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1 is designed for the workplace looking for a single, comprehensive set of tests that establish baseline laboratory values for wellness and disease management programs. The Test Package describes the normal ranges for our tests. Because there are numerous variables that could cause a test result to be outside the normal range, please be sure to share your myhealth Analytics Report with your physician, who is best able to interpret your results in the context of your medical history and to determine the best course of action for you. A1C Cholesterol Cholesterol- Ratio

2 A1c Measures Glucose Attached to Hemoglobin A1C A1C Sugar, in the form of glucose, is an important energy source for your body. Sometimes, because of what you eat or medicines you may be taking or if there an underlying disease that affects how your body deals with the sugar, you may have high levels of glucose circulating in your blood. When that happens, some of that sugar will attach to hemoglobin that is found in red blood cells and stay attached until for the life of the red blood cell (up to about 120 days). A1c (also often called HbA1c where Hb is the abbreviation for Hemoglobin) is a measurement of the amount of glucose that is attached to hemoglobin and is expressed as a percentage of hemoglobin that have bound glucose molecules. cholesterol While a glucose test measures the amount of glucose in the bloodstream at a point in time, the results can be affected by anything the individual might have eaten recently. An A1c test provides an average glucose level over the preceding 3 months. As a result, the A1c results can provide you and your physician a better picture of how well glucose levels have been controlled over the preceding 3-month period. High levels of sugar for extended periods of time can lead to a variety of serious health conditions (vision loss, nerve damage, gangrene, kidney failure, heart attacks and strokes). Ideally, starting at age 45, you should have your A1c checked at least every 3 years if your A1c levels are normal and up to 4 times a year as required by your physician to monitor treatment. Your physician may start your screening at an earlier age if you have certain risk factors, such as obesity, high blood pressure or a family history of diabetes. Cholesterol- Ratio 2

3 A1C (cont.) Using our testing protocol, A1C levels of between 4.0% and 6.0% are considered normal. An A1C result between 6.0% to 7.0% is considered pre-diabetic and is a warning sign that you may be in danger of developing diabetes. A1c levels of 7.0% or greater are a strong indication that diabetes may already be present. cholesterol If you have been diagnosed with diabetes, keeping your A1c less than 7% will help prevent the onset of the health conditions noted above. Cholesterol- Ratio 3

4 Cholesterol Cholesterol Molecule Cholesterol is a lipid (or steroid) that is important in cell membrane structure, the production of steroid hormones, bile acids and Vitamin D. Cholesterol is typically associated with special particles called lipoproteins. These lipoproteins are important transport vessels that help move cholesterol and other fats through your bloodstream. Cholesterol Cholesterol is a measure of the cholesterols carried in your bloodstream by the lipoproteins. There are five types of lipoproteins: ( good cholesterol, ( bad cholesterol), V (very low density lipoprotein), IDL (intermediate density lipoprotein) and Chylomicrons. and are primary carriers of cholesterol in the blood, so knowing those levels is important. For V, we introduce another type of lipid, called, a dietary fat that comes from the foods you eat and used as a source of energy by your body. are primarily carried in the bloodstream by V and chylomicrons. The ratio of triglycerides to cholesterol in V is about 5-to-1, so the laboratory measures the amount of in your blood and divides that by five (5) to obtain the V estimate. This is generally accurate as long as your Triglyceride level is below 400 mg/dl. Since IDL is a transient breakdown particle, it is not found in appreciable amounts in the blood. Cholesterol = + + ( 5) How Your Cholesterol is Calculated Cholesterol- Ratio Cholesterol generally comes from your diet, and is concentrated in certain foods, such as fried chicken, red meat and butter. Cholesterol is produced by your body and can be too high even in individuals who maintain a healthy diet. Family history and genetics also play a role in determining cholesterol levels. So, while cholesterol is essential in the proper functioning of the body, too much cholesterol is strongly linked to cardiovascular disease, such as, heart attack, stroke and atherosclerosis (hardening of the arteries). 4

5 Cholesterol (cont.) Ideally, starting at age 20, you should have your Cholesterol checked along with a complete lipid profile at least every 5 years if your cholesterol levels are normal and every 6 months to a year as required by your physician to monitor treatment. Your physician may also monitor your cholesterol and lipid levels more closely if you have two or more of the following risk factors for coronary artery disease: high blood pressure, history of cigarette smoking, diabetes or low levels. A Cholesterol level less than 200 mg/dl is generally considered healthy. Diet and exercise are the two best ways to reduce an elevated Cholesterol. Sometimes, medication is needed to control your cholesterol level and keep it at a healthy level. Cholesterol Cholesterol- Ratio 5

6 Molecule is a type of fat particle that circulates in your bloodstream. stands for Low Density Lipoprotein, and is often described as bad cholesterol. This is because of its tendency to stick to the walls of blood vessels, creating atherosclerotic plaques. These plaques harden and narrow the arteries, decreasing the amount of blood that gets through to your organs. When this happens, it can put you at higher risk for heart attacks or strokes. Cholesterol can come from your diet and can be elevated from eating too many high fat foods, such as fried foods, red meat and butter. is also produced by your body and can be elevated even in individuals who eat a healthy diet. There can be genetic factors, such as family history, that can put someone at a higher risk for increased. Atherosclerotic Plaques Ideally, starting at age 20, you should have your checked at least every 5 years if your levels are normal and every 6 months to a year as required by your physician to monitor treatment. Using our testing protocol, a normal level is 100 mg/dl or less. However, certain conditions such as diabetes, obesity or heart disease or activities such as smoking could put you at a higher risk for heart attacks or strokes. In these cases, your doctor may want your level even lower. Diet and exercise are two of the best ways to reduce your and also reduce your risk of heart disease. In some instances, medications are necessary to help lower or to maintain lower cholesterol levels. Cholesterol- Ratio 6

