Eric Bakker N.D.April 1, 2022
8 Mins.

There are many different kinds of blood tests you can do to assess the state of your heart and circulatory system. Has your doctor informed you of the availability of specialised tests as well? Likely not, unless he or she has has specialised training in functional medicine. Check out this page if you want to know what I'm talking about.


Your Heart Risk – What Are the Real Risk Factors?

If you have heart disease, what are the best blood tests to get? If you follow conventional Western medicine, you will be told that high blood pressure and cholesterol are your predominant threats when it comes to heart disease. You will be told this for one very good reason, it is profitable. But why would you ask do I appear so cynical, am I just scare mongering?

Let me ask you this question: If we have the ability to create the amazing technology that we do in the 21st century, then why on earth can’t we prevent heart disease?  Well, the sad truth is, we can in most all cases. But it is not in medicines best interests to prevent any illness. It is in medicines best interest to manage sickness. There are other ways of assessing heart disease, cholesterol is a con, a big fat lie in fact, according to many cardiovascular health experts today.

The truth is, there are many other theories and causes of heart disease, as well as various other markers that can signal an increased risk of heart attack or stroke. Some of the important but often ignored risk factors include high homocysteine levels, depleted levels of Coenzyme Q10 (often caused by Statin drugs), elevated levels of platelet-activating-factor, fibrinogen, thromboxane, and high levels of free radicals and other inflammatory markers in the bloodstream that attack artery walls. Each of these markers can be a red flag for heart disease risk – and when all are taken into consideration, in conjunction with total cholesterol and HDL/LDL ration, they can provide much clearer warning signs before it’s too late.

According to the prestigious Mayo Clinic, the leading online American medical clinic, these additional cardiovascular risk blood tests are over and above what your current doctor will request, but do offer clues to your heart health. Here’s what the Mayo Clinic has to say about these blood tests:

Your blood offers many clues about your heart health. For example, high levels of “bad” cholesterol in your blood can be a sign that you’re at increased risk of having a heart attack. And “other specialised substances” in your blood an help your doctor determine if you have heart failure or are at risk of developing plaques in your arteries (atherosclerosis).

It’s a shame that the ‘other specialised substances in your blood’ are never tested by your doctor or cardiologist, who deems them to be ‘unscientific’ and ‘unproven’. What is vitally important to remember that one blood test alone doesn’t determine your risk of heart disease and that the most important factors contributing to heart disease are smoking, high blood pressure, high cholesterol, a strong family history of early mortality from heart disease and diabetes.

Below you can read some of the more important blood tests you may find relevant in your diagnosis, treatment and management of heart disease.

Cholesterol Blood Testing

As a test, cholesterol refers to the group of circulating fats inclusive of so called “good” fats (HDL)  and “bad” fats (LDL). It could be argued that any fats produced by the body must serve some purpose. In a perfect world this may be true, however because fats are biochemically quite unstable, that is they are prone to going ‘rancid’, and in the presence of ‘oxidising’ factors such as toxins, pollutants, drugs, waste products and other factors, they can be oxidised and become harmful. Just leave butter out in the sun for a day and taste it!

Fats are essential to life. Much of our brain and nervous system is actually composed of fat. Every cell has fat(lipid)-protein layers; many hormones are synthesised in our glands and liver from cholesterol and our immune system is highly dependent on fats. So it would be very worthwhile respecting, protecting and not depleting essential fats. Here we will explore the fats that are typically measured as blood lipids, rather than discuss the issues of dietary fats like saturated, unsaturated, polyunsaturated, essential fatty acids and so on.

The Problem with Cholesterol

Cholesterol gets oxidised by environmental pollutants, dietary neglect as well as other biochemical factors. Then it does harm to the arteries and other tissues. Of course the body attempts to reduce this oxidising process with natural antioxidants as one example. That is why off the shelf cooking oils have antioxidants added to stop the oil going rancid too quickly.

Read More About Cholesterol:

  1.  Cholesterol, The Risks, The Facts and The Politics
  2. – Lowering Cholesterol – Statin Drug Side-Effects
  3. – Lowering Cholesterol – Best Natural Solutions

Why are doctors so concerned to reduce cholesterol levels? Firstly it is important to recognise which subgroup of the lipid group is the concern. There is a link between high levels of some lipids with heart disease severity. Certain drugs, such as the ‘Statin’ family can reduce these levels very dramatically. The controversy arises as to how low should these lipid levels be forced, not that there is dispute about the benefits of statin drugs and cardiac risk (although the risk benefit conferred is very low), but there may be other non-heart related disadvantages and side-effects.

