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 specialized 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 specialized 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:
- – Cholesterol, The Risks, The Facts and The Politics
- – Lowering Cholesterol – Statin Drug Side-Effects
- – 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 Downright 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 (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 liter, 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 to order an Lp(a) test if you already have atherosclerosis or heart disease but appear to have otherwise normal cholesterol levels. (apart from a few NZ doctors with specialised nutritional medicine training). Lp(a) should certainly be tested if you have a family history of early-onset heart disease or sudden death. It should also be tested if your LDL cholesterol doesn’t respond well to 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 specialized supplements.
‘Non-Standard’ Blood Tests Are Shown In Red
Standard Blood Cholesterol Testing
|Standard Testing||Description||Ideal Range nmol/L||How to treat without drugsdrug treatment covered elsewhere||Tick if you have problem|
|Is the total of all the subgroups, so may comprise good and bad fats. May not mean much by itself therefore.||4.34 – 5.91|
|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.||0.62 – 2.26|
LDL (Low Density Lipoproteins)
|A mixture of lipoprotein particle types. Some are worse than others. It seems the particle number rather than just particle type is more important. Its measured as apoprotein B.||2.4 – 3.83|
HDL (High Density Lipoproteins)
|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.||1.05 – 2.25|
Cholesterol / HDL Ratio
|The lower the better, meaning more HDL than bad fats. A guide.||Less then 4.5|
LDL / HDL
|The lower the better, compares bad fat with good fat. A guide.||Less then 2.8|
Advanced Blood Testing To Assess Heart Disease
|Name of Test||Description||How to treat without drugs||Tick if you have a problem|
LDL Particle Number
|Is very 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.||
|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||
Strict low fat diet may actually worsen the Small LDL factor!
Large HDL (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||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.
Intermediate Density Lipoproteins
|Very 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 oxidized more and cause damage. About 10% have raised IDL.||
Very Low Density Lipoproteins
|Are packed with triglycerides, so if trigs are high then these VLDL’s may also. VLDL’s get into the LDL and HDL causing small particles of LDL and deficient large HDL!||
|Lp(a) Lipoprotein (a)||Lipoprotein ‘little a’ is a very 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 other risk factors’ dangers.||
Other Risk Factors To Assess Heart Disease
|Test or Risk Factor||Description||Test Level||Treatment||Tick if you have problem|
|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.||Less than 2||
|Homocysteine||This has been covered on our Homocysteine page.||Best under 8||
|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. Estrogen may increase it in some at risk women. Certain types of HRT||Between200 and 400 milligrams per liter (mg/L).||
|Smoking||Major Risk||Are you crazy!|
|Blood Pressure||Major Risk||Lower blood pressure|
|Diabetes||Major Risk||Get treatment, avoid risks|
|Overweight, obesity||Modest risk, worse if have Metabolic Syndrome||Low GI Mediterranean style diet.|
|Lack of exercise||Modest risk.||Daily cardio fitness.|
|Family history||Especially when associated with high risk lipid profile in the family.|
|Metabolic Syndrome||Also called Insulin Resistance, Syndrome X. Read more.||Must 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.
- Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome. BMJ1992;305: 15-19.
- 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.
- Ischaemic heart disease and cholesterol. Optimism about drug treatment is unjustified. BMJ 1994;308:1038.
- 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.
- Quotation bias in reviews of the diet-heart idea. J Clin Epidemiol 1995;48:713-719.
- Implications of 4S evidence on baseline lipid levels. Lancet 1995;346:181.
- Beneficial effects of simvastatin may be due to non-lipid actions. BMJ 1995;311:1436-1437.
- The American College of Physicians guidelines on cholesterol screening. Ann Intern Med 1996; 125:1010-1011.
- The questionable role of saturated and polyunsaturated fatty acids in cardiovascular disease. J Clin Epidemiol 1998;51:443-460.
- Why heart disease mortality is low in France. AuthorÂ´s hypothesis is wrong. BMJ 1999;319:255
- VAT and fat. Evidence is contradictory. BMJ 2000;320:1470
- Prevention of atherosclerosis in children. Lancet 2000;355:69.
- The Cholesterol Myths. Washington: New Trends Publishing, 2000; ISBN 0-9670897-0-0
- Cholesterol and all-cause mortality in Honolulu. Lancet 2001; 358: 1907.
- Diet-heart disease hypothesis is wishful thinking. BMJ 2002; 324: 238
- Studies of dietary fat and heart disease. Science 2002; 295: 1464-5.
- Statins as the new Aspirin. Conclusions from the heart protection study were premature. BMJ 2002;324:789.
- 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
- ASCOTT-LLA: Questions about the benefits of atorvastatin. Lancet 2003;361:1986.
- Lipoproteins and cardiovascular risk. Lancet 2003;361:1988-1989.
- 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
- Dietary fat intake and risk of stroke. Allegations about dietary fat are unfounded. BMJ 2003; 327:1348
- Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis. JAMA 2004;291:1833-1834.
- Aggressive lipid-lowering therapy and regression of coronary atheroma. JAMA. 2004;292:38
- Intensive lipid-lowering with atorvastatin in coronary disease. N Engl J Med 2005;353:94.
- Dietary fat is not the villain. BMJ 2005;331:906-7.
- Should we lower cholesterol as much as possible? BMJ 2006;332:1330-1332.
- High-Dose Statins and the IDEAL Study. JAMA 2006;295:2476. In their response the authors did not give us the requested information.
- Saturated fat does not affect blood cholesterol Am J Clin Nutr 2006;84:1550-51. Read also Martijn B KatanÂ´s response as well as a discussion about our correspondence by Michael R Eades and others.
- Lack of Evidence for Recommended Low-Density Lipoprotein Cholesterol Treatment Targets. Ann Intern Med 2007;146:614.
- Cholesterol lowering and mortality: A sea of contradictions.Nutr Metab Cardiovasc Dis. 2007;17:e25-7
- Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metabol 2008, 5:9
- Re: The Association Between Statins and Cancer Incidence in a Veterans Population.J Ntl Cancer Inst 2008; doi: 10.1093/jnci/djn160
- Should medical science ignore the past? BMJ 2008;337:a1681
- The fallacies of the lipid hypothesis. Scand Cardiovasc J 2008;42-236-239
- Vulnerable plaque formation from obstruction of vasa vasorum by homocysteinylated and oxidized lipoprotein aggregates complexed with microbial remnants and LDL autoantibodies. Ann Clin Lab Sci 2009;39:3-16
- Fat and Cholesterol are GOOD for You. GB Publishing 2009.
- Cholesterol was healthy in the end. World Rev Nutr Diet 2009;100:90-109.