Metabolic Profiles and Heart Disease
Thousands of complex chemical processes are required to take today’s lunch and turn it into the innumerable molecules that are carried by the blood to nourish the cells of your body. We can examine a subset of markers that will help us understand how well your body affects these processes. These tests provide good insight into the presence and progress of heart disease and many other conditions.
Asymmetric dimethylarginine (ADMA) and Symmetric dimethylarginine (SDMA)
Elevated levels of ADMA provide an excellent indication of insulin resistance — the earliest form of a disease that can, untreated, become diabetes. About 70% of heart attacks show evidence of elevated ADMA levels. These results are closely tied to endothelial dysfunction; ADMA inhibits nitric oxide, a key to endothelial health. In addition, high levels of ADMA clearly predict heart disease deaths independent of commonly understood risk factors.
Hemoglobin A1c (HbA1c)
A test of your blood glucose gives us a clear indication of the current concentration of sugar in the blood. As you probably know, these levels go up and down all day long in response to the type and quantity of food you eat. But blood glucose levels are just a quick snapshot; they provide no indication of how well your body controls these levels over time. The HbA1c test is more like a movie than a photograph — it tells us about the average blood glucose levels in increments of three months. This test is an excellent way to check for prediabetes or to monitor how well those with diabetes are controlling the condition.
Insulin resistance forces the body to generate too much insulin, resulting in high levels in the blood. This changes the body’s lipid profile, increasing triglycerides and LDL cholesterol while decreasing HDL cholesterol. These changes in blood lipids can also increase the prevalence of plaque in the arteries, increasing the risk for heart attack and stroke. Prolonged elevated insulin can also create other problems: increased inflammation, increased risk of blood clots and increased blood pressure.
High levels of homocysteine in the blood have been associated with cardiovascular disease and its most severe manifestations: heart attack and stroke. This can be caused by low levels of B6, B12 and folic acid, but it may also indicate low levels of cysteine, a protein with a wide range of important functions.
25-Hydroxy Vitamin D
Vitamin D has long been associated with bone health, but a number of recent studies have begun to associate it with cardiovascular disease. Deficiency may be linked to strokes, high blood pressure, diabetes, congestive heart failure and peripheral artery disease. Women tend to be more prone to vitamin D deficiency, as do older populations. Understanding your level of vitamin D will give us one more indication of your overall risk factor and, if it is low, an easy and inexpensive way to begin improving overall health.
Comprehensive metabolic panel (CMP)
The CMP is to the metabolism what the complete blood count is to blood health and inflammation. This series of 14 individual tests give us the opportunity to examine a wide range of indicators. An abnormal result is not a diagnosis, but but can point us in a direction, indicating the need for further, more specific tests. This series includes: glucose, calcium, blood urea nitrogen, creatinine, sodium, potassium, chloride, carbon dioxide, calcium, total protein, albumin, bilirubin, alkaline phosphatase, aspartate amino transferase and alanine amino transferase.
Inflammation Profiles & Heart Disease
Inflammation is a key component of many diseases, including all forms of heart disease. Over the past several years, physicians have begun to recognize the critical importance of measuring inflammation markers in the diagnosis of heart disease and its progression. Testing for inflammation can provide us with an opportunity to catch heart disease before it becomes critical. As part of the process of developing your overall preventive care plan, we may test for some of the following:
Your body responds to arterial damage by trying to repair it. MPO is released during the process of inflammation, even at the early stages. It provides a specific, identifiable indication of damage that is more specific to atherosclerosis and unlikely to be associated with chronic infections. People with high levels of MPO are more than twice as likely to experience heart attacks or other cardiac events, even those who would be otherwise considered low-risk.
Lipoprotein-associated phospholipase A2 (Lp-PLA2)
Lp-PLA2 is carried in the blood with LDL cholesterol, and has been shown to possess a high correlation to heart disease and stroke. (A meta-analysis of 79,000 patients demonstrated a risk factor similar to that in patients with poor cholesterol profiles and high blood pressure.) Unlike C-reactive protein (CRP), Lp-PLA2 levels do not rise with colds or infections, providing a clearer picture than with CRP testing alone. Elevated Lp-PLA2 is a direct measure of artery wall health, and indicates that plaque is inflamed to a more advanced degree.