Many cholesterol experts such as Dr. Uffe Ravnskov believe that high cholesterol is not a disease in and of itself. Cholesterol does not CAUSE heart disease, it is merely a marker – and one marker out of many. Having ‘normal’ or even low cholesterol levels does not eliminate your risk of heart attack or stroke. Unfortunately, many people who rely on the mainstream (or their doctors) for health information haven’t gotten the message.

An Interview with Uffe Ravnskov MD, PhD. November 2009
Dr. Ravnskov is an expert in cholesterol metabolism and believes the “cholesterol lowering” hypothesis to be useless in preventing heart disease.  – “This kind of treatment is meaningless, costly and has transformed millions of healthy people into patients”.


Why Are We Ignoring The Whole Picture In Heart Disease?

Some people believe that maybe the mainstream hasn’t focused on the other known markers of heart disease because the pharmaceutical companies haven’t come up with a pill to treat them. The focus has been on lowering cholesterol because that’s what they’re selling – and they’re selling plenty. (Statin drugs, the class of cholesterol-lowering drugs that includes Lipitor and Zocor, are some of the top sellers in this country).

An interesting fact I have observed for many years is that our clinic has seen various patients – seemingly healthy, fit, active men – die from a heart attack. Most didn’t smoke, they exercised and watched what they ate. Many even had low to normal cholesterol level.  But they still died suddenly – of a heart attack. When I practiced at a medical centre some years ago, I noticed that three men died of an acute MI (myocardial infarction, or heart attack) within a six week period. We call this a cluster, and it gave me a perfect opportunity to observe their case histories, look at their blood tests and enquire into their diet and lifestyle in general. Interestingly, two out of thee had normal cholesterol and blood pressure readings and the third man had only a slightly elevated cholesterol level. What they had in common were elevated inflammatory blood markers, and we will look at those particular blood markers in this article.

Every day, heart attacks and strokes kill or disable people who never see it coming. They thought they were safe – because their cholesterol levels were within ‘normal’ range. Many people live their lives with such a false sense of security, thinking they are “off the hook” because their medical check-up revealed a “perfect bill of health”. I’ve heard it all before: “I can’t understand why my husband had that heart attack, he was so into fitness, was not overweight and his doctor only recently told him that his health was perfect”.

Different Types of Fats – The Good, The Bad and The Ugly

Cholesterol as a fat is transported around in the blood attached to a protein carrier. Its this protein that determines what happens to the fat. Standard lipid testing may not accurately ‘test’ the risks properly. Some labs can do more expanded assessments. As mentioned earlier, some people having heart attacks may have normal standard lipid tests but not until delving more deeply do the faults appear.

For more information on the Fredericksen classification of LIPID abnormalities see Wikipedia Lipidaemia

Risk Markers To Assess Heart Risk Not Commonly Tested (explained below)

C-Reactive Protein

C-reactive protein (CRP) is a protein your liver produces as part of your body’s response to injury or infection (inflammatory response). CRP is a marker for an inflammatory response somewhere in the body. However, CRP tests can’t pinpoint exactly where in the body this may be happening. I call CRP the “smoking gun”, the shot was fired and the damage has been done but who pulled the trigger? Inflammation plays a central role in the process of atherosclerosis, in which fatty deposits clog your arteries.

Measuring CRP alone won’t tell your doctor your risk of heart disease. But factoring in CRP test results with other blood tests results (like Homocysteine and Lipoprotein a, along with your cholesterol tests) and risk factors for heart disease such as blood pressure, body weight, etc; helps create an overall picture of your heart health. According to the American Heart Association, your CRP test result can be interpreted as putting your heart disease risk at:

  • Low risk (less than 1.0 milligrams per litre, or mg/L)
  • Average risk (1.0 to 3.0 mg/L)
  • High risk (above 3.0 mg/L)


You will find that your cardiologist doesn’t yet recommend CRP screening for the general public — only those at known risk of heart disease. You may be told that cholesterol-lowering statin medications may reduce CRP levels and decrease your heart disease risk, but it’s not recommended that you take statin medications solely to decrease your CRP level. Talk to your doctor if you’re concerned about your CRP level.


Fibrinogen is a protein in your blood that helps blood clot. But too much fibrinogen can cause a clot to form in an artery, leading to a heart attack or stroke. Having too much fibrinogen may also mean that you have an inflammatory response that accompanies atherosclerosis. It may also worsen existing injury to artery walls.

  • I always recommend that our patients  check their fibrinogen levels if they have an increased risk of heart disease. Smoking, inactivity, excessive alcohol consumption and supplemental estrogen — whether from birth control pills or hormone therapy — may increase your fibrinogen level. A normal fibrinogen level is considered to be between 200 and 400 milligrams per liter (mg/L).


