What Tests Will I Need

After examining several laboratories, I would suggest the Great Smokies Diagnostic Laboratory for most of my cardiovascular testing. They offer a series of tests that measures markers for cardiovascular disease risk. Each of these tests indicates either an independent risk or a combined risk. For example, if both your LDL cholesterol and C-reactive protein are increased, you have a much greater risk of heart disease than if either one was elevated alone. All of these tests are available with the Comprehensive Cardiovascular Assessment.

Blood Lipids

This test measures the circulating levels of the major lipid (fats) in the blood stream. This portion of the test includes:

Total Cholesterol

While the numbers do not directly relate to heart-attack risk, it can indicate the presence of a problem. Total cholesterol is a combination of LDL, HDL, and VLDL cholesterol levels. While this study is suggestive, there are many other factors involved as well, such as dietary differences in the two groups, exercise levels, and overall healthier lifestyle of the lower cholesterol group.

LDL Cholesterol Levels

Numerous studies have shown that the level of LDL cholesterol correlates better with coronary-death risk than does total cholesterol. And, as we have seen, even more important is the size of the LDL particle. Unfortunately, most labs do not differentiate for particle size. LDL is subclassified into small dense (LDLsd) and large buoyant types. The LDLsd is the only one associated with increased risk. The large buoyant type may actually reduce risk.

HDL Cholesterol Levels

In the lay press, HDL cholesterol is known as good cholesterol. Its function is to remove cholesterol from the tissues and blood stream, but it should be recognized that even oxidized HDL can contribute to atherosclerosis. Fortunately, it is more difficult to oxidize than LDL. Higher levels of HDL appear to be protective.

Triglycerides

These are esterified fatty oils. High levels of triglycerides also act as an independent risk factor separate from all other factors. Some studies have shown that triglyceride levels are a good measure of the severity of coronary artery disease. Diets high in some saturated fats (especially myristic and laurel fats) may increase triglycerides, but in most cases, it is a high sugar and carbohydrate diet that elevates triglycerides.

Homocysteine

As we have seen, elevations in homocysteine are independently associated with coronary heart disease. That is, even if all other studies are normal, high homocysteine levels put you at substantial risk of atherosclerosis.

Lipoprotein (a)

This is a special transport molecule bound to the LDL molecule. When elevated, it is an accurate measure of coronary-artery-disease risk, even when all other tests are normal. Elevations in this lipoprotein are mostly hereditary, but can be controlled nutritionally.

A diet high in vegetables and low in hydrogenated oils lowers lipoprotein(a) levels, as do steps that increase HDL levels. Inositol hexaniacinate, L-lysine, vitamin C, and proline (an amino acid) also lowers levels of this factor. Diabetics and those with low thyroid function often have elevated levels of this factor.

Apolipoprotein A-l

This molecule is major constituent of HDL. Higher levels of this factor predict a lower risk of coronary artery disease.

Apolipoprotein B

This is a primary molecule in LDL structure. Elevated levels are associated with increased cardiovascular disease risk.

Ratio of Apo B/Apo A-l

A high ratio has been associated with a high incidence of coronary artery disease. Several studies have shown that this ratio is particularly valuable in predicting a family history of coronary artery disease.

Fibrinogen

This is a globulin associated with blood coagulation. Studies have shown an important link between high levels of fibrinogen and death from strokes. It also plays a critical role in the mechanism of atherosclerosis of all vessels. Levels are increased by smoking, oral contraceptives, chronic inflammation and with aging.

C-reactive protein

C-reactive protein is a marker for inflammation, which is accompanied by release of special chemicals called cytokines. These chemicals encourage coagulation of the blood, and promote atherosclerosis. A high C-reactive protein indicates a significant risk of heart attack or stroke. It also raises suspicion of a possible infection by Chlamydia pneumonia or Helicobacter pylori, both associated with atherosclerosis.

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