Screening for Heart Disease

Heart disease is the leading cause of death in men and women in the United States. Heart disease is commonly treated by controlling the symptoms like lowering blood pressure, decreasing cholesterol, and controlling blood glucose. These actions are managed with drugs without fully understanding the root cause of these symptoms or inflammation. Functional Medicine firmly believes that proper screening for heart disease leads to a better finding of the main cause of inflammation and the best care possible.

To become the CEO of your healthcare, first, you have to become educated about the correct cardiometabolic test and screening for heart disease that should be used to diagnose, treat, and reverse the illness. The best tests are the NMR Profile by Labcorp or Cardio IQ test by Quest Diagnostics Lab.

Total cholesterol: This number describes the amount of all types of cholesterol, HDL, and LDL. While it may give you the total sum of these cholesterol types, it does differentiate between particle characteristics. Previously the normal ranges of CT were 100-239 mg/dL, but current studies have found that the problem is not the amount. It is if your cholesterol is oxidized; this often happens when there is inflammation.

Normal: 100-239 mg/dL
Optimal: 150-200 mg/dL

HDL: Commonly known as “the good cholesterol.” Higher levels of HDL cholesterol are inversely associated with carotid intima-media thickness and coronary artery disease.

 Normal:
Men: 40-50 mg/dL

Women: 40-50 mg/dL

 Optimal:
Men: >50 mg/dL

Women: >60 mg/dL

LDL: The treatment and prevention actions are focused on lowering LDL cholesterol below 100mg/dL. As we develop better testing, we have found that we need to dig deeper, the amount of LDL in the lipid profile should be monitored, but the number and size of LDL particles must be an important part of the screening. If we carry small particles of LDL in our blood is more problematic than if we carry big but less dense particles of LDL.

Normal:  <100 mg/dL Optimal:  <100 mg/dL

LDL particle number:

Total particle count optimal: <1000 Small dense LDL particle number (sdLDL) optimal: <400

Oxidized LDL: We mentioned that might be the main reason for a heart attack is not high LDL levels rather than oxidized LDL, in addition to chronic inflammation.  This marker is quantitative of the LDL that forms plaques and narrow our vessels.

Normal: <70 U/L
Optimal: <60 U/L

Triglycerides:  This marker is associated with a high carbohydrate diet. Triglycerides are part of our fatty storage.

Normal: <150 mg/dL
Optimal: <70 mg/dL

Triglycerides to HDL ratio: This ratio is more predictive of heart disease than any other in your lipid panel. It also gives us an idea of how our insulin is working.

Optimal: <2 – A measurement greater than 2 suggests insulin resistance

hsCRP: C reactive protein is secreted by the liver and is an inflammatory cardiac-specific marker. High levels of cholesterol accompanied by chronic inflammation increases the risk of cardiovascular disease.

Normal <3.0mg/L
Optimal <1.0mg/L

Homocysteine: Homocysteine is a marker of B12 and folate status as well as an inflammatory marker. If your screening shows a high homocysteine level, your methylation ability might be compromised, and MTHFR status should be considered.

Normal 0−15 μmol/L
Optimal <7 μmol/L

ApoB and ApoA1: Each of these markers are important for heart disease. ApoB is an indicator of LDL as ApoA1 is to HDL. The ratio of these two markers is an accurate risk predictor for heart disease.

ApoB ApoA1 Ratio ApoB-ApoA1
Normal: 52−135 mg/dL Normal Men: 101−178 mg/dL

Normal Women: 116−209 mg/dL

Optimal:<0.8

Fibrinogen: This is a protein involved in clotting.  We want this marker to stay between ranges. If it gets too high, it is a sign that our blood flow is reduced and more likely to clot.

Normal  193−507 mg/dL
Optimal  <300 mg/dL

Lp(a): Lp(a) is a genetic marker. If you have a family member with CVD and high LDL levels is a marker that you might want to get looked at.

Normal  <75 nmol/L
Optimal  <30 nmol/L

Carotid Intima media thickness test (CIMT): CIMT is performed by an ultrasound on the neck and will measure the plaque built around your arteries. The past information correlates to your heart status and can predict cardiovascular risk.

NMR Profile by Labcorp

Cardio IQ test by Quest Diagnostics Lab.

The treatment of CVD is the same as the prevention plan for heart disease. This is why the American Heart Association, as a part of the 2020 impact goals, has set 7 ideal health goals:

-No smoking.

-Maintaining a normal weight.

-Increased physical activity.

-Following a healthy diet.

-Normal blood lipid levels.

-Normal blood pressure.

-Normal fasting glucose.

Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020.

Rao, Gundu HR. “Prevention or reversal of cardiometabolic diseases.” Journal of Clinical and Preventive Cardiology 7.1 (2018): 22.

 

Kosmas, Constantine E., et al. “High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease.” Drugs in context 7 (2018).

 

Hyman, Mark. Commune, 2020, http://www.onecommune.com/products/hacking-your-healthcare-with-dr-mark-hyman/categories/1666652/posts/2929886.

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