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DOKÁŽE STANOVIŤ RIZIKO KARDIOVASKULÁRNYCH OCHORENÍ ANALÝZOU KRVNÉHO SÉRA
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Why Everyone Should Know Their LDL Particle Number
(This article is highly recommended to read all, we just selected few sections…)
LDL cholesterol levels and LDL particle number are often concordant (i.e. when one is high, the other is high, and vice versa), and this is probably why there is an association between LDL cholesterol and heart disease in observational studies. The elevated LDL cholesterol was more of a proxy marker for elevated LDL particle number in these cases. But here’s the kicker: they can also be discordant. In layperson’s terms, it’s possible to have normal or even low cholesterol, but a high number of LDL particles. (1) If this person only has their cholesterol measured, and not their particle number, they will be falsely led to believe they’re at low risk for heart disease. Even worse, the patients that are the most likely to present with this pattern are among the highest risk patients: those with metabolic syndrome or full-fledged type 2 diabetes. The more components of the metabolic syndrome that are present—such as abdominal obesity, hypertension, insulin resistance, high triglycerides and low HDL—the more likely it is that LDL particle number will be elevated. (2)
On the other hand, patients with high LDL cholesterol (LDL-C) and low LDL particle number (LDL-P) are not at high risk of heart disease. In fact, studies suggest they’re at even lower risk than patients with low LDL-C and low LDL-P. (3) Yet they will often be treated with statin drugs or other cholesterol lowering medications, because the clinician only looked at LDL-C and failed to measure LDL particle number. This is a concern for two reasons. First, statin drugs aren’t harmless. (I’ll go into more detail on this in the third post of the series.) Second, studies suggest that low cholesterol can increase the risk of death, especially in women and the elderly.
In one study of over 52,000 Norwegians, researchers found that women with total cholesterol levels below 195 mg/dL had a higher risk of death than women with cholesterol levels above that cut-off. (4) And a study published in the American Journal of Medicine found that people over 70 years of age with total cholesterol levels below 160 mg/dL had twice the risk of death than those with cholesterol levels between 160-199 mg/dL. (5) Low cholesterol is also associated with increased risk of disease—especially mental health and brain disorders.
Heart disease is a complex, multifactorial process. The likelihood that we’ll have a heart attack depends on numerous factors, including genetics, diet, lifestyle and living environment. The purpose of this article is not to suggest that LDL-P is the only risk factor that matters, or that other risk factors shouldn’t be taken into consideration. It is simply to point out that existing evidence suggests that LDL-P is a much better predictor of heart disease risk than LDL or total cholesterol, and that it appears to be one of the better markers available to us now.
New Blood Test Better Predicts Heart Attack Risk
The Quebec Cardiovascular Study was the first large study demonstrating that heart attack can occur when a person’s LDL particle number is high and LDL level is low.8 This has been repeatedly confirmed in other studies, most recently in the AMORIS study, which enrolled a remarkable 175,000 participants and demonstrated the superiority of LDL particle number (measured as apoprotein B) in predicting heart attack risk.9 This measure can be thought of as actually counting the number of LDL particles in one cubic centimeter, or one milliliter of blood.
LDL particle number is among the most powerful tools we have to predict the risk of heart attack. It can be measured directly as LDL particle number by the nuclear magnetic resonance spectroscopy method or indirectly as apoprotein B, which is a more widely available method. Apoprotein B is the major protein particle of LDL, with a single protein per LDL particle. Apoprotein B thus provides a “count” of LDL particles.
Reducing Your Small, Dense LDL Cholesterol
Having high LDL cholesterol, otherwise known as “bad” cholesterol, is not good for your heart health. However, more studies are now finding that it isn’t only the quantity of LDL circulating in your blood — it’s the quality, too. The type of LDL in your body may influence your risk of having heart disease down the road. Small, dense LDL is a type of LDL cholesterol that is considered to be an emerging risk factor for cardiovascular disease. It is smaller and heavier than typical LDL cholesterol and can increase your risk of developing atherosclerosis. It is thought that small, dense LDL contributes to atherosclerosis because it is small enough to penetrate the walls of arteries, is more susceptible to being oxidised, and stays in the bloodstream longer.
- Reducing the Formation of Small, Dense LDL
- You can do some things to reduce the formation of small, dense LDL in the blood. Although you cannot do much if you have inherited raised small, dense LDL, you can make some changes to your lifestyle to lower your chances of developing this particle.
- Small, dense LDL is not routinely measured in a cholesterol test that you would get in your healthcare provider’s office. However, there are tests that can measure small, dense LDL…
- These tests can be fairly expensive and are not available at all medical facilities.
Should You Get the Particle Test for High Cholesterol?
