Health

Ceramide testing helps shape individualized heart health treatment plan:

For a lot of his life, Mark Kocak stored in nice shape, lifting weights, doing aerobics and yoga, all whereas being an avid runner. But as he approached his 60s, Mark discovered himself coping with high LDL (or “bad”) cholesterol. His main care physician advisable he go on a statin, however Mark refused, till sooner or later, “I felt a little weird and thought maybe I was having a heart attack,” Mark says. Though the episode was a false alarm, it served as a wake-up name for Mark.

“My primary doctor, for the last few years, had been recommending I go to a cardiologist because of my high cholesterol and things like that, and I’d been kind of kicking the can down the road,” says Mark, now 62 and lately retired from instructing health and bodily training at a junior high college in southwest Minnesota. “But when I had that scare with my heart, I decided I better see one. And I knew right away where I wanted to go, and that was Mayo Clinic.”

At Mayo, Mark got here underneath the care of preventive heart specialist Vlad Vasile, M.D., Ph.D., co-director of Mayo’s Clinical Specialty Laboratory, who advisable he endure ceramide testing. A novel assay developed at Mayo, ceramide testing can reveal extra about heart illness and stroke threat than commonplace lipid checks. Ceramides are sphingolipids, discovered in all places in our body. Though they’re “ubiquitously expressed,” the take a look at focuses totally on three ceramides of cardiovascular curiosity.                                              

“The beauty of these three ceramides is they’re involved in different pathways,” says Dr. Vasile, who additionally serves as medical director of Mayo Clinic’s Cardiovascular Health Clinic. “All of them are involved in plaque formation. Some reflect inflammation, some reflect the bad cholesterol, and some reflect coagulation or thickening of the blood.”

Jeff Meeusen, Ph.D., who co-directs Mayo’s Clinical Specialty Laboratory alongside Dr. Vasile, believes ceramides to be “a very biologically active group” of sign 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,” he says. “When they’re imbalanced they seem to have a stronger physiological signal that informs our ceramide test.”

Moving past the grey space of threat calculators

Mayo Clinic’s ceramide take a look at makes use of liquid chromatography-mass spectrometry expertise to kind by means of complicated molecular compounds and render an algorithmic rating — a easy quantity that locations the affected person in a “bucket” of threat. For clinicians, it’s simple to interpret as a result of this quantity is correlated with certainly one of 4 threat classes, from low to very high threat. The take a look at can also be accessible to physicians outdoors of Mayo Clinic; one want solely ship in a affected person’s blood specimen to obtain their ceramide rating.

“I WOULD SAY ABOUT HALF OF OUR CERAMIDE TEST ORDERS ARE EXTERNAL AND THE OTHER HALF ARE FROM MAYO CLINIC PHYSICIANS,” DR. MEEUSEN SAYS. “BUT BECAUSE WE ARE THE ONLY CENTER OFFERING THIS TEST RIGHT NOW, VERY FEW PHYSICIANS KNOW ABOUT IT. AT THE SAME TIME, THERE’S QUITE A BIT OF LITERATURE BUILDING UP IN ITS SUPPORT.”

When Mark got here to Dr. Vasile, in addition to high ldl cholesterol, he additionally had stage 1 hypertension.

“His LDL level was 137, which was not really at goal,” Dr. Vasile says. “And he has a family history of premature coronary artery disease in first-degree relatives, so I ran the ASCVD calculator (a tool that estimates a patient’s 10-year risk of heart attack), which put him in a gray area of intermediate risk.”

Cardiologists like Dr. Vasile additionally use chest imaging and conventional blood checks to point coronary artery illness threat elements. But even this testing is restricted, as are present threat calculators.

“We’re looking at many, many things, not just one parameter,” Dr. Vasile says. “With these calculators, we plug in all these clinical parameters, like blood data such as cholesterol, the demographics of the patient, and these calculators render a certain risk for developing heart attacks and strokes within a certain time span. But we know very well that these calculators are far from being perfect. There is a lot of criticism with such calculators because coronary artery disease and plaque formation are very complex and multifactorial processes.”

