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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19314
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I've recently had a PLAC test with a private health company

Customer Question

I've recently had a PLAC test with a private health company and my results are 195.3 putting me in the high risk category indicating an increased risk for rupture prone atherosclerotic plaque leading to blood clots blocking supply to the heart or brain. Unfortunately when I went to my GP, she hadn’t heard of the test and advised me to have the usual blood tests for cholesterol etc which I had in July and November so it’s not going to help me much with understanding how to deal with this. My bad cholesterol levels are high but good cholesterol is high too so the ratio is in the normal range. (This has been confirmed by doctors in the practice). Added to this, the bad cholesterol has decreased over the last three years whilst the good has increased so I’m working on that with a healthy diet and exercise.
All my other tests were normal but I am still concerned to be in a high risk category for heart attack/stroke despite doing my best to lead a healthy lifestyle. Is there anything that I can do to help to reduce my risk?
Submitted: 2 years ago.
Category: Medical
Customer: replied 2 years ago.
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Customer: replied 2 years ago.
I have a BM! of 20.9 and BP is 116/75. No diabetes. Everything else normal. NO history of heart disease
or stroke in family
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
Can you provide the actual values of the most recent lipid profile?
Customer: replied 2 years ago.
Triglycerides 0.6 mmol/L
HDL 3.0
LDL 4.4
Total 7.7
Total ratio 2.57
Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.
There is no treatment that will directly lower the PLAC, so the recommendation when the PLAC is elevated is that there should be more aggressive treatment of the modifiable risk factors, particularly smoking, cholesterol, high blood pressure, and diabetes.
In your case, your blood pressure is already excellent and you have no diabetes. You do not mention that you smoke, although I suspect that you would have said so if you did smoke.
So, the focus would be on more aggressive treatment of your lipids. Your level of lipids is such that it would usually not warrant treatment, but with an elevated PLAC, it would be reasonable to better control lipids. If you have only recently started a healthy diet and exercise program, it certainly would be reasonable to first see the effect of lifestyle interventions. But if the levels remain at this level, then it would be appropriate to consider medicines to lower the cholesterol.
There are two approaches for medicinal management of cholesterol. The approach that has been used for years is to lower the LDL to a desired goal, and the goal would vary according to the clinical situation. For someone at high risk of heart disease, the goal would be to lower the LDL to 2.6, while in someone at very high risk of heart disease, the goal would be to lower the LDL to 1.8. A newer approach that was recently recommended is that anyone that warrants treatment, including people that are defined to be high risk by clinical criteria, should be treated aggressively with statins. By this approach, there is no starting at a lower dose of statin and adjusting the dose until a goal is achieved, and instead, the goal is to use the maximal dose of a statin to get the maximal lowering of LDL cholesterol. In someone that is at higher risk of side effects, using moderate doses of statins would be an alternative.
It is also reasonable to use supplements that can help lower heart disease risk, such as the omega-3 supplements that you are already taking.
So, the appropriate next step in response to the elevated PLAC would be aggressive treatment of the cholesterol.
If I can provide any clarification, please let me know.