Straight from the heart

Mitch Leslie in Science:

Stephanie Blendermann, 65, had good reason to worry about heart disease. Three of her sisters died in their 40s or early 50s from heart attacks, and her father needed surgery to bypass clogged arteries. She also suffered from an autoimmune disorder that results in chronic inflammation and boosts the odds of developing cardiovascular illnesses. “I have an interesting medical chart,” says Blendermann, a real estate agent in Prior Lake, Minnesota.

Yet Blendermann’s routine lab results weren’t alarming. At checkups, her low-density lipoprotein (LDL), or “bad,” cholesterol hovered around the 100 milligrams-per-deciliter cutoff for normal values, and her total cholesterol—the good and bad versions combined—remained in the recommended range. “I thought I was cruising along just fine,” she says.

But because Blendermann’s risk was unclear, in late 2021 her doctor decided to refer her to cardiologist Vlad Vasile at the Mayo Clinic. To pin down her susceptibility to atherosclerosis, Vasile prescribed a test for substances Blendermann had never heard of: lipids called ceramides. Long overlooked, they are emerging as powerful alternatives to standard markers of heart disease risk such as LDL cholesterol. Blendermann’s score was moderately high, suggesting that compared with a person with a low score, she was more than twice as likely to suffer a cardiovascular event such as a heart attack. “It woke us up big time,” she says. “The ceramides told me the bigger story.” She began to take cholesterol-lowering drugs and overhauled her diet and exercise regime.

More here.