Assessing your cardiovascular disease risk through laboratory tests
For many patients, the desire to investigate their risk of heart disease begins after a personal or family member's cardiac event scares them into action. However, when it comes to heart health, the standard lipid panel only tells part of the story. As Benjamin Franklin famously said, "an ounce of prevention is worth a pound of cure". I recommend looking at more than the standard lipid panel when patients are wanting to assess their cardiac risk and take meaningful steps to prevent heart disease. I routinely order additional lab markers to help guide my development of a comprehensive and individualized treatment plan that focuses on prevention and risk reduction for my patients.
Assessing your risk of cardiovascular disease is an important step towards longevity. Heart disease is the leading cause of death in America for men and women. Your risk increases if you're diabetic, have a thyroid disorder, have elevated blood pressure, live a sedentary lifestyle, or if you smoke. Fortunately there are laboratory tests that give a lot of insight into your overall heart disease risk. These tests can help to inform and empower patients and their health care team.
Below are some of my go-to tests for patients who want to assess their risk of a future heart attack or stroke.
NMR LipoProfile®
This test is a deeper dive into the standard lipid panel most people are familiar with. It includes total cholesterol, triglycerides (the storage form of excess calories from the diet), HDL ("good cholesterol"), and LDL ("bad cholesterol") measurements. It also directly measures the LDL and HDL particle numbers and sizes. Rather, a standard lipid panel gives you an indirect measurement of LDL.
Apolipoproteins A1 & B
Apolipoprotein A1 (ApoA1) is the primary protein component of HDL cholesterol, and Apolipoprotein B (ApoB) is the primary protein component of LDL cholesterol. Research has shown that ApoA1 and ApoB1 are better predictors of cardiovascular disease risk than HDL or LDL alone. [1]
Lipoprotein (a)
Lipo(a) is a genetic marker that assesses your inherited risk of heart disease, and may predict risk of premature atherosclerosis. Knowing this piece of the puzzle is important for understanding how aggressive you may need to be with your treatment approach.
Homocysteine
This amino acid is associated with increased risk of forming blood clots, which can lead to a heart attack or stroke. I like to check this marker for any patient on hormonal contraceptives, and those who smoke as they have a higher risk of blood clots. Getting adequate amounts of vitamins B12, folate, and B6 are essential for keeping homocysteine from accumulating in the body.
hs-CRP
High sensitivity (or cardiac) C-reactive protein (CRP) evaluates the level of inflammation in your blood vessels. It's an important predictor of heart disease risk. It's scored as low, average, or high risk. It's important to investigate hidden areas of inflammation if this is high, such as periodontal (gum) disease.
Ox LDL
Oxidized LDL is a product of lipid oxidation and reflects how much oxidative stress is present within the blood vessels. When LDL cholesterol becomes oxidized, or damaged, it further contributes to plaque buildup and atherosclerosis. There's evidence that individuals with high OxLDL are 3.5 times more likely to develop metabolic syndrome in the next 5 years. [2]
Lp - PLA2
An assessment of vascular wall inflammation that predicts risk of stroke and atherosclerosis, or damage to blood vessel walls. Research has found that individuals with normal systolic blood pressure but elevated Lp-PLA2 levels are twice as likely to have a stroke. [3] Individuals with elevated systolic blood pressure AND elevated Lp-PLA2 are 7x more likely to have a stroke. [4]
Fasting insulin
Insulin resistance, which is demonstrated by an elevated fasting insulin level, is a known risk marker for heart disease. Even for patients who are not diabetic, a low fasting insulin is an important goal. Laboratory reference ranges often report "normal" fasting levels as anything below 25 mIU/L, but < 5 is a more optimal level.
HbA1c
Hemoglobin A1c assesses your average blood sugar levels over the past 3 months. It's an important screening test as it's well established that HbA1c > 5.6% increases your risk of heart disease (and diabetes).
Ordering comprehensive and thorough laboratory tests for my patients helps to guide my treatment recommendations, but it also helps to inform and empower patients. There are many other tests that may be indicated for a specific patient based on their own health history, symptom picture, and physical examination findings. If you want to take a deeper dive into assessing your heart disease risk that looks beyond the standard lipid panel, I'd love to work with you.
[1] Kaneva AM, Potolitsyna NN, Bojko ER, Odland JØ. The apolipoprotein B/apolipoprotein A-I ratio as a potential marker of plasma atherogenicity. Dis Markers. 2015;2015:591454. doi: 10.1155/2015/591454. Epub 2015 Mar 23. PMID: 25852220; PMCID: PMC4380097.
[2] Holvoet P et al. Association between circulating oxidized low-density lipoprotein and incidence of the metabolic syndrome. JAMA. 2008; 299: 2287-2293.
[3] Ballantyne CM et al. Lipoprotein-associated phospholipase A2, high sensitivity C-reactive protein, and risk for incident ischemic stroke in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Arch Intern Med. 2005; 165: 2479-2484.
[4] Gorelick PB. Lipoprotein-associated phospholipase A2 and risk of stroke. Am J Cardiol. 2008; 101 (suppl): 34F-40F.