIDGERWOOD OWL PHARMACY
5901 N LIDGERWOOD ST # 100
SPOKANE, WA 99208
(509) 483-3566

PROFESSIONAL CENTER PHARMACY
5901 N LIDGERWOOD ST
SPOKANE, WA 99208
(509) 489-2981

ROSAUERS SUPERMARKETS INC
1724 W FRANCIS AVE
SPOKANE, WA 99205
(509) 328-1260

RITE AID
5520 N DIVISION ST
SPOKANE, WA 99208
(509) 489-6010

FAMILY CENTER PHARMACY
235 E ROWAN AVE
SPOKANE, WA 99207
(509) 483-5050

YOKE’S FRESH MARKET
14202 N MARKET ST
MEAD, WA 99021
(509) 242-0200

YOKE’S PHARMACY
3321 W INDIAN TRAIL RD
SPOKANE, WA 99208
(509) 325-8720

SAV-ON PHARMACY
9001 N INDIAN TRAIL RD
SPOKANE, WA 99208
(509) 465-8590

RITE AID
9007 N INDIAN TRAIL RD
SPOKANE, WA 99208
(509) 464-2791
South and Central Spokane

FRED MEYER
400 S THOR ST
SPOKANE, WA 99202
(509) 532-4033

MEDICATION REVIEW INC
104 S FREYA ST # 119
SPOKANE, WA 99202
(509) 536-1900
KMART STORE PHARMACY
4110 E SPRAGUE AVE
SPOKANE, WA 99202
(509) 534-7367

NORTHWEST HEALTH SYSTEMS PHARM
1011 E 2ND AVE # 6
SPOKANE, WA 99202
(509) 744-9891

RIVERPOINT PHARMACY
528 E SPOKANE FALLS BLVD # 110
SPOKANE, WA 99202
(509) 343-6252

SAFEWAY PHARMACY
933 E MISSION AVE
SPOKANE, WA 99202
(509) 482-2089

CARDINAL HEALTH
413 E PACIFIC AVE
SPOKANE, WA 99202
(509) 747-3050

WALGREENS PHARMACIES
400 E 5TH AVE # 102
SPOKANE, WA 99202
(509) 838-0175

RELIANT RX LLC
120 N PINE ST # 156
SPOKANE, WA 99202
(509) 343-3400

FIRST AVENUE PHARMACY
6 E 1ST AVE
SPOKANE, WA 99202
(509) 624-3017

COSTCO PHARMACY
5601 E SPRAGUE AVE
SPOKANE VALLEY, WA 99212
(509) 842-0002

FIFTH & BROWNE PHARMACY
104 W 5TH AVE # 180E
SPOKANE, WA 99204
(509) 838-4117

SAFEWAY PHARMACY
2509 E 29TH AVE
SPOKANE, WA 99223
(509) 532-9182

ROSAUERS SUPERMARKETS INC
2610 E 29TH AVE
SPOKANE, WA 99223
(509) 535-3683

RITE AID
2929 E 29TH AVE
SPOKANE, WA 99223
(509) 535-9056

MEDICINE SHOPPE
105 W 8TH AVE
SPOKANE, WA 99204
(509) 624-2106

SOUTH CENTER PHARMACY
105 W 8TH AVE
SPOKANE, WA 99204
(509) 624-2106

MEDICINE SHOPPE
820 S MCCLELLAN ST
SPOKANE, WA 99204
(509) 624-2106

SIXTH AVENUE MEDICAL PHARMACY
508 W 6TH AVE # 100
SPOKANE, WA 99204
(509) 455-9345

RITE AID
112 N HOWARD ST # 115
SPOKANE, WA 99201
(509) 838-1851

HART DILATUSH PHARMACY
601 W RIVERSIDE AVE # 140
SPOKANE, WA 99201
(509) 624-2111

RITE AID
810 E 29TH AVE
SPOKANE, WA 99203
(509) 838-3508

WALGREENS PHARMACIES
2830 S GRAND BLVD
SPOKANE, WA 99203
(509) 455-3736

YOKE’S PHARMACY
210 E NORTH FOOTHILLS DR
SPOKANE, WA 99207
(509) 325-6933
YOKES FOODS-PHARMACY
210 E NORTH FOOTHILLS DR
SPOKANE, WA 99207
(509) 325-5611

Posted in Contraception, Emergency Contraception, Preventative Care, Specialty Gynecologic Services | Tagged , , , , , , , , , , , , , , , , , , , | Leave a comment