Red meat and high-starch meals like mashed potatoes had been the household fare whereas Stephanie Blendermann was rising up in Long Island, New York. Her father was a butcher in spite of everything, and a smoker, who ultimately required bypass surgery for clogged arteries. And tragically, three of her sisters died prematurely (of their 40s and 50s) from heart assaults. So as she approached 65, despite the fact that her LDL (or “bad”) levels of cholesterol had been tremendous, Stephanie was involved her household historical past may meet up with her. At Mayo Clinic, she underwent ceramide testing, a novel assay that may reveal extra about heart illness and stroke risk than customary lipid exams.
“I’m sure my sisters’ early deaths were partly from lifestyle, and from smoking, which I never took up,” says Stephanie, an actual property agent primarily based in Prior Lake, Minnesota, who focuses on govt relocation for prime companies. “It’s pretty devastating to think here I am now, just about 65, and they didn’t get to live full lives and see all the things I’ve seen.”
Stephanie got here beneath the care of heart specialist Vlad Vasile, M.D., Ph.D., co-director of Mayo Clinic’s Clinical Specialty Laboratory and medical director of the Cardiovascular Health Clinic, who beneficial ceramide testing. “Coronary artery disease and plaque formation are both very complex processes,” says Dr. Vasile. “I think the more tests we have, to assess cardiovascular risk of a specific patient, the better off we are. One of these tests is the ceramide score that we developed here at Mayo Clinic, and I use it extensively in my practice.”
Ceramides are sphingolipids, discovered in every single place in our body. Though they’re “ubiquitously expressed,” the check focuses totally on three ceramides of cardiovascular curiosity. “The beauty of these three ceramides is they’re involved in different pathways,” says Dr. Vasile. “All of them are involved in plaque formation, some reflect inflammation, some of these ceramides reflect the bad cholesterol, and some coagulation or thickening of the blood.”
Jeff Meeusen, Ph.D., co-director of the Clinical Specialty Laboratory, chimes in: “I think ceramides are a very biologically active group of signal molecules. So, whereas cholesterol is more or less a scaffolding, a building block that the cells can use to make other things, these ceramides seem to be specific actors in these different roles. So when they’re imbalanced they seem to have a stronger physiological signal that informs our ceramide test.”
A easy quantity correlates with heart attack risk
The ceramide check makes use of liquid chromatography-mass spectrometry know-how, which types by way of complicated molecular compounds after which renders an algorithmic rating — a easy quantity that locations the affected person in a “bucket” of risk. For clinicians, it’s simple to interpret as a result of this quantity is correlated with one of 4 classes of risk, from low risk to very high risk.
Stephanie’s ceramide rating was an 8, which put her at increased risk for a heart attack. The rating was “eye-opening” to her as a result of she had way back reduce out pink meat and was staying energetic. Still, she observed shortness of breath on walks, particularly when attempting to take hills, in addition to achiness and a scarcity of vitality.
“I couldn’t figure out what was wrong with me,” says Stephanie, who additionally suffers from a connective tissue dysfunction, a persistent inflammatory situation that may contribute to coronary plaque formation. “I just knew I wasn’t myself. But I wasn’t having heart pain or anything else. And I just figured the achiness was from the statin I was on. But we found out from the ceramide test that I have certain ceramides where you get a thickening of the blood in your body, in your arteries and whatnot. And it just doesn’t let the body act as efficiently as it should even though my cholesterol was going down.”
Ceramide testing shouldn’t be the one assay for assessing cardiovascular risk. Cardiologists like Dr. Vasile additionally use conventional blood exams just like the lipid panel and lipoproteins as blood biomarkers to point coronary artery illness risk components. There’s additionally a coronary calcium rating and ECG chest X-ray, amongst others.
