At your annual physical checkup, your doctor orders blood tests. One of the most common tests is the lipid panel. Lipids are fats, and a lipid panel measures levels of different types of fat in the blood. More specifically, it measures lipoproteins, which are proteins that transport lipids in the blood. A typical lipid panel includes total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C).
Unfortunately, this type of risk analysis of developing heart disease is pretty much outdated according to experts. As I mentioned in my previous newsletter, 50 percent of people who are hospitalized with heart attacks have normal cholesterol levels, and 25 percent of people who develop premature heart disease, have no traditional risk factors at all. Some experts say that there are better measurements to look at when comes to accessing heart disease. So, I would like to discuss several types of tests which give you a more accurate risk assessment.
1.LDL Particle Number
LDL and HDL particles are the containers that transport cholesterol through your bloodstream which can contribute to, or protect against atherosclerosis. Since LDL particles interact with the arterial wall as the beginning of the oxidation process that forms plaque, the higher number of LDL-P and small LDL-P, the greater the risk for coronary heart disease.
On the other hand, a higher number of HDL-P is considered to be more protective, since HDL removes LDL by transporting it to the liver. In general, people with higher levels of HDL-P are at a lower risk for CHD. It is also well known that LDL particle size provides extremely important information on cardiovascular health. Small, dense LDL particles are dangerous since they contribute to plaque formation in the arterial wall. Ideally, one would want their results to show large, buoyant LDL particles. Small, dense particles are also closely associated with insulin resistance and an increased risk of developing type 2 diabetes.
We have been focused on only the LDL amount, which is the weight of your cholesterol. So, you can have 90 LDL which is a normal number, but it may consist of 1,000 small and heavy particles that are dangerous, or you can have 100 large, puffy particles like beach balls that don’t do anything, and it’s the same number you get on your regular blood test.
- Total particle count optimal: <1000
- Small dense LDL particle number (sdLDL) optimal: <400
2. Oxidized LDL cholesterol
Although LDL is usually thought of as “bad cholesterol”, non-oxidized LDL is just a protein carrying cholesterol and fats from the liver to the rest of the body. In order for LDL particles to cause disease, they have to be small and dense and capable of entering the wall of your arteries like I discussed above. Once inside the endothelium, fats in the LDL particles react with free radicals and oxidized LDL (OxLDL) is formed.
Oxidation is a term used when LDL becomes damaged and can cause harm to the artery walls, and that causes plaque formation, it causes narrower vessels, and is one of the biggest contributors to heart disease.
- Normal: <70 U/L
- Optimal: <60 U/L
3. C-Reactive Protein Test
The C-reactive protein (CRP) blood test measures the level of systemic inflammation. The Physicians’ Health Study found that among healthy adult men, those with a high level of CRP were three times more likely to have a heart attack than those with low levels of CRP. This was among men who had no previous history of heart disease. According to the Cleveland Clinic, the Harvard Women’s Health Study showed that high CRP levels were more predictive of coronary conditions and stroke in women than were high cholesterol levels. So, this will help you calculate your actual risk for heart disease.
- Normal: <3.0 mg/L
- Optimal: <1.0 mg/L
Homocysteine is an amino acid made from a common dietary amino acid, methionine, that inflicts damage to the inner arterial lining (endothelium) and contributes to many diseases such as cardiovascular disease, stroke, brain atrophy, Alzheimer’s disease. It can indicate problems with folic metabolism, and when it’s elevated it can be inflammatory. Studies have shown that even moderate levels of homocysteine pose an increased risk for arterial plaque formation when compared with the lowest 20th percentile (<7.2 mcmol/L) of population controls.
- Normal: 0−15 μmol/L
- Optimal: <7 μmol/L
5. ApoB and ApoA1
Apolipoprotein B (ApoB) is a protein involved in the metabolism of lipids and is the main protein constituent of all non-HDL cholesterol in your blood. Since each ApoB-containing lipoprotein particle contains one ApoB molecule, measuring ApoB levels gives a good approximation of the total number of atherogenic particles in your blood. The greater the number, the greater the risk of more cholesterol ending up in your artery wall and the greater the risk of artery calcification and heart attack.
Apolipoprotein A-I (apo A-I) is a protein that has specific roles in the transportation and metabolism of lipids and is the main protein component in HDL. HDL is like an empty taxi. It goes out to the tissues and picks up excess cholesterol, then transports it back to the liver. Deficiencies in apo A-I correlate with an increased risk of developing CVD. Apo A-I levels provide more information to help evaluate CVD risk, especially when HDL levels are low.
The study shows that apoB to Apo A1 ratio possesses superior diagnostic efficacy for coronary heart disease as compared to conventional lipid parameters.
ApoB • Normal: 52−135 mg/dL
Apo A-1 • Normal Men: 101−178 mg/dL • Normal Women: 116−209 mg/dL
Ratio of APOB to APOA1 • Optimal: <0.8
Fibrinogen is a protein, a coagulation factor (factor I) that is essential for blood clot formation. This test helps find out whether you have a bleeding or blood clotting disorder. Fibrinogen is an important protein made by your liver. If you have bleeding anywhere in your body, fibrinogen is released from your liver and travels to the site of bleeding to help form a blood clot.
You may need this test if you bleed too much or for too long. You may also need this test if you are forming blood clots abnormally. Too little fibrinogen can cause prolonged bleeding. But too much fibrinogen can cause you to form clots inside blood vessels. These clots could break loose and travel to your brain or your lungs, putting your life in danger. The test is also part of a general evaluation of your risk of cardiovascular disease. People with clotting disorders can have an increased risk of heart disease and stroke.
- Normal: 193−507 mg/dL
- Optimal: <300 mg/dL
From your traditional lipid panel, definitely, you need to keep eye on Triglycerides and Triglyceride to HDL ratio. Your optimal number of triglycerides should be less than 70 mg/dL, and Triglyceride to HDL ratio should be less than 2. A measurement greater than 2 suggests insulin resistance.
Heart disease markers are one of the most controversial topics in medicine, and it’s difficult to navigate on your own. So that’s the reason I want you to work with a good practitioner who understands how these markers all work together. They’re going to be able to look at your entire biochemical picture and help you make an informed decision about what is going on with your health, and not just focus on LDL. We’re so LDL-centric. We want to look at all these biomarkers and get a real picture of what’s going on, and combine that with all these other variables, your family history, your genetics, and much more.