Cardiovascular Laboratory Testing Q&A
Understanding your lipid results.
All people who have diabetes should have regular blood tests to check on lipids. Most people are familiar with the "basic" lipid tests—LDL-cholesterol (the "bad" cholesterol), HDL-cholesterol (the "good" cholesterol), and Triglycerides (another lipid that is "bad" if levels are too high). There are other lab tests that your health care provider may order that can be helpful to determine your risk for cardiovascular disease. It is important to remember that there is no one blood test that alone can predict your risk. Your health care provider takes into consideration many things including your medical history, lifestyle components, physical examination, and other risk factors. He or she will work with you to determine just what testing you need.
Q. My lab report states "LDL-C calculated." What does this mean?
A. On most lipid testing, the LDL cholesterol is not directly measured. A calculation (called the "Friedewald Formula) is used to approximate the amount of LDL cholesterol that you have. While not a direct measurement, it is accurate if your Triglycerides are less than 400 mg/dL. Decades of research have determined that this calculated number is associated with risk for cardiovascular disease. Our current guidelines set goals for patients based on the calculated number. If your Triglycerides are over 400 mg/dL you may have the direct measurement of your LDL-cholesterol performed.
Q. Wouldn't a direct measurement of LDL-cholesterol be better?
A. The chief drawback of direct measurement is the cost—this can be well over $100 and may not be covered by your insurance. Many people have several measurements a year so the cost can add up. The calculated and direct measurements are not exactly comparable so it is best to stay with either calculated or direct measurements to monitor your levels and progress if you are on medication.
Q. Many people talk about their "total cholesterol" number. Is this important?
A. It is a bit of a misrepresentation to use the total cholesterol number reported to determine if you are at goal for your lipids. The reason for this is that the "total" number reflects the individual components—LDL-cholesterol, HDL-cholesterol, and Triglycerides. So, if your HDL-cholesterol is high it can make the total number high—but for a good reason (HDL is the good cholesterol and higher numbers are better).
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...