"Doctor's orders"

He seemed like a perfectly normal 17-year-old teenager, but when I asked him his medical history, I was stunned.
He had actually had a stroke a couple of years ago! What would cause a teenager to have a stroke?
It is actually an abnormality that you or I could have and we might not be aware of it. He had an elevated level of lipoprotein(a), which is basically a kind of cholesterol.
As we learn more about cholesterol we are finding out many small nuances that can often mean the difference between life and death.  It turns out that my teenage patient’s whole family had a history of high lipoprotein(a) levels and everyone in his family had been checked for it. Those who had high levels had to be on aspirin and often had to take a cholesterol medication.
If this teenage patient was not enough, I had another patient who had two heart attacks in spite of leading a very healthy life style.  He was 60 years old, but his biceps seemed bigger than mine and he exercised more than I did. I wondered why such a health conscious individual kept having heart attacks?
I checked for some of the new forms of cholesterol and found that his cholesterol consisted mostly of small, dense particles. The bad form of cholesterol called LDL can exist as large, buoyant particles or as small, dense particles. A preponderance of the small, dense particles predisposes people to heart attacks.
Even though this gentleman was followed by a famous cardiologist, this physician did not check for these subtleties. I explained this new finding to the patient and started a medication called Niacin, which is actually a kind of B vitamin. This medication changed his LDL particle size to the more favorable kind, thereby reducing his risk for a third heart attack.
In addition, there is another molecule called homocysteine that acts like cholesterol and increases the risk of heart attacks. But in order to check for this, a separate test has to be ordered, one most cholesterol tests do not include.
The treatment for an elevated homocysteine level is Folic Acid, which is a kind of vitamin but needs to be taken in large quantities to reduce the homocysteine level.
For anyone who is having way more problems with heart issues than can be explained by the numbers, perhaps your physician is not looking at some of the newer numbers out there.
At present it is not recommended that everyone should have all of these numbers checked. Several of these tests are too expensive to check them on everyone. But if you have a strong family history of heart attacks or have had numerous heart issues, you might need to get some of these additional numbers checked.
That would make sure that you do not have a stroke as a teenager or you do not keep having heart attacks one after the other.
Dr. Nitin Bawa is a board certified internal medicine physician. He can be reached at (850) 534-4170.