7 is a type of fat particle in your bloodstream. stands for High Density Lipoprotein and is often referred to as good cholesterol. absorbs and breaks down other fats and clears them from your blood stream. As a result, there is less fat available to adhere to the walls of your arteries (the cause of strokes) or clog the blood vessels in your heart (the cause of heart attacks). Because helps reduce the amount of fat in your blood stream, high levels of are considered cardioprotective. is produced by your body and can be increased in a number of ways. Exercise is one of the best ways to raise your level. Another important way to increase your is by not smoking or quitting if you do smoke. Losing weight and avoiding trans and saturated fats are other good ways to raise your. Genetic factors can also predispose someone to either high or low levels of. Cholesterol Ideally, starting at age 20, you should have your checked along with a complete lipid profile at least every 5 years or more frequently as required by your physician to monitor treatment. Typically, an level of greater than 60 mg/dl is optimal for the cardio-protective effects discussed above. Using our testing protocol, an below 40 mg/dl is considered low, and may increase your risk for heart attacks or stroke. Again, quitting smoking, increasing physical activity, and losing weight are some of the best ways to increase your level. Some individuals may need a medication to control their level. Cholesterol- Ratio 7

8 Triglyceride Molecule are a type of fat that your body uses for energy. The primary source of triglycerides is from the foods you eat. In the bloodstream, special particles called lipoproteins help carry this fat to parts of your body, such as your muscles to be used as energy or for storage in fat cells. Too much of this type of fat can contribute to the hardening and narrowing of your arteries. This puts you at risk of having a heart attack or stroke. Diseases such as diabetes, obesity, kidney failure or alcoholism can cause high triglycerides. Often, high triglycerides occur along with high levels of cholesterol. Ideally, starting at age 20, you should have your Cholesterol checked along with a complete lipid profile at least every 5 years if your cholesterol levels are normal and every 6 months to a year as required by your physician to monitor treatment. Your physician may also monitor your cholesterol and lipid levels more closely if you have two or more of the following risk factors for coronary artery disease: high blood pressure, history of cigarette smoking, diabetes, low levels, family history of coronary artery disease, or if you are over 45 years old (men) or 55 years old (women). Cholesterol Using our testing protocol, a normal Triglyceride level is 200 mg/dl or less. After a meal, the level of triglycerides in the bloodstream is typically high. Therefore, it is important that the triglyceride test be done fasting, preferably 8 to 12 hours.diet and exercise are the two best ways to reduce an elevated triglyceride level. Avoiding certain types of foods known to increase triglycerides in the blood, such as simple sugars (like fructose, corn syrup, sucrose, glucose, honey and molasses), alcohol, highly refined grains and excessive intake of saturated or trans fats will also help to lower triglyceride levels. Omega-3 fatty acids have also been found to lower triglyceride levels. Cholesterol- Ratio 8

9 190 mg/dl 50 mg/dl = 3.8 How Your Cholesterol Ratio Is Calculated A1C Cholesterol- Ratio The Cholesterol Ratio ( Cholesterol Ratio ) provides useful information about your heart disease risk. This ratio is typically provided as part of the Cholesterol and lipid profile testing. You can calculate this ratio by dividing your Cholesterol by your High-Density Lipoprotein (), the good cholesterol. For example, if your Cholesterol is 190 mg/dl and your cholesterol is 50 mg/dl, your Cholesterol Ratio is 3.8. Generally, individuals should strive for a Cholesterol Ratio of 5 or lower. A high Cholesterol and low increases the ratio. In this undesirable situation, with fewer particles to remove cholesterol from the bloodstream and more particles circulating, leading to the potential buildup of atherosclerotic plaques. This leads to the thickening and hardening of the arteries and the decrease of blood supply to the tissues and organs, including the heart. Cholesterol The Cholesterol Ratio is a helpful monitoring tool. However, it should be used along with the results of the total cholesterol and lipid profile tests to provide a more complete picture. Cholesterol- Ratio 9

10 N N o A1C Molecular Structure of is a chemical that is made by the body from nicotine. Since cotinine can be made only from nicotine, and since nicotine enters the body with tobacco use (what about chewing tobacco?), cotinine measurements can gauge how much nicotine enters your body. According to a 2011 study by the Centers for Disease Control (CDC), tobacco use is the single most preventable cause of disease, disability, and death in the United States with an estimated 443,000 premature deaths each year. Another 8.6 million people live with debilitating illnesses caused by smoking such as cancer, emphysema, acute respiratory illness, cardiovascular disease, stroke, and various other disorders. Cholesterol If you are committed to stopping or reducing your tobacco use, or if you are interested in the amount of smoke or nicotine that has entered your body, a cotinine test can be useful. By establishing a base line level of cotinine, you can monitor your progress to stop tobacco use. People who do not smoke or who are not exposed to other peoples smoke should not have measurable cotinine levels. People who do smoke will have a cotinine level of 10 or higher in their blood, and a typical smoker has levels of 150 to 450 units. tests are designed to accommodate the trace amounts of cotinine commonly found from second-hand exposure when compared to levels found in smokers. Cholesterol- Ratio 10

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