Dr. Jeffrey Gottfried is a man on a mission.
That mission is to help his patients better detect signs of coronary artery disease and, as a result, help prevent heart attacks.
According to the Centers for Disease Control and Prevention, coronary artery disease – or CAD – is the leading cause of death in the United States for both men and women.
And Gottfried says there’s a big problem in diagnosing the disease.
One of the most commonly used diagnostic tools in fighting CAD, he says, is seriously flawed.
In simple terms, CAD is the narrowing or blocking of arteries that supply blood to the heart as a result of the buildup of cholesterol or plaque deposits along the inner walls of those arteries. Over time the condition can lead to heart attacks, heart failure and, yes, death.
Each year, says the CDC, about 715,000 Americans will have a heart attack brought on by CAD and more than 385,000 will die from the disease.
“The statistics,” admits the gregarious Gottfried, “are scary.”
Gottfried then turns his attention to what he feels is a woefully under-performing diagnostic tool: the traditional lipid panel cholesterol test.
“The biggest thing we look at is cholesterol, because we know from studies that having high bad cholesterol and having low good cholesterol causes significant risks,” Gottfried explains. “So how do we check that? We do a blood test called a lipid panel.”
Indeed, approximately 60 million lipid panels are ordered and performed annually in the U.S., making it one of the nation’s most frequently ordered lab tests, but Gottfried maintains those lipid panels miss important clues.
“They’re just not giving us enough information,” he states flatly. “In one study, 75 percent of people who had heart attacks had normal cholesterol profiles according to their lipid panel results.”
Gottfried points to two somewhat newer tests as much better alternatives to the standard lipid panel – the Vertical Auto Profile (VAP) test by Quest Diagnostics, and the Nuclear Magnetic Resonance (NMR) test by LabCorp and Atherotech Diagnostics.
The U.S. National Library of Medicine at the National Institutes of Health seems to agree with Gottfried’s assertion. It emphatically states that VAP tests “can identify patients at high risk for coronary artery disease who cannot be identified using the standard lipid panel.”
Additionally, Gottfried says these newer tests actually count the low-density lipoproteins (LDL) – the so-called “bad cholesterol” – while traditional lipid panels merely estimate the presence of LDL.
The Wall Street Journal reports “the typical cholesterol test doesn’t directly measure LDL. It just measures high density lipoproteins or HDL – the ‘good cholesterol’ – and triglycerides (another type of lipid or fat cell) and then uses a mathematical formula to come up with an LDL score.” But that formula, says the Journal, can be very unreliable.
The newer tests “not only provide a direct measurement of LDL, they also look at the size, type and number of LDL and HDL particles. A person with a low LDL score could actually have a lot of small LDL particles, putting him or her at higher risk for heart disease. And a person with very high HDL, thought to offer dramatic protection against heart disease, might not be getting as much protection as he thinks, because he can have too much of the wrong kind of HDL,” according to the Journal.
In other words, traditional lipid panels don’t characterize the size or the shape of any of the lipoproteins examined and they only estimate the levels of bad cholesterol present in the blood and arteries.
Gottfried knows this all too well from first-hand experience.
Ten years ago, at the ripe old age of 40, this muscular family practice physician suffered a heart attack of his own.
It was an attack that no one, including Gottfried, saw coming. His lipid panel test results at the time, he says, showed no sign of a problem yet his main coronary artery was actually 99 percent blocked.
Today, because primary care physicians are usually a patient’s first line of defense against coronary artery disease, Gottfried is fixated on finding better ways to prevent heart attacks in his patients.
“I’m really focused on this,” Gottfried summarizes. “Clinically, I’m seeing a big difference. [These newer tests] allow me to help reduce risk dramatically. I feel like I’m definitely making a difference and that’s very rewarding.”
Dr. Jeffery Gottfried practices family medicine with the Sebastian River Medical Group. His Vero Beach office is at 1300 36th Street, Suite H-1. The phone number is 772-569-5714.