“WE’RE LOOKING AT MANY, MANY THINGS, NOT JUST ONE PARAMETER,” EMPHASIZES DR. VASILE. “WE ALSO HAVE CERTAIN CALCULATORS WHERE WE PLUG IN ALL THESE CLINICAL PARAMETERS, LIKE BLOOD DATA SUCH AS CHOLESTEROL, AND THE DEMOGRAPHICS OF THE PATIENT. AND THESE CALCULATORS RENDER A CERTAIN RISK FOR DEVELOPING HEART ATTACKS AND STROKES WITHIN THE NEXT 10 YEARS, OR OVER THE LIFETIME, FOR EXAMPLE. BUT WE KNOW VERY WELL THAT THESE CALCULATORS ARE FAR FROM BEING PERFECT. THERE IS A LOT OF CRITICISM WITH THESE CALCULATORS BECAUSE CORONARY ARTERY DISEASE AND PLAQUE FORMATION ARE, AS I’VE SAID, VERY COMPLEX PROCESSES.”
Dr. Vasile places a high worth on ceramide testing as a result of it rises above such calculators to raised inform him on therapy plans for sufferers like Stephanie. “When you look at a traditional biomarker, such as a lipid profile, it really only looks at the LDL or bad cholesterol that deposits on the plaque,” he says. “So it’s just one risk factor out of the many risk factors. But the ceramide score is a more comprehensive biomarker because it looks at three different pathways that are involved in plaque formation. So, I trust the ceramide score more than just a simple biomarker like the lipid profile.”
Dr. Meeusen provides, “We would still recommend starting with the standard lipid assessment and other risk factors. And when there is intermediate risk and you’re trying to gauge how aggressive you want to take your treatment plan, the ceramide test is designed to help with that scenario.”
A brand new lease on life
Once he knew Stephanie’s ceramide check rating, Dr. Vasile refined her statin remedy. “Mrs. Blendermann’s ceramide score of 8 placed her at high cardiovascular risk,” he says. “So this number told me that we needed to be aggressive. We needed to not only address her lifestyle with diet and exercise, but we also needed to be more aggressive with lowering her lipids, her LDL cholesterol.”
The LDL goal for the typical inhabitants must be lower than 100 milligrams per deciliter. But given Stephanie’s ceramide rating, Dr. Vasile beneficial an LDL goal of lower than 70 milligrams per deciliter. The next LDL stage is all the time correlated with heart assaults and strokes; thus, the decrease the LDL, the decrease the risk of growing these occasions down the road.
As for way of life adjustments, Dr. Vasile beneficial that Stephanie enhance her dietary habits. “When I first saw her, she was not following a perfect diet, but she was not on a bad diet either,” he says. “We did have her talk with our dietician in the Cardiovascular Health Clinic, who recommended a Mediterranean diet, and she really changed her diet accordingly. We also recommended initiation of a systematic aerobic exercise. She talked with our cardiovascular physiologist who tailored her exercise program at home. So she did both these things. She is a very compliant patient.”
Dr. Meeusen additionally advocates food plan and exercise. “People with high ceramides received a stronger benefit than those with normal ceramides when they were on the Mediterranean diet intervention,” he says. “The ceramide score can respond quickly to improved diet and increased exercise, which can motivate patients to maintain their healthy lifestyle changes.”
TODAY, STEPHANIE FEELS LIKE A NEW PERSON WHO IS BETTER ABLE TO ENJOY HER ACTIVE LIFE. AND SHE NOW LOOKS FORWARD TO MANY YEARS AHEAD. “MY CERAMIDE TEST SCORE REALLY PUT ME IN HIGH GEAR TO MAKE CHANGES,” SHE SAYS. “IT’S AMAZING HOW YOU CAN ADJUST YOUR WAY OF THINKING AND DESIRES OF WHAT YOU WANT TO EAT. AND WITH DR. VASILE’S TREATMENT, IT’S MADE A REMARKABLE DIFFERENCE, REALLY A REMARKABLE DIFFERENCE.”
It’s additionally a bit of bittersweet for Stephanie, who provides, “Had my sisters had ceramide testing, and had they had this type of great medicine at Mayo, I think that would have given them longer lives.”
This article initially appeared on the blog of Mayo Clinic Laboratories.