There are some illnesses we learn about through research and some we learn about through firsthand experience. As the world’s leading cause of death, heart disease is something that should hold personal stakes for us all.

For too long our cardiovascular treatments have been overly broad, incomplete, reactionary and ineffective. Instead of a proactive lifestyle change, we wait until crisis sets in and hope that a statin or some other miracle drug will fix us. This is hardly effective and a far cry from “Functional Medicine.”

Today we learn which tests you should be pursuing for a total view of your heart health and how to synthesize those results systemically. We move beyond the traditional lipid profile and really look into what’s under the hood. By addressing it now, we can start to shape a plan for continued heart health for years to come.

~Dr. Mark Hyman

One of the biggest myths out there is that high cholesterol is the enemy.  In fact, 75% of heart attacks occur in people with normal cholesterol levels, so there must be something else driving heart disease! Cholesterol becomes problematic when it is damaged by free radicals, where it oxidizes or goes rancid. In addition, there are forms of cholesterol that are much less concerning than other forms. This goes for LDL as well as HDL, which is why it is essential for your doctor to order a test that shows the full profile of your cholesterol. The best tests are the NMR profile by Labcorp or Cardio IQ test by Quest Diagnostics Lab

Total cholesterol: The total amount of cholesterol is not specific to the type of cholesterol. This number doesn’t tell us too much because it lumps together HDL and LDL and it doesn’t differentiate between the particle characteristics.

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

HDL: This is the “good cholesterol.” It is protective against heart disease and can be raised with exercise.

• Normal men: 40-50 mg/dL
• Normal women: 40-50 mg/dL
• Optimal men: >50 mg/dL
• Optimal women: >60 mg/dL

LDL is the “bad cholesterol,” but as we learned, we need to dig deeper. LDL particle number is a better measure for heart disease. We can also look at whether the LDL present is oxidized and whether it is small and dense (more problematic) or big and fluffy (less problematic).

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

LDL particle number: This is the number of particles that are in your blood. We can compare this to LDL-C (LDL) which is the amount (weight) of the LDL in the blood. This measurement is more important when considering risk factors for heart disease than the LDL measurement found on a standard lipid panel.

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

Oxidized LDL: This is the amount of LDL that is damaged. Oxidized LDL increases the risk for heart disease compared to non-oxidized LDL because it forms plaques that can narrow our vessels and increase our risk for heart attack and stroke.

• Normal: <70 U/L
• Optimal: <60 U/L

Triglycerides: Triglycerides are fatty acids that participates in fat storage, and elevated triglycerides are associated to carbohydrate intolerance. Thus having high levels of triglycerides might mean that you need to cut out processed carbohydrates from your diet.

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

Triglyceride to HDL ratio: This ratio tells us about your sensitivity to insulin, the hormone that is responsible for regulating our blood sugar levels. Thus in addition to fasting insulin levels we can also look at this ratio to see if insulin resistance is a reason for your symptoms.

• Optimal <2
• A measurement greater than 2 suggests insulin resistance

hsCRP: This is a cardiac-specific inflammatory marker. If it is elevated it suggests an increase risk for cardiovascular disease. If you have high cholesterol as well as high inflammatory markers, like CRP, then it is more concerning than just elevated cholesterol levels by itself.

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

Homocysteine: This is a general inflammatory marker, similar to CRP. It is also a marker of B12 and folate status, and gives us an insight to our ability to methylate. If this marker is elevated, then looking at causes for inflammation, as well as your MTHFR status, can be helpful.

• Normal: 0−15 μmol/L
• Optimal: <7 μmol/L

APOB: This is an advanced cardiac marker found on LDL cholesterol. It is a marker for cardiovascular disease, but is better when looked at as a ratio (see below).

• Normal: 52−135 mg/dL

APOA1: This is an advanced cardiac marker found on HDL cholesterol. It is a marker for cardiovascular disease, but is better when looked at as a ratio (see below).

• Normal Men: 101−178 mg/dL
• Normal Women: 116−209 mg/dL

Ratio of APOB to APOA1: This is a more accurate risk predictor for cardiovascular disease then APOA1 or APOB alone.

• Optimal: <0.8

Fibrinogen: Fibrinogen is a measure of blood flow and clotting risk. Fluid blood flow is important in preventing cardiovascular disease because when we form clots we are more likely to have a stroke. Adequate blood flow is needed to maintain all of our vital organs!

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

Lp(a): This is a marker of cardiovascular risk linked to genetics, and may be even more problematic than LDL. If you have a family history of heart disease and your lipid panel shows elevated LDL, then this is a must-order test. Lp(a) has more to do with genetics than it does with diet, however there are natural therapies that can lower Lp(a) and reduce your risk of ever developing heart disease in the first place. One of the therapies that has been found to reduce Lp(a) is niacin, a b-vitamin.

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

Carotid Intima media thickness test (CIMT): If you have elevated cardiovascular measurements for the markers above, then getting a CIMT will give you even more information about your actual risk. This test looks at whether you have plaque in your arteries, which causes narrowing and increases your risk for stroke/heart attack. Many facilities offer this test, and it can often be done at health fairs for a reduced rate, as well.

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The content in this course has been made available for informational and educational purposes only. This content is provided on the understanding that it does not constitute medical or other professional advice or services. Always work with qualified healthcare practitioner when making changes to your medication, diet or overall healthcare plan.