Dr. Vasile continues, “So, here’s this patient, Mr. Mark Kocak, who comes to me with a high LDL cholesterol of 137 mg/dL and a strong family history of heart disease. He’s also at higher risk because he’s a male. Should I target for him an LDL of less than 100, or should I be more aggressive and target an LDL of less than 70? The ASCVD risk calculator was not very helpful in this situation because it ignores family history completely, and so I needed more information.”

Targeting LDL numbers to suit the person

This is the place ceramide testing turns into invaluable for Dr. Vasile. It’s a device that helps him push by means of these grey space situations and higher individualize treatment plans for sufferers. Mark’s ceramide rating was zero, which positioned him at low cardiovascular threat — not like one other affected person of Dr. Vasile, Stephanie Blendermann, whose rating was an 8, which put her at high threat.

“So, his score was in opposition to Mrs. Blendermann’s, who had a high score and a similar family history,” Dr. Vasile says. “This told me that Mr. Kocak’s family history probably doesn’t have a significant influence on him. So, we jointly decided that because his ceramide score was zero, we shouldn’t be as aggressive with him as we were for Mrs. Blendermann, whose LDL we targeted at less than 70 milligrams per deciliter. His score told us we should target an LDL number of less than 100, which is the risk category for the average person walking the street.” 

Higher LDL ranges are correlated with heart assaults and strokes; thus, the decrease the LDL, the decrease the chance of creating these occasions down the road. To scale back Mark’s threat and produce his LDL to objective, Dr. Vasile advisable a statin and medicine for hypertension.

“WITHOUT THAT CERAMIDE SCORE, I WOULDN’T BE ABLE TO COMPLETELY SAY, ‘YEAH, I WANT THIS PATIENT’S LDL TO BE BELOW 100 OR BELOW 70,’” DR. VASILE SAYS. “AND TO REACH THAT SPECIFIC GOAL FOR THE LDL, IT DOES MAKE A DIFFERENCE AS FAR AS WHAT DOSE OF STATIN YOU ARE ON.”

Though his ceramide rating put him at low threat, Mark heeded Dr. Vasile’s suggestion to go on meds to additional lower his probabilities of an occasion. “If a statin and then a low-dose hypertension pill can keep a heart attack at bay, it’s sort of a no-brainer,” Mark says. “I agreed with him on that, and it was part of our preventative plan.”

Dr. Vasile additionally urged Mark to proceed his cardio exercise program, weight training, and yoga, and had him speak with a dietician in Mayo’s Cardiovascular Health Clinic, who advisable he start following a Mediterranean food regimen. Meanwhile, Mark continues to run, although he’s taking it a bit simpler nowadays. “I’m down to 5 and 10Ks,” he says. “Those are a lot more comfortable at this age.” 

Dr. Vasile additionally urged Mark to proceed his cardio exercise program, weight training, and yoga, and had him speak with a dietician in Mayo’s Cardiovascular Health Clinic, who advisable he start following a Mediterranean food regimen. Meanwhile, Mark continues to run, although he’s taking it a bit simpler nowadays. “I’m down to 5 and 10Ks,” he says. “Those are a lot more comfortable at this age.” 

As a part of his preventative plan, Mark will probably be re-tested for his ceramide rating on follow-up visits with Dr. Vasile in order that any change may be caught early, and his treatment adjusted accordingly. Although he resisted taking medicines for a time, Mark says, “I’ve always tried to be proactive. An ounce of prevention is worth a pound of cure, and I think medicine’s trying to head that way, getting in on the front end of preventing things, versus having to deal with the aftermath. But Mayo is just an amazing place, leading the way. My family is really blessed to have a facility like this so close to home.” 

This article initially appeared on the Mayo Clinic Laboratories blog.

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