BLOOD WORK
Half of women and two thirds of men over the age of 40 are already affected by cardiovascular disease, so in order to beat the number one killer in our nation, we must identify and treat these intermediate risk patients sooner. (REF 9) Unfortunately, many patients continue to carry residual cardiovascular risks even after “appropriate” treatment is implemented (based on current national guidelines).
THIS is the main reason we order advanced blood tests - so we can identify the residual (or hidden) risks a patient carries and treat them BEFORE it is too late!
We order extensive blood work on every patient. Here are just a few examples of some of our key tests.
Cholesterol Biomarkers:
1 - APO B: The best measurement of “bad” cholesterol
Apo B is a direct measurement of all the atherogenic particles that a patient has so it is the most accurate measurement of "bad" cholesterol. On the other hand, LDL cholesterol is an indirect measurement based on a calculation, so lab results can vary up to 30% . . . and LDL cannot even be calculated if the patient’s triglycerides are too high.
A large meta-analysis of twelve independent reports concluded that Apo B is the most potent marker of cardiovascular risk. Based on the number of CVD events at 10 years, a treatment strategy that used Apo B instead of LDL-C would prevent 500,000 – 800,000 more CV events! (REF 6, 7)
2 - sdLDL (small dense LDL) cholesterol: small cholesterol particles that build up more easily in the lining of the arteries
sdLDL is a type of LDL cholesterol – they are smaller denser particles so they are more atherogenic. These smaller particles can penetrate the endothelial wall more easily, so they are more susceptible to oxidation in the intima of the artery. Oxidized particles contribute to the formation of foam cells, which over time develop into arterial plaque.
Elevated levels of sdLDL confer a 3-fold increased risk of coronary artery disease (a level of cardiovascular risk similar to that of cigarette smoking), and this risk is independent of LDL cholesterol! (REF 1) In addition, sdLDL is linked to insulin resistance and metabolic syndrome – patients with elevated levels are twice as likely to develop diabetes.
3 - Lp(a) (Lipoprotein a): a dangerous type of inherited cholesterol that speeds up plaque growth in the arteries
One in five people have lp(a), an inherited type of LDL cholesterol that accelerates the progression of atherosclerosis (plaque build up in the arteries). Also known as “sticky cholesterol,” it is a small, dense, highly inflammatory protein that has been shown to be an independent risk factor for early coronary artery disease. (REF 2, 3, 4) Think of Lp(a) like a “FAST PASS” – it gets cholesterol into the lining of the artery quicker. In addition, elevated Lp(a) levels can also increase a patient’s propensity for developing blood clots. (REF 5)
Lp(a) can raise the risk of cardiovascular disease by 200–400%. High levels of Lp(a) have been correlated with an increased risk of: coronary artery disease, stroke, peripheral vascular disease, abdominal aortic aneurysm, re-stenosis (after a stent), and retinal artery occlusion (obstruction of blood flow in the eyes).
Inflammation Biomarkers
In 2015, a peer reviewed study published in the Journal of Medical Economics proposed that if medical providers would order inflammation testing routinely on patients, we could decrease thousands of heart attacks and strokes, and save millions of healthcare dollars. Read more HERE. (REF 8)
So clearly the problem is not just cholesterol - vascular inflammation needs to be identified and treated in order to lower cardiovascular risk in patients.
1 - hs-CRP (highly sensitive C reactive protein)
In the Jupiter trial, patients with normal LDL cholesterol but positive inflammation (indicated by hs-CRP), had worsening atherosclerosis (as measured by CIMT). The only patients who experienced plaque regression were the ones who controlled both cholesterol and inflammation (REF 10).
Many other well-designed studies have confirmed cardiovascular risk associated with elevations in CRP. The Women’s Health Study that included over 27,000 “apparently healthy” middle-aged women, showed that CRP was actually better than LDL cholesterol for predicting cardiovascular risk in women. (REF 11)
According to the ARIC trial, the stroke risk goes up from 2-fold to 11-fold when hsCRP is also elevated. (REF 12)
2 - Lp-PLA2 (Lipoprotein-associated phospholipase A2)
This test will determine if your arteries are "on fire." Lp-PLA2 is an enzyme marker of plaque forming, cracking, or shifting . . . but unlike hsCRP, Lp-PLA2 is vascular-specific (REF 13)
Due to its pro-inflammatory and pro-oxidative effects, Lp-PLA2 plays a key role in the pathogenesis of atherosclerosis (plaque build up in the arteries).
When Lp-PLA2 is elevated in conjunction with systolic blood pressure, the patient has a 7-fold increased risk of a cardiovascular event or stroke.
3 - MPO (Myeloperoxidase)
Myeloperoxidase is a vascular specific enzyme that is a marker and mediator of inflammation and oxidative stress. This test can help determine if you are at risk of a plaque rupture (that can cause a sudden heart attack or stroke).
