Heart Disease, Inflammation, and the Cholesterol Myth

Cardiovascular disease is the leading cause of death of men and women in developed countries. It tops the list of most serious health problems. Between 84 million and 121.5 million adults in the United States have some form of cardiovascular disease. Meaning nearly half of American adults may have heart disease.

 

Over one in four deaths are the result of heart disease. Heart failure affects over 5 million adults in the United States alone. Nearly 15 million adults in the U.S. have coronary heart disease, the most severe type of cardiovascular disease.

 

The best way to determine your risk for heart disease is to undergo screening for risk factors. Some people are afraid to learn about their cardiovascular risk level.  However, you are not destined to develop cardiovascular disease with less than ideal lab results. Instead, you can use the insights to make positive changes for your heart health and lower your risk level.



Myth: Cholesterol Predicts Heart Disease

When most people think of heart disease, they think of high cholesterol.  However, traditional cholesterol screening is not the best way to predict heart disease.

 

For five decades, most doctors have considered high total cholesterol and low-density lipoprotein (LDL) to be the major causes of atherosclerosis and cardiovascular disease. However, newer scientific data has shown that the causes of heart disease are more complicated, and the “cholesterol hypothesis” is based on weak evidence and ignoring contradictory observations.

 

Here are some surprising facts about diet, cholesterol, and the risk of cardiovascular disease and mortality:

 

  • Half of heart attacks and strokes occur in people with normal or good cholesterol levels.
  • Eating saturated fat and dietary cholesterol doesn’t raise cholesterol in most people.
  • LDL cholesterol levels do not predict cardiovascular disease accurately.
  • Higher total cholesterol predicts lower risk of death from all causes.
  • High LDL cholesterol (“bad” cholesterol) is associated with longer life in most people over the age of 60.
  • Low LDL cholesterol levels correlate with a higher risk of cancer.
  • Statin treatment for high cholesterol may not help prevent heart disease.

 

In short, new research undermines the notions that saturated fat is bad, dietary cholesterol is to be avoided, and statins are necessary for people with total cholesterol levels over 200 milligrams per deciliter.

 

In contrast to newer science, large portions of the medical establishment continue to promote low-fat diets and the use of cholesterol-lowering statin drugs for heart health. However, if you are concerned about cardiovascular disease, there are better strategies and screening methods for managing your risk.


Inflammation and Heart Health

Inflammation in your body can cause or play a key role in coronary heart disease, coronary artery disease, atherosclerosis, and other serious forms of cardiovascular disease. Unlike cholesterol levels, inflammation is a reliable indicator of heart disease risk.

 

Moreover, certain behaviors or lifestyles increase your risk of serious cardiovascular disease by causing inflammation in your body. For example, smoking or using tobacco products, drinking excessive amounts of alcohol, having high levels of stress, living a sedentary lifestyle, being overweight or obese, having type 2 diabetes or metabolic syndrome, and having poor periodontal health can all significantly increase your risk of heart disease.

 

Along with proper screening for heart health, you can also reduce your risk of heart disease by avoiding smoking, drinking in moderation, managing stress, being physically active, maintaining a healthy weight and good insulin sensitivity, and brushing and flossing regularly.


10 Lab Tests for Heart Health and Cardiovascular Risk

As you age, your risk of cardiovascular disease increases. Whether you are currently healthy or have had a past diagnosis of cardiovascular disease, early detection and prevention of cardiovascular problems is the most effective strategy for managing your risk.

 

Here are the top ten lab tests you can use to gain an understanding of your heart health and reduce your risk of heart disease:

 

  1. VAP Cholesterol Test
  2. Fasting Insulin Levels, Glycated Hemoglobin
  3. Heart Rate Variability (HRV)
  4. OmegaCheck
  5. ADMA and SDMA Biomarker Test
  6. Apo A1, Apo B
  7. High Sensitivity C-Reactive Protein (hsCRP)
  8. Trimethylamine-N-oxide (TMAO)
  9. Fibrinogen
  10. N-terminal Pro-B-type Natriuretic Peptide (BNP)

 

Your insurance may cover some or all of these tests.  You may choose to get screened annually, biannually, or quarterly depending on your health history. Most importantly, testing more frequently can give you a better understanding of how your habits and lifestyle affect your risk factors.

 

Consider making an appointment with your doctor or healthcare professional to discuss which tests are right for you, how to interpret your results, and how to lower your risk level.


VAP Cholesterol Test

The Vertical Auto Profile (VAP) cholesterol test is designed to identify your risk of cardiovascular disease more accurately, compared to traditional cholesterol tests.

 

In addition to the four routine types of cholesterol measurements (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein), VAP provides a more accurate direct measure of LDL, measures LDL pattern density (sdLDL), and lipoprotein subclasses including HDL2, HDL3, intermediate-density lipoprotein (IDL), very-low-density lipoproteins (VLDL1, VLDL2, and VLDL3), and lipoprotein(a) (Lp(a)).


