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.
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Blood Tests for Heart Disease: What You Need to Know
If you have heart disease, what are the best blood tests to get? In conventional Western medicine, high blood pressure and cholesterol are often highlighted as the main risks. But is that the full picture? You might wonder why these are the primary focus. The answer is complex, but financial interests play a role.
Can We Prevent Heart Disease?
In the 21st century, with all our advanced technology, why is heart disease still so prevalent? The sad truth is, heart disease can often be prevented. However, the focus of modern medicine is more on managing illness than preventing it. Many cardiovascular health experts argue that the emphasis on cholesterol is misleading.
Beyond Cholesterol: Other Risk Factors
There are many other theories and causes of heart disease. Important but often overlooked risk factors include:
– High homocysteine levels
– Low levels of Coenzyme Q10 (often due to Statin drugs)
– Elevated platelet-activating factor
– High fibrinogen and thromboxane levels
– Increased free radicals and other inflammatory markers
These markers can indicate an increased risk of heart attack or stroke. When considered together, along with cholesterol levels and the HDL/LDL ratio, they provide a clearer picture of heart disease risk.
What the Experts Say
The Mayo Clinic, a leading medical authority, acknowledges that your blood reveals much about your heart health. High “bad” cholesterol levels can signal a higher risk of heart attack. The Clinic also notes that other specialized substances in your blood can indicate heart failure or the risk of artery plaque buildup.
Unfortunately, these “other specialized substances” are often not tested by your doctor or cardiologist, as they may be considered “unscientific” or “unproven.” However, it’s crucial to remember that no single blood test can determine your heart disease risk. Key contributing factors include smoking, high blood pressure, high cholesterol, a family history of early heart disease, and diabetes.
Below, we’ll explore some of the most relevant blood tests for diagnosing, treating, and managing heart disease.
Cholesterol Blood Testing
Cholesterol testing measures the levels of circulating fats in your blood, including “good” fats (HDL) and “bad” fats (LDL). While it might seem that all fats produced by the body have a purpose, the reality is more complex. Fats are biochemically unstable and can become harmful when exposed to oxidizing factors like toxins, pollutants, drugs, and waste products. Just like butter left out in the sun, fats can go rancid and lose their beneficial properties.
Fats are essential to life. Much of our brain and nervous system is composed of fat, and every cell in our body has fat-protein layers. Cholesterol is also crucial for synthesizing many hormones in our glands and liver, and our immune system relies heavily on fats. It’s important to respect, protect, and maintain essential fats in our bodies.
In this section, we’ll focus on the fats typically measured in blood lipid tests, rather than delving into dietary fats like saturated, unsaturated, polyunsaturated, and essential fatty acids. Understanding your blood lipids can provide valuable insights into your heart health.
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.
The Problem with Cholesterol
Cholesterol is susceptible to oxidation due to environmental pollutants, poor diet, and various biochemical factors. When cholesterol becomes oxidized, it can damage arteries and other tissues. The body naturally tries to counteract this oxidation with antioxidants. This is similar to how antioxidants are added to cooking oils to prevent them from going rancid too quickly.
Understanding the Cholesterol Debate
Why are doctors so focused on lowering cholesterol levels? It’s important to recognize that not all lipids are equally concerning. Certain types of lipids are linked to the severity of heart disease. Statin drugs, for example, can significantly reduce these lipid levels. However, the controversy lies in how low these levels should be. While there’s agreement on the heart-related benefits of statins, some experts question the non-heart-related disadvantages and side effects.
A Different Perspective on Cholesterol
Many experts, such as Dr. Uffe Ravnskov, argue that high cholesterol is not a disease in itself. According to Dr. Ravnskov, cholesterol doesn’t cause heart disease; it’s merely one of many markers. Having “normal” or even low cholesterol levels doesn’t guarantee protection against heart attack or stroke. Unfortunately, many people who rely on mainstream sources or their doctors for health information may not be aware of this.
In an interview from November 2009, Dr. Ravnskov, an expert in cholesterol metabolism, expressed his views on the cholesterol-lowering hypothesis. He believes that lowering cholesterol is ineffective in preventing heart disease. He described such treatment as “meaningless, costly, and responsible for turning millions of healthy people into patients.”
Why Are We Ignoring the Whole Picture in Heart Disease?
Many experts argue that the mainstream medical approach to heart disease is incomplete. The heavy focus on lowering cholesterol, primarily through the use of statin drugs, may be driven more by pharmaceutical profits than by a holistic understanding of heart health. Statins like Lipitor and Zocor are among the top-selling drugs in the country, which raises questions about the broader motivations behind this singular focus.