MPO oxidatively modifies LDL cholesterol, as well as causing HDL to be less functional . . . which both precipitate atherogenesis by leading to an excess of cholesterol rich plaque in the arterial wall. (REF 15)
“Multiple lines of evidence suggest an association between MPO and cardiovascular disease including coronary artery disease, congestive heart failure, arterial hypertension, pulmonary arterial hypertension, peripheral arterial disease, myocardial ischemia/reperfusion-related injury, stroke, cardiac arrhythmia and venous thrombosis.” (REF 14)
Metabolic Biomarkers:
About 70% of diabetics will eventually die of heart disease and 15% from stroke. (REF 16) The number of Americans with diabetes and pre-diabetes is rapidly increasing. Statistics show that 34% of Americans over the age of 18 are already pre-diabetic so we actually have an epidemic on our hands. (REF 17)
It is important to note that the damage from elevated blood sugars starts years before a patient becomes a diabetic. Even pre-diabetics (patient’s with only slight elevations in blood sugars) are often already victims to arterial inflammation and plaque growth from the disease. Studies have shown that 10% of these patients already have permanent damage such as retinopathy (eye damage) or neuropathy (nerve damage) from microvascular complications. (REF 18)
Because of these known health implications, we take pre-diabetes seriously and target the disease as early as possible (often with both lifestyle and medical interventions).
Insulin is a hormone released from the pancreas that is responsible for the transportation and storage of glucose in the cells. A fasting insulin level may be used in conjunction with the oral glucose tolerance test (2hrgtt) to assess pancreatic function.
Pancreatic beta cells make insulin, which regulate glucose levels in the blood. However, insulin levels will go up much earlier than blood sugars do, indicating there is a metabolic problem. When a patient’s fasting insulin level is elevated, this indicates the pancreas is overworking . . . and burning out beta cells in the process (even when blood sugars remain in normal range). This defect is called insulin resistance. With insulin resistance, the cells become “resistant” to insulin, meaning they have a reduced ability to absorb and utilize blood glucose for energy. As a result, the body requires higher insulin levels to function.
Even patients who do not meet the diagnostic criteria for pre-diabetes, may still have insulin resistance and be at increased cardiovascular risk. The presence of insulin resistance indicates a higher risk of developing: type 2 diabetes, high blood pressure, high cholesterol, and heart disease. (REF 19)
1 - Insulin
Adiponectin is a cardioprotective hormone produced by adipocytes (fat cells) that help defend against heart disease and diabetes. Adiponectin has potent anti-inflammatory and anti-atherogenic effects. If a patient’s level is low, they have a three-fold increased risk of metabolic syndrome and a two-fold increased incidence of coronary artery disease. Pioglitazone (Actos) seems to be particularly effective at raising adiponectin levels.
2- Adiponectin
3 - Two-hour Glucose Tolerance Test (Optional Add On)
Patients can have normal fasting blood sugars while still having elevated levels after eating, indicating there is still a serious problem that needs to be addressed.
Historically the American Diabetic Association (ADA) has defined a 2hrgtt level of less than 140 mg/dL as “normal,” a level of 140-199 as pre-diabetes, and a level above 200 as diabetes.
However, Dr. Ralph Defronzo, a world expert in diabetes, has published excellent data in peer-reviewed journals indicating that once the one-hour sugar levels exceed 125 mg/dL, or the two-hour sugar reading reaches 120 mg/dL or higher, at least 60 percent of the beta cells in the pancreas (the cells that make insulin) are non-functioning . . . so this patient should be considered pre-diabetic. Once 90 percent are fatigued (also known as beta cell function loss), the patient is a diabetic. If the one-hour glucose exceeds 150 mg/dL, or the two-hour goes above 159, then this person is 13 times more likely than the average person to progress to diabetes in the next seven to eight years.
Nutrient Biomarkers
There are good and bad fats in our diet. Omega-3 fatty acids are the good guys – these polyunsaturated fats are deemed “essential” fatty acids because they are necessary for health. But since our body cannot make these fats, they have to come from our diet. Omega-3 fatty acids help maintain the balanced production of hormone-like substances called prostaglandins. Prostaglandins help regulate many important physiological functions including inflammation, heart and vascular health, and brain and nervous system function.
Omega-3 fatty acids also play an important role in other bodily processes such as immune heath. They can help diminish allergic responses, nurture eye and skin health, improve symptoms of depression and arthritic pain, improve blood pressure and blood clotting, and even increase learning and mental development in children.
