Are you are risk for Heart Disease? Six blood tests that will tell you
Heart Disease is by far the number one cause of death and many patients ask me "what blood tests can I get to see if I'm at risk a heart attack?" Remember, we can work to prevent death from heart disease so it's important to know what your risk is. .
Most of us know to have a fasting cholesterol panel done, but there are six other markers of risk you may want to think about having tested. Elevated LDL (the "bad") cholesterol, high blood pressure, family history, and tobacco use can predict patient risk for heart disease events in 80-90% of patients. Having said this, 50% of patients with coronary artery disease have NORMAL LDL cholesterol. Beyond LDL cholesterol what other blood tests are there?
1) HDL Cholesterol (the "good" cholesterol):
What is it? The job of HDL is to remove LDL from the bloodstream so the HIGHER the HDL the LOWER your risk (high is good).
Why do we care? We know that HDL levels are a strong, independent risk factor for heart disease: low is bad, high is good.
What can you do about it? You can increase your HDL by doing 30 minutes of aerobic exercise a day, quit smoking, maintain optimal weight, and if needed the use of statins (Lipitor, Simvastatin), fibrates (Lopid or Gemfibrocil) and niacin.
2) Apolipoprotein A-1:
What is it? This molecule appears to be critical for the anti-oxidant/anti-inflammatory functions of HDL. It can be tested for on a blood test and is an independent risk factor for coronary artery disease.
Why do we care? It may be that we shouldn't! There are no outcome studies proving that INCREASING apolipoprotein A-1 will reduce events from heart disease, but stay tuned.
3) Apolipoprotein B
What is it? Well, it's confusing. This molecule coats all non-HDL species and is a direct measure of total atherogenic (accelerating formation of atherosclerosis) particle concentration. It can be tested for on a blood test and is fairly cheap.
Why do we care? Apolipoprotein B is considered more predictive of heart disease risk compared to LDL and reflects risk in patients who are TAKING a statin. There are many problems though: exact cutoff points for normal/abnormal aren't known.
4) Lipoprotein (a)
What is it? Briefly, this is a modified form of LDL cholesterol. As with the previous markers, Lipoprotein (a) is easily measured on a blood test.
Why do we care? It is independently associated with heart disease risk and is associated with unstable angina and complex coronary lesions. Again, there are no "outcome" studies so we don't know if LOWERING Lipoprotein (a) reduces risk of death from heart disease.
What can we do about it? Statins (Simvastatin, Atorvastatin) DON'T lower lipoprotein (a) but Niacin DOES at a dose of 2-4 grams per day.
5) Triglycerides
What is it? These are the free fatty acids in the blood and are measured on a standard fasting cholesterol (or "lipid") panel.
Why do we care? High triglycerides confer an increased risk of coronary artery disease. Increased triglycerides can also signal uncontrolled blood sugars, fat filled diet, or hypothyroidism.
What can we do about it? You can lower your triglyceride levels through weight loss, aerobic exercise, reduced intake of simple sugars and increased intake of omega-3 fatty acids.
6) C-reactive protein (high sensitivity CRP)
What is it? The highly sensitive CRP is a blood test that measures the inflammatory process. A level of less than 1 mg/L indicates low risk; of 1-3 mg/L, moderate risk; and greater than 3 mg/L, high risk.
Why do we care? CRP predicts cardiovascular risk independently of age, smoking, LDL, HDL, blood pressure, diabetes, and gender.
What can we do about it? CRP can be lowered with statins, smoking cessation, aerobic exercise, blood pressure control, and by maintaining an optimal weight.
Remember, these six serum markers are useful because they are measurable, because most of them add new information to a cardiac risk assessment beyond LDL, and because most enhance the management of those of you at risk for cardiovascular disease
Dr O.
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10
Thanks you! Different blood tests useful to know about the heart diseases. Nice information.
By ellaallison November 17, 2008 2:07am
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Forgot one thing! Dr. O. I recently saw an over the counter, cholesterol test. How accurate are they?
By dorothiec November 16, 2008 10:36am
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Thank you! Ofcourse I read this as I ate my breakfast from McDonald's LOL! Thanks for writting this!
By dorothiec November 16, 2008 10:34am
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Boy Dr. O, you must be reading my mind :) Now I know why my Trigs are so darn high- Hashimotos. I eat an excellent diet and that has always confused me. Thank you
By willow54 November 6, 2008 7:28pm
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Great information!
Thanks so much for this post.
Have a great day,
Holly
By HollyN November 6, 2008 8:23am
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I had a CRP test done some time ago by a rheumatologist. The resuslts were greater than 3 mg/L, but he dismissed them (I assumed it was because I was only in my 30's and we weren't looking for a heart related issue). I have now been diagnosed with a slight heart condition (PSVT with slight MVR). My cardologist has never run any bloodwork on me. Am I falling thru the cracks or do I not have anything to worry about? I go about my business ignoring my strange symptoms for the most part and check in with my cardiologist once a year.
By BayBrat November 4, 2008 5:45pm
4
Having just had the priviledge of listening to Dr. Underberg of NYU Medical Center and a leading cardiologist speak about testing for the risk factors in heart disease, I find this very interesting and running along the same lines as what he said. I will add one other test that he advocates and is becoming more common, and that is testing for the LDL particle % saturation (LDL-P) as he demonstrated that this was an even more telling marker than the others. You can have normal LDL and HDL levels, but if the LDL-P was elevated over 800, it put you at much higher risk. They have been using this for the last decade on the East Coast, and now it is becoming known (and paid for by insurances) on the West Coast. As he said, the more information you have on which to base treatment, the better.
By aprilshowers4657 November 4, 2008 1:49am
3
Thank you so much or this vital information. Thank you for taking the time to educate us. I deeply appreciate you so much. Have a Blessed Day with Jesus and pass it on. This is National Care Givers Month and I know as a Caregiver to my young husband that the stress can sometimes be overwhelming. I have heard that Caregivers have a higher risk of heart attacks due to the stress. I am not sure if this info is correct for Caregivers so any info you have on this would be deeply appreciated. Thanks again. Blessings, Angelunaware
By angelunaware November 3, 2008 8:42am
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In addition to these blood tests, there is another thing that primary care physicians should check for that indicates an high risk for heart disease and many other serious ailments. Primary care physicians should learn how to effectively screen their patients as a routine for sleep apnea, which in at least the mild form affects about 20% of US adults. Even the mild form of sleep apnea can have serious consequences if left untreated over the long term.
By painfree123 November 3, 2008 8:19am
1
Thanks Do. O, for explaining all that. I just got the results from the lab work yesterday and all those things you are talking about were on it. Thank you for being so thorough. Ok, so how come, if everything is so normal, why do I feel so sick? LOL Ok, don't answer that!
I wish everyone could know how nice you are and how great you treat your patients.
By NormLNorma November 3, 2008 2:24am