High Sensitivity C-reactive protein (hsCRP)
The standard CRP test can be an excellent indication of inflammation. CRP levels rise when the body responds to trauma, such as a disease or an injury, and this tells us that the body is working to repair itself. But heart disease is the product of long-term, chronic inflammation. In order to understand the progression of the disease, we need to understand how much inflammation is present all the time. This high-sensitivity test creates a more precise standard baseline, allowing us to understand and chart long-term progress as we work to decrease levels of heart disease.
Complete Blood Count (CBC)
The CBC measures a large number of blood components (various types of white blood cells, red blood cells and platelets) to determine how many of each type are present. High or low numbers of various cell types can give us an indication of a wide range of conditions.
This test is done routinely as a part of most annual physical exams. Think of it as a good early diagnostic: if something is flagged, it’s the indicator light on the dashboard telling you to pay attention so you don’t end up stuck on the side of the road, steam billowing from under the hood.
Lipid Profiles and Heart Disease
Most of us are familiar with the idea that high levels of cholesterol in the blood are associated with a higher risk of heart disease. Yet the majority of those who suffer a heart attack have cholesterol levels within the “normal” range. Why? There are many developing theories, but one thing that’s become clear is that the truth is far more complex than was once assumed.
In order to accurately understand both the risk of a cardiac event, including heart attack or stroke, and the progression of cardiovascular disease, it’s important to understand the interactivity of the various types of fats in your blood and how much of each kind you have. We determine the right mix of tests for each individual and, once we have the results, craft a specific plan to help you improve these numbers, retesting as needed to monitor our progress.
The oxidation of LDL cholesterol occurs in the earliest stages of atherosclerosis. High levels of this marker can indicate a higher risk of metabolic syndrome and coronary artery disease. In one study of middle aged men, high levels of OxLDL correlated with four times the risk of developing coronary artery disease.
LDL cholesterol is not usually measured directly. Instead, levels of HDL cholesterol, triglycerides and total cholesterol are analyzed and placed into a formula to provide a good estimate of LDL levels. But in those with high triglyceride levels, this formula becomes less accurate. In addition, LDL particle size seems to have a strong correlation with the risk of developing heart disease. Small particle sizes may put patients at a far greater risk: they indicate a higher risk for heart attack, insulin resistance and metabolic syndrome as well as increased danger from other cardiac risk factors such as high total cholesterol or high CRP.
The only way to determine particle size is by direct measurement. Using nuclear magnetic resonance (NMR) spectroscopy to measure the number and size of these particles negates the effects of triglyceride levels and can produce a much clearer picture of the real risk of cardiovascular disease.
Small, Dense LDL (sd LDL)
In addition to measuring LDL particle size, particle density can indicate higher risk for coronary heart disease. Small, dense particles are associated with three times the risk of heart attack and may contribute to an accelerated progression of disease. These particles may also accompany high triglycerides, reduced HDL cholesterol, insulin resistance and obesity. Understanding the nature of your LDL and HDL cholesterol is as important — if not more so — than understanding how much cholesterol you have.
N-terminal pro b-type natriuretic peptide (NT-proBNP)
When the heart is under duress and working hard to pump blood, BNP is released into the blood. Sometimes, certain conditions can mimic the symptoms of heart disease. This test is done to ensure that a diagnosis of some level of heart failure is warranted. Normal results can indicate the presence of some other problem. It can also indicate an increased risk of future or recurring cardiac events.
Lipids are carried through the blood stream once they are combined with a protein produced by the APOE gene. Some people carry a variant of this gene that interferes with this process, giving them an increased risk of atherosclerosis. They seem to deposit fat into the artery walls more easily and tend to have higher levels of blood cholesterol and triglycerides.
This is is gene has a role in a highly complex chain of events converting homocysteine to methionine. People with a mutation in this gene can develop abnormal blood clotting and may have a higher risk for heart disease, stroke, high blood pressure and preeclampsia. This test maybe ordered to discover whether or not high homocysteine levels are related to genetic causes.