Balancing fatty acids can improve cholesterol and triglyceride levels, improve immune system function, as well as reduce inflammation and rates of heart disease. (REF 20, 21)
1 - Omega-3 (Fatty Acid Balance Test)
A large percentage of the population is deficient in Vitamin D - this is important to identify and treat for many reasons. First of all, a deficiency in vitamin D is correlated with an increased risk of cardiovascular disease: heart attacks, heart failure, and sudden cardiac death. (REF 22) In addition, vitamin d deficiency has been linked to depression, stroke, osteoporosis, several forms of cancer, and some autoimmune diseases. (REF 23)
Vitamin D is crucial for calcium absorption to support the bones, but it also helps maintain healthy blood pressure, immune system, (REF 24) brain function, (REF 25, 26) and even offers some protection from cancer (REF 27,28) and heart disease. (REF 29) It is a critical vitamin for numerous functions in our body, so we recommend everyone get tested to make sure their levels are in the optimal range (ideally between 60-80 ng/ml).
2 - Vitamin D
Coenzyme Q10 is often referred to as the “miracle nutrient.” It is a natural chemical compound we make in our bodies (similar to a vitamin) that plays a significant role in the formation of energy within cells. CoQ10 is found in almost every cell of our body and it acts as a powerful antioxidant.
CoQ10 resides in our mitochondria (the tiny energy centers in each of our cells), and plays an important role in helping our body produce its cellular fuel (called ATP). As your heart muscle consumes huge amounts of oxygen and energy, CoQ10 essentially recharges the energy system in the heart, enabling the heart muscle to pump blood more efficiently (helping with oxygen utilization and energy production, particularly in heart muscle cells).
CoQ10 assists in our overall circulatory and vascular health, but it also has the potential to help combat fatigue, improve muscle function, strengthen our immune system, lower blood pressure, decrease migraines, diminish the risk of blood clot formation, and improve exercise tolerance.
3 - Coenzyme Q10 (CoQ10)
Make an appointment now for advanced testing. We are here to help.
REFERENCES
1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999643/
2 – Nordestgaard BG, Chapman MJ, Ray K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31(23):2844–2853.
3 – Hoff HF, Beck GJ, Skibinski CI, et al. Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation. 1988;77(6):1238–1244.
4 - Lamon-Fava S, Marcovina SM, Albers JJ, Kennedy H, Deluca C, White CC, Cupples LA, McNamara JR, Seman LJ, Bongard V, Schaefer EJ. Lipoprotein(a) levels, isoforms, and coronary heart disease risk in the Framingham Off spring Study. J Lipid Res. 2011;52(6):1181-1187.
5 – Okafor, O. N., & Gorog, D. A. (2015). Endogenous Fibrinolysis An Important Mediator of Thrombus Formation and Cardiovascular Risk. J Am Coll Cardiol, 65(16), 1683-1699.
6 – Rosenson, R. S., Hegele, R. A., & Gotto, J. A. M. (2016). Integrated Measure for Atherogenic Lipoproteins in the Modern Era Risk Assessment Based on Apolipoprotein B. J Am Coll Cardiol, 67(2), 202 – 204.
7 - https://www.ncbi.nlm.nih.gov/pubmed/21487090
8 - M. S. Penn, M. A. Yenikomshian, A. K. G. Cummings, A. Klemes, J. M. Damron, S. Purvis, M. Beidelschies & H. G. Birnbaum (2015) The economic impact of implementing a multiple inflammatory biomarker-based approach to identify, treat, and reduce cardiovascular risk, Journal of Medical Economics, 18:7, 483-491, DOI: 10.3111/13696998.2015.1029490
9 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639398/
10 – Ridker PM, Danielson E, Fonseca FA, et al. JUPITER Trial Study Group. Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet. 2009;373(9670):1175-1182.
11 - Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002; 347: 1557–1565.
12 - https://www.ajconline.org/article/S0002-9149(08)00714-5/pdf
13 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994000/
14 - https://www.sciencedirect.com/science/article/pii/S0009898119300841
15 – https://www.ncbi.nlm.nih.gov/pubmed/19556446
16 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811436/
17 - https://www.ncbi.nlm.nih.gov/pubmed/17239709
18 - https://diabetes.diabetesjournals.org/content/58/4/773
19 – https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
20 – Schaefer EJ. Lipoproteins, nutrition, and heart disease. Am J Clin Nutr. 2002;75(2):191-212.
21 – Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63 (25 Pt B):2960-2984.
22 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851242/
23 – https://www.ncbi.nlm.nih.gov/pubmed/18400738
24 – https://www.ncbi.nlm.nih.gov/pubmed/15585788
25 – https://www.ncbi.nlm.nih.gov/pubmed/17138809
26 – https://www.ncbi.nlm.nih.gov/pubmed/23377209
27 – https://www.ncbi.nlm.nih.gov/pubmed/17556697
28 – https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199265