Almost 50% of patients who suffer a heart attack have normal cholesterol levels.  How can that be?  This is a common area of confusion for patients, so let’s talk about cholesterol, as well as some of the lesser-known risk factors and screening tests for heart disease. 

Fun fact: Cholesterol measurements are often referred to as a “lipid panel”, or more simply, “lipids”!

When your primary care provider runs a lipid panel, it is often reported as total cholesterol, HDL cholesterol, and LDL cholesterol.  LDL is the “bad” cholesterol, and HDL is the “good” cholesterol.  With this information, a “Framingham Risk Score” can be calculated which includes other risk factors such as smoking, diabetes, high blood pressure, family history, age, and sex.  The score is reported as a percent, which corresponds to the percent risk of heart disease over the next ten years. If your score is less than 10% you are considered low risk. Moderate risk is between 10% and 20%, and high risk is above 20%.  

While the Framingham Risk Score is convenient, it does not account for other known risk factors for heart disease:
– Excess body weight
– Physical inactivity
– Excess alcohol consumption
– Excess iron accumulation
– Excess inflammation
– High stress
– Depression
– Unhealthy diet
– Exposure to harmful toxins

In order to get a comprehensive risk assessment for my patients, there are a variety of useful tests and measurements (beyond cholesterol) that I frequently use:
– homocysteine: an amino acid in the blood that can independently predict risk of cardiovascular disease
– ferritin: a reflection of iron stores in the body
– hs-CRP (highly sensitivity C-reactive protein): a measure of inflammation in the body
– fasting insulin and glucose: used for assessing insulin resistance
– Other lipid/cholesterol parameters including ApoB, V-LDL, Triglycerides, Lp(a), LDL particle size and counts; some of which have a strong genetic influence
– body composition assessment: utilization of bio impedance analysis to measure percent body fat, muscle, and visceral fat
– pulsewave analysis: estimates arterial stiffness, an early sign of cardiovascular disease
– toxic element analysis to assess levels of lead, cadmium, arsenic, and mercury
– vitamin D: low levels are associated with increased cardiovascular risk

With this additional information, I can recommend more targeted treatment strategies to reduce heart disease risk.  For example, 
– specific dietary recommendations; what foods to incorporate and which foods to avoid to lower your cardiovascular risk
– physical activity/ exercise requirements as well as what types of exercise to incorporate
– lifestyle counselling to address stress, sleep, depression, and other factors
– which nutraceuticals or dietary supplements offer the most benefit 
– other treatments that are specific to your laboratory findings

How do we know if the treatment plan is working?  Follow-up testing is especially important to reassess measurements, track progress, make adjustments, and most importantly it helps the patient stay motivated.  So take control of your health, and get a more comprehensive look at your heart disease risk!

– Dr. Tim

Selected references:
PMID 31065045
PMID 30158148
PMID 31905706
PMID 28327451
PMID 20054195
PMID 22689009
PMID 19509380
PMID 31980747
PMID 30453617
PMID 18706278