Lipoprotein (a), or Lp(a), is a type of LDL cholesterol. Your Lp(a) level is determined by your genes and according to conventional medicine isn’t affected by lifestyle. Others would beg to differ, and research has shown that it is possible to reduce LP (a) levels with Vitamin C, for example.

            Research articles on LP (a)

  • Angles-Cano ; Structural basis for the pathophysiology of lipoprotein(a) in the athero-thrombotic process. Braz J Med Biol Res 1997 Nov;30(11):1271-80.
  • Chong PH; Bachenheimer BS Current, new and future treatments in dyslipidaemia and atherosclerosis. Drugs 2000 Jul;60(1):55-93. High levels of Lp(a) may be a sign of increased risk of heart disease, though it’s not clear how much risk.

I have not found any doctor in New Zealand (in 2014) to order an Lp(a) test if you already have existing atherosclerosis or heart disease, but appear to have otherwise normal cholesterol levels.  The doctors in NZ that do have an interest in this test have specialised nutritional medicine training. Lp(a) should be tested if you have a family history of early-onset heart disease or sudden death. It should also be tested if a person’s LDL cholesterol level doesn’t respond well to conventional pharmaceutical drug treatment.


  • Homocysteine is a substance your body uses to make protein and to build and maintain tissue. But too much homocysteine may increase your risk of stroke, certain types of heart disease, and disease of the blood vessels of the arms, legs and feet (peripheral artery disease). You can read more about Homocysteine on the Homocysteine page.
  • Your (enlightened nutritional medicine) doctor may check your homocysteine level if you’ve had cardiovascular problems but don’t have any of the traditional risk factors, such as smoking.
  • Your practitioner may also suggest screening if any family members developed heart problems at a young age or have high homocysteine levels.Your homocysteine level may drop if you get plenty of folate (folic acid) and B vitamins in your diet through foods such as green, leafy vegetables and fortified grain products or through specialised supplements.

Standard Cholesterol Blood Testing

  • Cholesterol –  Is the total of all the subgroups, so may comprise good and bad fats. May not mean much by itself therefore. Ideal range is 4.34 – 5.91 nmol/L

  • Triglycerides – Most of the body’s fat is stored in this form and only a small amount should be in the blood. By themselves triglycerides don’t cause heart problems but if high, then they do influence the bad fats like LDL and VLDL. Ideal range is 0.62 – 2.26 nmol/L

  • LDL (Low Density Lipoproteins – These are considered the “bad fats”. LDL consists of a mixture of lipoprotein particle types. Some are worse than others. It seems the particle number rather than just particle type is more important. It is measured as apoprotein B. Ideal range is 2.4 – 3.83 nmol/L.

  • HDL (High Density Lipoproteins) – These are considered by your doctor to be the “good fats’ in your blood. Also a mixture. The larger HDL particles are good at extracting cholesterol out of atheroma plaques. It has other benefits too. Small particles don’t have this usefulness. So it would be beneficial to know the subtypes is possible. Some labs can. Ideal range is 1.05 – 2.25 nmol/L.

  • Cholesterol / HDL Ratio – Lower is better, meaning more HDL than bad fats. A guide. A good range is considered under 4.5 nmol/L.

  • LDL/HDL – The lower the better, compares “bad fat with good fat”. A guide. Ideal range is less than 2.8 nmol.L.

Advanced Blood Testing To Assess Heart Disease

  • LDL Particle Number – Apo B – Is strongly linked to heart attack risk. Actual counting is very specialised by nuclear magnetic resonance spectroscopy, but more easily but indirectly by the apoprotein B test. Apo B is the main protein in LDL. So you could have a low LDL (low risk) but a high count which is high risk.
  • Solution for elevated Apo B – Oat bran reduces particle number & size. Ground flaxseed, psyillium, almonds, walnuts, pecans, soy protein in smoothies etc., glucomannan fibre before meals, stanol/sterol (butter substitutes), chitosan 1-2gm / day. Beans: spanish, red, black, lima beans.

  • LDL size – Small or low density lipoproteins – LDL particles can be small, medium and large, like jeans! It is the small ones that are deadly. They easily penetrate the blood vessel walls and they hang around longer, clinging to that delicate artery lining called endothelium. It can make you more at risk of being ‘insulin resistant’ or even diabetic if overweight. It trebles heart attack risk and if the CRP is high 6x the risk.Genetic factors if strong can cause high risk even if otherwise healthy. Risk increases with unhealthy lifestyle and being overweight.
  • Solution for elevated LDL – Rapid weight loss increases LDL size. Exercise helps. Niacin 500mg to 1500mg corrects size (must be under supervision). Diet: reduce sugar release by: Mediterranean diet, low GI foods, high fibre foods, psyllium, oat bran, ground flaxseed, nuts like almond, pistachio, and walnuts, omega 3 fish oil (especially if your triglycerides are up). Strict low fat diet may actually worsen the Small LDL factor!

