Cardiovascular Risk Assessment

Cardiovascular Risk Assessment

Testing is critical when it comes to the conversation of cardiovascular health. Most often your primary care physician or conventional medical doctor will run a lipid panel consisting of total cholesterol, LDL, HDL, and triglycerides to assess your cardiovascular risk. However, these biomarkers give us an incomplete picture of what is going on inside our bodies, as nearly half of individuals who present to the hospital with a heart attack have absolutely perfect cholesterol numbers by conventional standards. This is why at 5280 Functional Medicine, we gather more information from your blood chemistry in order to more accurately assess your risk for a cardiovascular event (ie stroke, heart attack, etc).

The comprehensive cardiovascular risk assessment blood work we run in our office goes well beyond the conventional basic lipid panel in its ability to assess a patient’s future cardiovascular risk. First, because cholesterol is fat soluble, in order for it to be transported through the bloodstream it needs to be carried by lipoproteins (HDL, LDL, etc.). Imagine your arteries as a highway, the lipoproteins are the vehicles, and the cholesterol are the passengers in the vehicles. When you have a standard lipid panel done, what is being measured by HDL-C and LDL-C is the volume of cholesterol in those lipoproteins. This is analogous to the number of passengers in the vehicles on the highway. But according to the best and most current scientific literature, knowing the number of passengers in the vehicles does not accurately assess our future risk. What is now known is that the number of LDL particles (the number of cars of the road) and the size of these particles (motorcycles versus semis) is much more predictive of your risk for future cardiovascular events. The comprehensive testing we do in our office measures just that, the number of vehicles on the road (LDL and HDL particle number) and the size of those particles. The smaller and denser the LDL particles, the more likely they are to crash into the endothelium of the arteries and contribute to atherosclerosis. Furthermore, the more LDL particles there are, the more likely a person is to develop atherosclerosis and/or embolus formation leading to heart attacks and strokes respectively. This is better information regarding what is happening inside your arteries and has a higher correlation of predicting future health risks like heart disease, heart attack, and stroke. Advanced testing is crucial considering that several people can have an elevated LDL-C of 130, but only those with elevated LDL particle number and small, dense LDLs are those at risk. Conversely, there can be several patients with LDLs in the “good” range by conventional standards, lets say 90, and some of those may actually be at elevated risk because most of their LDL particles are small and dense and they have too many LDL particles overall!

The comprehensive panel we run includes, but is not limited to, the following essential cardiovascular disease risk biomarkers:

• Lipid Fractionation/Lipid Particle Profile – tells us the number and the size of the LDL and HDL particles.
• ApoB/ApoA ratio – ApoB is a protein that attaches to each harmful lipid particle while ApoA attaches to each HDL particle. This is important because knowing the ratio of harmful to protective particles is perhaps the best lipid marker of your future cardiovascular risk. The higher the ratio is of ApoB to ApoA, the higher your risk.
• Lp(a) (Lipoprotein a) – Lp(a) is estimated to be ten times as atherogenic as small dense LDL, and like small dense LDL, it too can penetrate the arterial lining, become oxidized and build plaque (atherosclerosis). Additionally, the higher your Lp(a) levels, the less your body is able to break down clots, which raises the likelihood of blood clot formation and contributes significantly to stroke or heart attack risk.
• HS CRP (High Sensitivity C-Reactive Protein) – This is a marker for evaluating systemic inflammation associated with an increased risk of heart attack and stroke. Elevated levels of hsCRP are caused by inflammation of the cells lining blood vessels. Inflammatory markers like hsCRP are essential to have run since again, nearly half of all heart attacks occur in people with perfectly normal cholesterol/plasma lipid levels!
• Homocysteine – this is a metabolic intermediate protein and arterial abrasive. When levels are high it could indicate a nutrient deficiency in folate (often found in green leafy vegetables), or poor methylation (detoxification) ability contributing to CAD, kidney disease, stroke, and dementia. High homocysteine also lead to blood clot formation, which recent research indicates is related to long haulers COVID.

Metabolic conditions such as type 2 diabetes, which is growing rapidly in the United States, go hand in hand with cardiovascular disease risk. For this reason, included in our blood chemistry panel is a comprehensive assessment of your diabetes risk to help us more comprehensively evaluate your health and more precisely tailor your lifestyle strategy.

After receiving results back from this test, Dr. Riggs and Dr. Spencer are able to personalize a lifestyle approach specifically for you. This includes specifics around food, exercise, supplements, stress management, sleep, etc. Most often these cardiovascular risks are lifestyle induced and making these changes can be a complex process. Dr. Riggs and Dr. Spencer are trained in supporting patients with the lifestyle changes they need to make in manageable steps. They meet you where the rubber meets the road, assisting you with finding answers to your questions and challenges. Often these include:

• What will I eat for breakfast?

• I don’t have the time to exercise.

• I’m just so stressed all the time.

• I never remember to take/re-order my supplements

For further information, please reference our website for great resources or contact us. We take great pride in helping patients become empowered to manage their health in safe, effective ways.