Summary of coronary heart disease risk factors
Ask your doctor for a complete lipid evaluation. In order to get reliable numbers, you must fast 10-12 hours before blood is drawn (you can drink water). Unless you are under age 50, total cholesterol (TC) and LDL are not reliable predictors of heart disease and are not delineated here.
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Total Cholesterol (TC): 180 mg/dl to 330 mg/dl - normal healthy range depending on age and other risk factors
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SUMMARY: Depending on your age and particular family history, you can largely ignore TC and LDL and focus on Fasting Glucose, Triglycerides (TG), and the ratio of TG:HDL. Also, further specific testing to determine whether your LDL is large buoyant subclass A or small, dense subclass B is highly recommended.
1. C-reactive protein (CRP) is produced by the liver in response to inflammation in the arteries. If monitored early enough, elevated CRP can be an early warning of a heart attack several years in advance.
2. Fasting glucose measures blood sugar concentration in a fasting state. Lowest all-cause mortality is associated with fasting glucose in the range of 80-89 mg/dl. High normal range (100 to 109) represents increased risk of heart disease.
3. Fibrinogen is a protein that promotes blood clot formation. Elevated fibrinogen = thicker blood. Thicker blood flows less easily through partially blocked arteries. Consistent elevated fibrinogen (over 350) conveys a 250 percent increased risk of heart disease compared to people with fibrinogen levels below 235.
4. Homocysteine is normally rapidly cleared from the bloodstream. Elevated homocysteine is a result of deficiencies of folic acid and vitamins B-6 and B-12. Elevated homocysteine damages arteries and dramatically increases the risk of heart attack and stroke. Levels greater than 8 micomoles per deciliter signal increased risk of heart disease.
5. Lipoprotein(a) has been called “heart attack cholesterol.” Lipoprotein(a) is actually a sticky protein that attaches to LDL and accumulates rapidly at the site of arterial lesions or ruptured plaque. Readings of 30 or more indicate serious increased risk of heart disease, especially in the presence of elevated fibrinogen (>350).
6. HDL is made by the liver and acts as a cholesterol mop, scavenging loose cholesterol and transporting it back to the liver for recycling. HDL is associated with protection from heart attacks. You want as much HDL as possible. HDL of 60 or more is associated with protection for men—70 or more for women.
7. Triglycerides – like fasting glucose - should be under 100 mg/dl. Triglycerides are made in the liver from excess carbohydrates. Readings above 100 signal increased risk of heart disease. Risk is linear—the higher the number, the greater the risk, especially for women. Readings above 150 for both men and women mean sticky, clot-prone blood and a much greater risk of a heart attack.
8. TG:HDL ratio – Ratio of TG to HDL is the most reliable predictor of heart disease risk. Calculate: TG number divided by HDL = ratio. For example, if TG = 80 and HDL = 80, your ratio = 1:1 and represents a low risk of heart disease. If your TG = 200 and your HDL = 50, your ratio = 4:1 and represents a high risk of heart disease.
LDL particle size: Large buoyant subclass A or small, dense subclass B
There are seven sub-fractions of LDL (and three sub-fractions of HDL). Testing for these sub-fractions is important for patients who have low or average total cholesterol and persistent symptoms of heart disease. Why, because the cholesterol number in routine cholesterol testing - milligrams of cholesterol in a deciliter of blood (mg/dl) - does not reveal the number or size of the cholesterol particles.
LDL is a particle consisting of protein, cholesterol, and varying amounts of triglycerides. At the same cholesterol level - say 220 mg/dl - a person can have a different distribution of LDL particle count and particle size. LDL subclass B particles, for example, are small, dense and contain more triglycerides, inducing chemical changes that make the LDL more likely to oxidize and damage artery walls.
High triglycerides are a warning sign that you have small, dense LDL - regardless of the LDL level in your blood. If your triglycerides are elevated (say over 150), your LDL is most likely the small, dense subclass B. On the other hand, if your triglycerides are near or below 100, your LDL is most likely the large, buoyant safe LDL subclass A.
To determine LDL particle size, ask your doctor for a VAP lipid panel. The test provides important information not available with standard cholesterol tests. Please go to http://thevaptest.com for more information.
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