The Best Cardiac Screening Tests

DR. WEEKS’ COMMENT:  We all struggle to keep current on developments in our field so please feel free to share this information with your cardiologist or your primary care doctor.  The “standard of care” for testing cardiac risk is the lipid panel consisting of “cholesterol, HDL, LDL and triglycerides”.  But as we learn that cholesterol is not the demon we were told it was over the past 50 years,  and as inflammation is now understood to be the greatest threat to cardiac health, other tests have become more important than the old lipid panel.  Here is what you need to test to determine the health of your heart. 

The AHA Cardiovascular Health Profile

 

1) The VAP – This panel contains the following tests

– Total cholesterol and all subtype measurements

– Atherogenic (plaque-forming) particles like LP(a) & APO-B100

– LDL-cholesterol density patterns and particle size

– Measurements of the most protective to least protective forms of HDL-cholesterol (good cholesterol)

2) C-reactive Protein (hs-CRP)
A general marker of inflammation or infection in the vascular network. Elevated levels have been shown in individuals with mild or subclinical CVD. The high sensitivity assay used for this report can detect increases signalling the early stages of disease.

3) Oxidized LDLany tissue when oxidized is dysfunctional and toxic. Oxidized LDL is LDL cholesterol (the “bad” cholesterol) that has been modified by oxidation, triggering inflammation leading to the formation of plaque in the arteries.Individuals with high levels of OxLDL are 4 times more likely to develop metabolic syndrome in the next five years. Increased OxLDL levels are associated with the presence of coronary artery disease. Levels of OxLDL increase in a step-wise fashion as the severity of coronary artery disease increases.

4) Myeloperoxidase – (MPO) is an enzyme, released by white blood cells, that measures your body’s response to damage in your artery walls and the subsequent formation of vulnerable plaque which is prone to rupture. MPO oxidizes LDL making it atherogenic, and HDL (your good cholesterol) rendering it dysfunctional. This results in inflammation linked to plaque buildup inside the artery wall.

5) Ferritin – The best measure of iron deficiency, elevated ferritin is also an important maker of cardiovascular health. High levels are found in ischemic heart disease, iron overload, and hemo-chromatosis.

6) Fibrinogen – In states of tissue injury/inflammation, elevated fibrinogen is correlated with early CVD, and is a better marker of risk for a coronary event than is elevated cholesterol.

7) Coenzyme Q10  – Critical to the generation of mitochondrial ATP, its demand by cardiac muscle is great. Numerous studies support the use of CoQ10 in congestive heart failure and other forms of CVD. Cholesterol-lowering “statin”

8) Homocysteine – Many studies, including the Physicians’ Heart Study, have demonstrated the association between elevated homocysteine levels and CVD.

9) RBC Magnesium – Magnesium plays many vital roles in preventing CVD, controlling blood pressure, and improving HDL levels. RBC magnesium is the most precise way to assess intracellular magnesium status, and has been show to be inversely related with hypertension. Mg supplementation may be a healthier alternative to calcium channel blockers.

10) H A1c – This is an important measure of blood sugar over time which is directly correlated to cardiac risk.

11) Insulin – Insulin insensitivity and the ensuing Syndrome X condition is now recognized as a major contributing factor to the development and progression of CVD. Fasting insulin is a good predictor of this problem which can be improved with dietary changes and exercise.

12) Testosterone, Total, Free and Weekly Bound   Calculation of the free androgen index from total testosterone and SHGB gives a very accurate approximation of free testosterone. The free androgen index is increasingly recognized as a critically important factor linked with almost every major aspect of heart disease in both men and women. Normalization of testosterone levels improves cardiac function and many known CVD risk factors, as well as improving functional capacity and reducing indicators of ischemia.

13) IGF-1   an indirect measure of Growth Hormone a cardio protective hormone which diminishes as we age.

14) 25-OH D3 – vitamin D3 levels are directly correlated with cardiovascular health and performance

15) Free T3 freeT4 and TSH   – hypothyroidism is a common cause of dyslipidemia (high cholesterol)

16) Total Micronutrient panel   – This evaluates your biochemical inventory (vit C, Vit E selenium etc.) see http://www.spectracell.com/clinicians/products/mnt/ for more details.   (This test requires that a kit to be sent from the lab before you schedule your blood draw).

That said,  the best test for predicting sudden heart attack is the exercise stress test under the careful eye of a trained physician.  After that, the CT scan for calcium score is very predictive.

 

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DR. WEEKS’ COMMENT:  We all struggle to keep current on developments in our field so please feel free to share this information with your cardiologist or your primary care doctor.  The “standard of care” for testing cardiac risk is the lipid panel consisting of “cholesterol, HDL, LDL and triglycerides”.  But as we learn that cholesterol is…
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