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Getting a Patient History


Click here to contact me with questions about your laboratory results - I do not volley e-mails back and forth because it is just too time consuming to keep track of who is responding to what e-mail. If you have a health question, please read about Signs and Symptoms before our conversation.

This is a brief summary of lab value interpretation and is not intended in any way to be comprehensive or replace any conversation of your results with your doctor.


Note there are insurance companies that refuse to pay for cardiac risk factor testing on the basis that it is "experimental" or "investigational."

C Reactive Protein (CRP): This is a protein found in the blood and the marker for inflammation. Usually it is used to assess inflammation in response to an infection. Many labs use a highly sensitive CRP (hs-CRP) that is useful in predicting a heart attack, vascular disease or stroke. The best treatment for a high CRP level has not yet been defined, although exercise, niacin, smoking cessation, the use of statin drugs, and weight loss all appear to improve CRP.

Some, if not many insurance companies consider (hs-CRP) testing medically necessary only for their members who meet 'all' of the following criteria: (A) the member has to have had two or more coronary heart disease (CHD) major risk factors (see below) and (B) their member has low density lipoprotein (LDL) cholesterol levels between 100 to 130 mg/dL; and (C) their member has been determined to be at an intermediate risk of cardiovascular disease by global risk assessment using Framingham point scoring.

The major risk factors include the following:

1. Men 45 years or older; Women age 55 years or older
2. Current cigarette smoker
3. Family history of premature coronary heart disease (CHD). CHD in male first degree relative less than 55 years of age and CHD in female first degree relative less than 65 years of age
4. Hypertension - Blood Pressure (BP) 140 mmHg or higher, or on antihypertensive medication
5. Low HDL cholesterol less than 40 mg/dL

Homocysteine: Homocysteine is an amino acid that is normally found in small amounts in the blood. Higher levels are associated with increased risk of heart attack and other vascular diseases. Homocysteine levels may be high due to a deficiency of folic acid or Vitamin B12, due to heredity, older age, kidney disease, or certain medications. Men tend to have higher levels.

Some insurance companies consider homocysteine testing experimental and investigational for assessing coronary heart disease (CHD) or stroke risk. They consider homocysteine testing medically necessary under the following circumstances: (A) patients with homocystinuria (cystathionine beta synthase deficiency); (B) patients with coagulation disorders (e.g., unexplained thrombotic disorders such as deep venous thrombosis or pulmonary embolism); (C) female patients with recurrent pregnancy loss and (D) for patients with borderline vitamin B12 deficiency. Homocysteine testing is considered experimental and investigational for all other situations.

Most lab normals are 4 - 15 micromole/l. If you have had previous vascular disease there may be recommended medications to reduce your homocysteine level below 10. You can reduce your homocysteine level by eating more green leafy vegetables and fortified grain products or cereals. The usual treatment is folic acid with or without Vitamin B-12.

Lipoprotein (a) or Lp(a): Elevated Lipoprotein(a) or Lp(a) concentrations are associated with premature coronary heart disease (CHD). The exact mechanism is not yet clear and preliminary research suggests that there is a strong genetic component to elevated Lp(a) levels that correlate with coronary disease. Those with diabetes and a high Lp(a) level appear to be at increased risk of asymptomatic coronary disease.

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