Without a doubt, the pandemic upended the way people live, work, and interact and as recent behavior and outcomes show, it also impacted how people approach health care — and not always in a positive way.
“Instead of being a catalyst for living a healthier lifestyle, the pandemic has had a reverse effect for many in our community, as we’ve seen a trend toward people ‘falling off the wagon’ and eating and drinking out of comfort and fear,” shared Marisa Semioli, a nurse practitioner who specializes in cardiology. “They’ve also adopted a more sedentary lifestyle that’s led to physical deconditioning.”
As a result, “we’ve been seeing an influx in patients, especially younger ones, complaining of shortness of breath, fatigue, and even palpitations — all symptoms that we believe are the fallout of physical deconditioning and the presence of underlying insulin resistance and inflammatory processes at play,” she said.
In an effort to help determine why so many cardiovascular, endocrine, and autoimmune diseases are on the rise, especially among younger people, RUMC has been providing the powerful Advanced Lipid Panel along with standard inflammation and insulin resistance testing. “This panel allows us to go beyond the standard screening and delve in deeper and earlier to better assess our patients’ risk of atherosclerotic cardiovascular disease (ASCVD) and hopefully prevent it or else slow its progression,” Semioli said.
According to Semioli, the Advanced Lipid Panel (ALP) goes beyond the standard lipid panel or A1C tests that people may routinely receive as part of a physical exam to more thoroughly investigate the composition of inflammatory, cholesterol, and glucose markers.
“The Advanced Lipid Panel breaks down the particles in such an in-depth manner that it can point out genetic and molecular components that put people at higher risk for cardiovascular, endocrine, and autoimmune diseases than others,” she said. “It helps screen our patients better than ever before, focuses on preventing these conditions, especially among those with a strong familial component, and delivers results that can add an important new level of clarity and accuracy to a patient’s diagnosis and resultant treatment plan.”
“For example, the Advanced Lipid Panel’s monitoring of ‘hs-CRP’ measures the amount of c-reactive protein (CRP) in the blood — a high level of which reflects the presence of inflammation in the body and can correlate to a higher risk of cardiovascular disease than someone with normal levels,” said Semioli, who added that the panel’s measure of ‘Lp-PLA2’ can also be used to identify active inflammation within the vessels that contributes to plaque formation. Among other measures tracked by the ALP, elevated levels of ‘Lipoprotein A’ can reflect an increased risk of cardiovascular and cerebrovascular disease, while higher levels of ‘ApoA1,’ which reflects the level of ‘good’ cholesterol (HDL) in the blood, can indicate a decreased risk of cardiovascular disease.
At the same time, “ApoB closely measures the level of ‘bad’ cholesterol (LDL) in the body and elevated levels of ApoB can suggest an increased risk of cardiovascular disease — even if the patient’s overall LDL cholesterol level is in the normal range,” Semioli said, adding that the size and shape of LDL particles measured by the Advanced Lipid Panel is also revealing. Specifically, “the presence of large numbers of small, dense LDL particles (as opposed to large, buoyant ones) may reflect underlying insulin resistance and a higher risk of developing diabetes.”
“Insulin resistance — which is associated with cardiovascular disease, nonalcoholic fatty liver disease, chronic kidney disease, and polycystic ovary syndrome and is even linked to dementia, cancer, and obesity — can be gradual and difficult to recognize,” Semioli said. “In fact, while ‘hemoglobin A1C’ is the main test most providers order when screening for diabetes, insulin resistance can go undetected for up to 10 to 15 years before it’s reflected in hemoglobin A1C levels. However, there are a number of in-depth insulin resistance panels offered by leading diagnostic labs that will hopefully soon become the gold standard tests for identifying insulin resistance and potentially preventing or slowing the progression of diabetes.”
For doctors and patients alike, “having access to more in-depth bloodwork enables us to develop a more accurate and personalized treatment plan as opposed to a more standard or ‘one-size-fits-all’ approach to treating cardiovascular disease, high cholesterol, inflammation, or insulin resistance,” Semioli said. “There’s more to the story than the standard guidelines we follow and these advanced-level blood tests provide new clarity and insight into each patient’s unique body chemistry, enabling us to provide more individualized treatment and help prevent these diseases. We’re at battle,” she said, “but we now have more tools to screen earlier and battle back instead of succumbing to these diseases.”
Semioli encourages community members to have their primary doctor or the Richmond University Medical Center team order the Advanced Lipid Panel and to see a cardiologist or endocrinologist as necessary based on the results of the ALP. “This test will help us prevent disease or accurately manage people’s therapy if they already have this disease,” Semioli said, “and it can potentially help prevent or reverse this disease process among others in their family as well.”