Getting lab work can be a daunting task to begin with, let alone figuring out which labs to actually ask your practitioner to run and then understanding how to interpret your results. When you consider the fact that cardiovascular disease (CVD) is the world’s leading cause of death, then you understand the magnitude of importance that should be given to running the appropriate labs for determining not only your risk factors for developing CVD, but also personalizing lifestyle and supplemental interventions to support overall health.
It is important to note that when talking about heart disease the conversation should include more than just topics such as atherosclerosis, plaque and having a heart attack. In general, the goal should be to support cardiovascular health in its entirety, which means understanding the role of systemic inflammation, oxidized cholesterol, high blood pressure, lack of physical activity, insulin and blood glucose dysregulation, prolonged stress (including emotional and mental stress), and obesity as contributing factors to approaching and supporting heart health.
It should also be noted that when interpreting lab results it is critical to look at trends or averages in your current and previous results. Are all of your numbers trending high? Have your numbers gone down with lifestyle interventions? Do you have a family history of having elevated markers? Yes, lab work is one piece of the health puzzle and it can provide insightful information to monitor your health and increase longevity, but it is not the zenith of truth. More than 70 percent of chronic diseases are preventable, but blood work can help to identify if you are at an increased risk for developing something such as heart disease.
Below are some key biomarkers (outside of total cholesterol levels, which only tell part of the cholesterol story and a complete blood count) for the prevention and assessment of cardiovascular disease that can be discussed with a doctor.
C-Reactive Protein (CRP)—This test is used to look at systemic inflammation. CRP is a protein that the liver makes as a part of the body’s response to infection, injury or inflammation and as we know, inflammation plays a role in the process of atherosclerosis (or the thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery). Higher levels of CRP are associated with a higher risk of heart attack, stroke, and cardiovascular disease. A CRP level above 2.0 mg/L indicates a higher risk of heart disease, and above 3 mg/L is now considered to be a marker of “high risk for cardiovascular disease.”
Homocysteine—Elevated plasma levels of homocysteine are an independent risk factor for cardiovascular disease. Homocysteine is a type of amino acid that regulates methylation, an important biochemical process that helps to influence and regulate your brain, hormones, DNA and immune system. One of the possible mechanisms suggests that higher levels of homocysteine can lead to a reduction of HDLs, as well as have adverse effects on the smooth muscle cells that can result in alterations to the structure and function of the endothelium and arteries. The optimal range for homocysteine is between 5-7 mmol/L, with any measurement below 12 being considered low.
Hemoglobin A1c (HbA1c)—This is a marker of your average blood sugar levels over the past three months. It can indicate prediabetes or diabetes, which can increase heart disease risk. HbA1c is positively associated with CVD such as atherosclerosis, ischemic heart disease, ischemic stroke, and hypertension. A1C levels below 5.7 percent are ideal.
Lipoprotein (a)—Lipoprotein (a) is a subclass of LDL cholesterol. Lp(a) is an LDL that is attached to a protein called apo (a) and is highly determined by your genetics (more so than lifestyle) however, Lp(a) has been shown to stimulate the immune cells to deposit cholesterol into the heart artery walls, which can promote the development of atherosclerosis. Ideally, levels should be under 20 mg/dl.
Apolipoprotein B (ApoB)—measures the amount of a certain type of protein on the surface of cholesterol called Apolipoprotein B-100 (which is made in your liver, as opposed to Apo-B-48, which is made in your gut). ApoB is the main protein that is found in LDL cholesterol and is involved in the metabolism of lipids and indicates the total number of atherogenic particles; it helps to carry fat and cholesterol through the body. The normal range for Apo-B is less than 100 mg/dL.
Triglyceride to HDL Level—Most people over-rely on LDL levels, often referred to as bad cholesterol, but LDL is only part of the picture. HDLs (high-density lipoprotein), often referred to as good cholesterol, can be a bit more helpful, especially when compared to triglyceride levels. HDL gets good press because it helps to carry away LDL cholesterol, which helps to keep the arteries open and your blood flowing more freely and they are the smallest lipoproteins; they have the highest protein-to-lipid ratio, as opposed to LDLs, which contain large amounts of cholesterol and triglycerides. Having higher levels of HDL can be beneficial if your LDL numbers tend to be on the higher side; optimal levels for HDL are above 60 mg/dl.
Triglycerides are a type of fat in the blood, and while they don’t cause heart disease directly, high levels are linked to an increased risk of heart disease. Triglycerides should be below 150, with an optimal range being about 100 mg/dl however, assessing your ratio triglyceride to HDL can be used as a tool to help determine a person’s risk of heart disease. Ideally, you want no more than 2:1 ratio of triglycerides to HDL cholesterol. You can do this by dividing your triglycerides by your HDL level; for example, 200 triglyceride levels divided by 60 HDL level = 3.3. The triglyceride/HDL level ratio should be below 2; 4 is high and 6 or greater is considered too high. Additionally, an LDL: HDL ratio of 2:1 or less is great.
Nuclear Magnetic Resonance Lipoprofile (NMR)—This test looks at your LDL particle size, specifically LDL-P, Pattern A and Pattern B LDL. There are different types of LDL particles depending on their size and the LDL particle size is important for assessing your risk factor for heart disease. As a side note, the ideal range for LDL is 100-200 mg/dl (shooting more toward 100-130 mg/dl). Pattern A LDL tend to carry more fat-soluble nutrients and antioxidants and is said to be more cardioprotective; they have a larger particle size. Pattern B LDL is more prone to oxidation as they are smaller particle sizes. Since they are smaller, they are more likely to enter the endothelial lining (a single layer of cells, called endothelial cells, which line all your blood vessels and lymphatic vessels) of the artery wall, which is where they can end up oxidizing and forming plaque. Optimal levels of LDL-P on the NMR test are under 1,000 nmol/L.
Coronary Angiography and Coronary Artery Calcium Score (CAC)—A heart scan, also referred to as a coronary calcium scan, is done via X-ray and can detect and measure calcium-containing plaque in your arteries and blood vessels and looks at how blood flows through the arteries in your heart. If you have a family history of heart disease, history of high cholesterol and other risk factors, this test might be a good idea. The CAC measures the amount of calcified plaque in your arteries and the score can range from zero to 400, with a score of zero indicating that you have a very low risk of having a heart attack within the next 10 years.
Brianna Diorio holds a PhD in integrative medicine from the University of Natural Medicine and is a clinical nutritionist with a Master’s of Science in Human Nutrition from the University of Bridgeport. She is also a functional diagnostic nutrition practitioner (FDN), an herbal practitioner through the Herbal Academy, a family herbalist through The School of Natural Healing, a NASM certified personal trainer, and a holistic lifestyle coach from the C.H.E.K Institute. Diorio is the host of the Brianna Approved Podcast, which is a podcast for people who like a holistic approach to real science and clinical research on all things nutrition, botanicals and balance. She currently works as a clinician with her private practice that specializes in alternative health, functional medicine and dietary supplements. Diorio works with a vast array of clients and businesses to educate and improve their health and dietary needs.