You may already know that HDL is considered „good“ cholesterol and LDL is considered „bad,“ but you may not have heard about an advanced cholesterol test called the particle test for high cholesterol. This test can essentially tell you whether you have bad LDL cholesterol or really bad LDL cholesterol.
What Do Your Cholesterol Levels Mean?
Understanding Cholesterol Markers
Low-density lipoproteins (LDL) and high-density lipoproteins (HDL) are usually classified as “bad” (LDL) or “good” (HDL) cholesterol. But recent studies have pointed out the importance of LDL particle size. Research shows that people who have a higher quantity of small, dense LDL particles and a lower quantity of large, fluffy LDL particles have a three times greater risk of heart disease. Small, dense LDL particles are more likely to enter blood vessel walls, become oxidized, and trigger the process of atherosclerosis, which increases the risk of heart attack. Large, fluffy LDL particles, on the other hand, may be protective against heart disease.
Utility of Advances Lipoprotein Testing in Clinical Practice
A standard lipid panel includes total cholesterol, triglycerides, and HDLc. LDLc can then be calculated (LDLc = total cholesterol – HDLc – triglycerides/5). In some instances a direct LDLc assay is employed because once the triglyceride levels are > 400mg/dl a calculated LDLc is not valid. Non-HDLc can also be calculated (non-HDLc = total cholesterol – HDLc). Increasing levels of LDLc and non-HDLc are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, numerous studies have demonstrated that the association of non-HDLc with ASCVD is more robust. It is possible to measure apolipoprotein B and A-I levels, LDL and HDL size, LDL and HDL particle number, and Lp(a). Numerous studies have documented a link between small dense LDL particles and an increased risk of ASCVD; however, the association is markedly reduced or entirely eliminated when the analyses are adjusted for other factors that affect ASCVD risk. Similarly, there is little data demonstrating that HDL subfractions are useful in risk prediction beyond HDL and other traditional risk factors. Apolipoprotein B levels and LDL particle number are more strongly associated with ASCVD than LDLc, particularly when the levels of LDLc and apolipoprotein B levels or LDL particle number are discordant. However, whether apolipoprotein B levels or LDL particle number are significantly better than non-HDLc is debated. The guidelines put forth by a variety of different expert panels and organizations do not require apolipoprotein B or LDL particle number. It is also the author’s opinion that at this time the routine measurement of apolipoprotein B and/or LDL particle number is not required. Until data demonstrate the superiority of measuring apolipoprotein B or LDL particle number on clinical outcomes it is hard to recommend the routine use of such testing. Studies have demonstrated an association of Lp(a) with ASCVD. Many experts recommend measuring Lp(a) in a) patients with unexplained premature CHD, b) patients with a strong family history of premature CHD, c) patients with resistance to LDL lowering with statins, d) patients with rapid unexplained progression of atherosclerosis, and e) patients with familial hypercholesterolemia. Elevations in Lp(a) will stimulate more aggressive lowering of LDL and the consideration of adding drugs that lower Lp(a) such as niacin or PCSK9 inhibitors. While routine use of advanced lipoprotein testing is not recommended it should be recognized that in selected patients the additional information provided can be helpful and result in changes in treatment. As additional drugs to treat lipids are developed and our understanding of lipid and lipoprotein metabolism expands in the future the use of advanced lipoprotein analysis may assume a more important role. For complete coverage of this and all related areas of Endocrinology, please visit our FREE on-line web-textbook, www.endotext.org.
What Is the Difference Between an LDL-P Particle Test and LDL Value?
Understanding different cholesterol values can be confusing. To add a bit more complexity, low-density lipoprotein, or LDL, can be measured as numbers of LDL particles in the blood, in addition to the conventional measurement of the actual value for LDL cholesterol. Clinical evidence indicates that having a large number of LDL particles in the blood is more strongly associated with a risk of heart disease, compared to having a high blood LDL cholesterol value.
Counseling patients on the role of blood lipids (fats) and their association with the risk of cardiovascular disease (CVD) can be a difficult task.
There are many types of lipids, and most of them play a major role in bodily functions. Nonetheless, some lipid measurements may reflect an increased risk of heart disease.
Cholesterol is the type of fat that is most often associated with increased risk of heart disease. High blood levels of low-density lipoprotein cholesterol (LDL-C) in particular are believed to increase risk.
New test for extended blood fat analysis
Cholesterol is seen as the cause of atherosclerosis, a disease that can lead to heart attacks and strokes. However, it now seems that the way cholesterol is packaged may be even more important than high blood cholesterol levels. Nuclear magnetic resonance (NMR) spectroscopy now allows the high-throughput analysis of such lipid packages. MVZ Labor Ravensburg GbR has been offering the measurement of lipoproteins in the blood as part of preventive health examinations since early 2017.