The Reality of Heart Attacks in “Healthy” Individuals
Over the years, I’ve observed a troubling pattern in patients at my clinic. Fit, active men—who didn’t smoke, exercised regularly, and maintained a healthy diet—still suffered from fatal heart attacks. Surprisingly, many of them had low to normal cholesterol levels. This observation was further reinforced during my time at a medical center, where I saw three men die of acute myocardial infarction (MI) within a six-week period. Despite two of them having normal cholesterol and blood pressure, and the third only slightly elevated cholesterol, all three shared elevated inflammatory blood markers. These markers are often overlooked in conventional heart disease assessments.
The Illusion of Safety
Every day, heart attacks and strokes strike without warning, often affecting people who believed they were in good health. Many assume they are safe because their cholesterol levels are within the “normal” range. This false sense of security is dangerous. I’ve heard from countless patients who were baffled by sudden heart attacks in loved ones who seemed perfectly healthy. The reality is that standard cholesterol tests may not tell the whole story.
Understanding Fats: The Good, The Bad, and The Ugly
Cholesterol, a type of fat, is transported through the blood attached to protein carriers. It’s these protein carriers that determine how the fat behaves in the body. Standard lipid tests may not accurately assess the true risks, but more advanced testing can provide a clearer picture. In some cases, heart attacks occur in individuals with normal lipid test results, but deeper investigation reveals underlying issues.
For more information on lipid abnormalities and their classification, you can refer to the [Fredericksen classification of lipid abnormalities on Wikipedia.
Risk Markers to Assess Heart Risk Not Commonly Tested
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
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
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
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:
Aneurysm of the heart and the post-myocardial-infarction syndrome. Acta Med Scand 1968;183:393-5.
Fluctuating pericardial effusion. N Engl J Med 1969;281:854.
Lowering cholesterol concentrations and mortality. BMJ 1990;301: 814.
An elevated serum cholesterol is secondary, not causal, in coronary heart disease. Medical Hypotheses 1991;36:238-41.
Atherogenicity and thrombogenicity indices. Lancet 338, 1328, 1991.
The fragile links of the diet-heart chain. Nutrition Quarterly 1992;16:19-21.
Cardiovascular disease in developing countries. BMJ 1993;306:145-6.
Dietary fats and blood lipids as cardiovascular risk factors in the general population. A critical overview. Proceedings of the I. World Congress of Dairy Products in Human Health and Nutrition. Madrid 1993. Rotterdam: Balkema 1994, p 361-369.
Reducing serum cholesterol. Lower cholesterol of doubtful benefit to anyone. BMJ 1993;307:125.
Coronary atherosclerosis on angiography-progress or regress and why? Circulation 1993;88:1358-9.
Hypercholesterolemia does not cause coronary heart disease – evidence from the nephrotic syndrome. Nephron 1994;66:356-7.
Is there a cause-effect relationship between high blood cholesterol and atherosclerosis? Workshop on cholesterol-lowering trials. National Heart, Lung and Blood Institute, Bethesda 1994.
What do angiographic changes after cholesterol lowering mean? Lancet 1994;344:1297.
Is intake of trans-fatty acids and saturated fat causal in coronary heart disease? Circulation 1994;90:2568-9.
Doing the right thing: stop worrying about cholesterol. Circulation 1994;90:2572-3.
Is atherosclerosis caused by high cholesterol? QJM 2002; 95: 397-403. This paper was also selected for publication in the third issue of South African Excerpts Edition of the QJM 2002
A hypothesis out-of-date: The diet-heart idea. J Clin Epidemiol, 2002 Nov;55(11):1057-63. Same issue: Dissent by W.S.Weintraub, and Reply by U. Ravnskov An evaluation of our discussion is available
The retreat of the diet-heart hypothesis. J Amer Phys Surg. 2003;8:no 3, 94-95
High cholesterol may protect against infections and atherosclerosis. QJM 2003;96:927-34. This paper has since long been one of the most-frequently read paper in QJM
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lowering hypothesis. He believes that lowering cholesterol is ineffective in preventing heart disease. He described such treatment as “meaningless, costly, and responsible for turning millions of healthy people into patients.”
primarily through the use of statin drugs, may be driven more by pharmaceutical profits than by a holistic understanding of heart health. Statins like Lipitor and Zocor are among the top-selling drugs in the country, which raises questions about the broader motivations behind this singular focus.