  • HDL size – Large density lipoproteins – (HDL2b) – Half of heart disease people have low HDL. Many have a low protective subclass of HDL which are the large particles called HDL2b or simply large HDL. Crucial for getting cholesterol out of plaque. Usually the higher your HDL the more likely you will have enough large HDL.
  • Solution for elevated HDL – Same as for treating small LDL particle size. Strict “low-fat diets” are not advised as it may generate more small HDL particles when total HDL is very low. The Mediterranean diet is good, nuts, olives, olive oil, low-glycemic foods, leafy green vegetables, tomatoes, increase protein intake, especially oily fish (omega-3).

  • IDL size – Intermediate density lipoproteins – Potent risk for heart disease. High IDL’s slow down the clearing of fat from the blood after eating. When fats hang around longer, they can get oxidised more and cause damage. About 10% of people have raised IDL.
  • Solution for elevated IDL – Red yeast rice extract works well, niacin (Vitamin B3) may help, fish oils (omega-3) help, weight loss may help.

  • VLDL size – Very Low Density Lipoproteins – Are packed with triglycerides, so if triglycerides are elevated then these VLDL’s may be also. VLDL’s get into the LDL and HDL causing small particles of LDL and deficient large HDL. They cause lots of problems due to their low-density.
  • Solution for elevated VLDL – High dose fish oil (omega-3) dosage from 4 – 10 grams/day with foods. Increase fibre intake.

  • LP (a) – Lipoprotein (a) – Lipoprotein ‘little a’ is a potent risk factor. 20% may have it, leading to heart attacks early in life; 40’s to 50’s. It seems to accelerate plaque growth and rupture as well as increase the dangers of other risk factors.
  • Solution for elevated LP (a) – Niacin is the most effective but in high doses 1000mg to 4000mg daily. (must be supervised). Oestrogens may be effective in women (needs to be weighed against risks). Testosterone for men reduces Lp(a). L-Carnitine (1gram twice daily). Vitamin C (several grams per day). Diet as above.

Other Risk Factors To Assess Heart Disease

  • hsCRP (C-Reactive Protein) – Inflammation is the underlying cause and key to the generation of future plaque. Inflammation is also the basis for many if not most of the body’s diseases even cancer. CRP is a non-specific test which signals inflammation going on somewhere. In the absence of other known inflammation, a low level of CRP could indicate a 3 fold increase risk of heart attack. Especially the hsCRP (high sensitivity CRP) is elevated. CRP not only is a ‘marker’, it also directly injures the endothelial lining. The level of this marker is best under 2. 
  • Treatment recommendations: Healthy lifestyle and diet as above, frequent exercise, fish oil (omega-3) is anti-inflammatory and highly recommended. Vitamin C, bioflavonoids and Vitamin E are all recommended.

  • Homocysteine – please read this page all about Homocysteine. The level is best kept under 8. There are various Homocysteine supplements available that can help to lower levels.

  • Fibrinogen – Fibrinogen is a necessary part of the blood clotting system to prevent bleeding when a blood vessel is injured when it turns into fibrin threads which help make a clot. Too much fibrinogen can increase the generation of clots (thrombosis) leading to a heart attack, stroke or other damage from blocked arteries. Poor diet, lifestyle raises fibrinogen. Oestrogen may increase it in some at risk women. Certain types of HRT (hormone replacement therapy). The fibrinogen level should be between 200 and 400 milligrams per litre (mg/L). Fish oil (omega 3 ) is effective, Mediterranean diet, green vegetables, plentiful, fish meals, exercise, niacin (Vitamin B3), fibrate class of drugs.

  • Smoking – One in four deaths in the United States in 2014 was related to smoking. I would say that smoking therefore is a pretty big risk factor.

  • High blood pressure is a major risk – Lower your blood pressure.

  • Diabetes – major risk. Get treatment and avoid risks, like inactivity, poor diet and obesity.

  • Obesity, overweight – Modest risk, worse if have you have Metabolic Syndrome. Consider a low GI Mediterranean style diet.

  • Lack of exercise – Moderate risk. Get some exercise, even walking daily is more than sufficient cardio exercise.

  • Family history – Especially when associated with high risk lipid profile in the family. Avoid any potential risk factors. Improve diet and lifestyle. Work on reducing stress levels.

  • Metabolic Syndrome – Also called Syndrome X or insulin resistance. Important to reduce abdominal circumference to under 100cm males, 80 females.

Papers and books published about cardiovascular issues:

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