LDL Particle Size Testing in Australia
The simple cholesterol test that says if you need statins — and why doctors in UK aren’t using it
Heart disease stubbornly remains one of the biggest killers in the UK, where there are 7m people living with the condition. During the past 60 years, the management of cholesterol has become an important weapon in the fight against this – and drugs called statins are often used in treatment.
The NMR and Your Heart Disease Risk
Understanding your heart disease risk is becoming easier to ascertain. As science progresses the level of understanding of cardiac risk factors and special testing continues to improve. Many leading health experts believe that the Nuclear Magnetic Resonance Lipoprofile (NMR) test is the most sophisticated lab for understanding cholesterol numbers and heart disease risk.
Small Dense LDL Treatment
Like traditional cholesterol tests, new advanced cholesterol testing like VAP (Vertical Auto Profile) measures total cholesterol, HDL (good) cholesterol, LDL (bad) cholesterol, and triglycerides.
But VAP, developed by scientists at UAB ( the University of Alabama at Birmingham) and now being utilised at Pritikin, also measures cholesterol subclasses such as size of particles.
Have you been told your LDL Particle Number is high?
Here are some dietary changes that may help lower these numbers.
The inherent accuracy of 1H NMR spectroscopy to quantify plasma lipoproteins is subclass dependent
Extremely accurate and precise quantitative NMR...
Analytical NMR – Identification, Quantification (qNMR) and Mixture Analysis
NMR is best known for its use in structure determination. The chemical structure of a small molecule dictates a rational spectrum. This is because the electronic structure, the bedrock of chemistry, is what determines the chemical shift, while the number of nuclei determine the coupling and relative intensities. These same properties result in NMR being excellent for quantification and identification. The peaks in the spectrum will appear in predictable locations in the spectrum and their intensities will be proportional to the number of nuclei in the sample. In other words, the peaks are a chemical signature and the sample concentration is proportional to the intensity of the NMR signal detected. Sample concentrations and purities can be easily measured from known peaks once the proportionality constant is calibrated using a reference of known concentration. Using these peak positions and relative intensities, the compounds, mixtures and impurities in a sample can be identified or quantified.
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|Goljer Clinic, Asmea s.r.o.||Štefánikova 12, 811 05,Bratislava||MUDr.||Ján||Goljerfirstname.lastname@example.org||421903460222||Mgr.Lenka Bačová||421911461121|
|Cinre, s.r.o., Centrum intervenčnej neurorádiológie a endovaskulárnej liečby||Tematínska 5/A, 851 05, Bratislava,||MUDr.||David||Liškaemail@example.com||421907964017||Mgr.Lenka Bačová||421911461121|
|KARDIONITRA, s.r.o.||Hviezdoslavova 1, 949 11, Nitra||MUDr.||Tatiana||Vykoukalováfirstname.lastname@example.org||421905514439||Mgr.Lenka Bačová||421911461121|
|PENTES, s.r.o.||Hálkova 3, Žilina,||MUDr.||Jana||Stuchlikováemail@example.com||421905615119||MVDr.Martin Lukačko||421905203894|
|CardiOR, s.r.o.||Legionárska 6434/2, 911 01, Trenčín||MUDr.||Roman||Oriešekfirstname.lastname@example.org||421903543953||Mgr.Lenka Bačová||421911461121|
|ALIAN, s.r.o., Poliklinika ČK PLUS||Sv. Jakuba 20, 085 01, Bardejov||MUDr. / PhD. MBA||Andrej||Džupinaemail@example.com||421905271208||PaedDr. Ľubica Durkajová, PhD.||421911460064|
|ALIAN, s.r.o., Poliklinika ČK PLUS||Sv. Jakuba 20, 085 01, Bardejov||MUDr.||Adriana||Krajňákováfirstname.lastname@example.org||421918884838||PaedDr. Ľubica Durkajová, PhD.||421911460064|
|LEAMED, s.r.o.||Vihorlatská 20, 080 01, Prešov||MUDr.||Anton||Leškoemail@example.com||421907910766||PaedDr. Ľubica Durkajová, PhD.||421911460064|
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|Martinské centrum imunológie, s.r.o.||Pavla Mudroňa 12, 036 01, Martin||MUDr. / PhD.||Daniela||Kantárováemail@example.com||421434222437||MVDr.Martin Lukačko||421905203894|
|MED-CENTRUM, s.r.o.||Kollárová 17, 036 01, Martin||MUDr.||Slavomír||Šuchfirstname.lastname@example.org||421905276109||MVDr.Martin Lukačko||421905203894|
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|ADLA, s.r.o., Analyticko-diagnostické laboratórium a ambulancie||Vajanského 1, 080 01, Prešov||MUDr.||Tomáš||Kužmafirstname.lastname@example.org||421905226036||PaedDr. Ľubica Durkajová, PhD.||421911460064|
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