Fasting Insulin Levels, Glycated Hemoglobin

A higher risk of cardiovascular disease,  metabolic syndrome, and type 2 diabetes are associated with insulin resistance. Even in non-diabetic individuals, insulin resistance independently predicts cardiovascular events.

 

By testing your fasting insulin levels and  hbA1c, you and your doctor can gain insight into your insulin sensitivity. If you have insulin resistance, you can improve your heart health by changing your diet to raise your insulin sensitivity.


Heart Rate Variability (HRV)

High chronic stress levels are a major risk factor for cardiovascular disease. Heart rate variability (HRV) is a measure of how your body deals with stress.

 

High HRV levels indicate positive health, low mortality, and parasympathetic nervous system dominance. Likewise, low HRV predicts poor health, higher mortality, and sympathetic nervous system dominance.

 

If you have a high HRV score, you probably have less inflammation in your body and a lower risk of cardiovascular problems. Heart rate variability also helps explain why people who suffer from depression are more likely to die of heart disease.


OmegaCheck

The OmegaCheck test measures the ratio between omega-3 and omega-6 fatty acids in your blood. Omega-3s are obtained from oily fish, shellfish, and grass-fed meats, and have anti-inflammatory effects in your body. Omega-6s are found in grains, corn-fed animal products, and some plant oils. Excess omega-6 levels can contribute to inflammation and blood clots.

 

A diet with a ratio of 4:1 or less has been shown to reduce the risk from cardiovascular disease and other causes by up to 70% over two years.  Unfortunately, the typical American diet has a ratio of about 10:1 of omega-6 to omega-3 fatty acids.

 

A 2015 meta-analysis of 70 randomized controlled trials also found that the omega-3 fatty acids DHA and EPA lower blood pressure. They were as effective as other lifestyles changes including exercise, reducing salt intake, and limiting alcohol.


ADMA and SDMA Biomarker Test

Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are compounds called toxic dimethylarginines. ADMA and SDMA are harmful because they inhibit nitric oxide (NO), causing an elevation in blood pressure.  They also play a role in many diseases.

 

High levels of ADMA and SDMA can indicate damage to the inner lining of blood vessels. It can also predict a higher risk of heart attacks.

 

A large study of people with and without heart disease found that ADMA levels predicted both all-cause and cardiovascular mortality in heart patient independently of established and emerging risk factors.

 

In a study of 1,908 people with heart disease, those with the highest levels of ADMA and SDMA were subsequently 2.5 times more likely to die over three years. ADMA and SDMA are also an early warning sign of insulin resistance, which increases inflammation and heart disease risk.


ApoA1, ApoB

Apolipoprotein A1 (ApoA1) is the major protein of high-density lipoprotein (HDL). Low ApoA1 levels are associated with increased risk of early cardiovascular disease.

 

Apolipoprotein B (ApoB) is another major protein found in cholesterol particles. ApoB occurs primarily in VLDL, LDL, and IDL cholesterols. ApoB is a better risk marker for heart disease than LDL alone.


High Sensitivity C-Reactive Protein (hsCRP)

C-reactive protein (CRP) is a protein produced by your liver during injury or infection. Inflammation plays an essential role in the process of atherosclerosis.  Also known as hardening and narrowing of the arteries — as well as cardiovascular events like heart attacks.

 

In short, the hsCRP test is a measure of how much inflammation is occurring in your body. Because higher levels of inflammation also predict cardiovascular problems, hsCRP helps create an accurate picture of your current heart health. But because CRP levels can vary over time, you should do the test two different times, two weeks apart.


Trimethylamine-N-oxide (TMAO)

Trimethylamine-N-oxide is a gut bacteria byproduct that causes inflammation and increases the risk of heart disease.

 

According to published research from the Cleveland Clinic, TMAO is an excellent predictor of future risk of heart attack, stroke, and early death in people not identified by traditional risk factors.

 

Fibrinogen

A protein found in your blood called fibrinogen is essential for blood clot formation. Fibrinogen is important because high blood pressure, higher body weight, and older age correlate with higher fibrinogen levels.

 

Increased risk of heart attack and vascular diseases are also linked to high levels of fibrinogen. Therefore, fibrinogen screening in addition to other testing can improve the detection and prevention of heart disease.


B-type Natriuretic Peptide (BNP) and N-terminal Pro-B-type Natriuretic Peptide (NT-proBNP)

If you have heart failure, your body will produce high levels of two proteins called natriuretic peptides. Levels of these proteins go up when heart failure worsens, and go down when it improves. A test called the BNP blood test can detect heart failure more than 80% of the time.

 

BNP and NT-proBNP are useful in patients who have known cardiovascular risk factors or chronic diseases or have already been diagnosed with serious heart conditions. In a study of patients with type 2 diabetes and heart failure, natriuretic peptide screening added as much predictive information about death as all other conventional variables combined.