Cardiac & Vascular Risk Assessment (Risk of Heart Attack & Stroke)

by Rick Liva

Cardiovascular disease remains the number one killer of Americans today, and we all associate cholesterol with heart disease. However, if your cholesterol levels are in the normal range do not become complacent. Half of all patients who have heart attacks have normal levels of cholesterol. It seems that other risk factors may be even more important than cholesterol.

In the October 19, 2000 issue of The New England Journal of Medicine, three articles were published showing that the presence of blood indicators of inflammation are strong predictive factors for determining who will develop coronary artery disease and suffer cardiac-related death.

The advanced risk factors that contribute to coronary artery disease are emerging as powerful prognostic indicators to determine risk. One or a combination of these risk factors can cause blood to thicken, become sticky and clot. They also cause inflammation of blood vessels and buildup of plaque. These risk factors are:

LAB TESTS THAT SHOW RISK OF HEART DISEASE

• Advanced Lipid Panel – Cholesterol, Triglycerides, HDL (good cholesterol), LDL (bad cholesterol), Lipoprotein Subfractions, Apolipoprotein B; Lipoprotein (a), HDL and LDL Particle Size
• hsCRP – a marker of inflammation in the wall of the artery. The higher the number the greater the risk of heart disease.
• Insulin Level - The higher the number the greater the risk of heart disease. Ideal is 6-8
• Homocysteine - The higher the number the greater the risk of heart disease. Ideal is 6
• Myeloperoxidase - The higher the level the greater the risk of heart disease. Ideal less than 470
• Fibrinogen – High levels of Fibrinogen contribute to hardening of the arteries. Ideal is 300
• Testosterone Level - Testosterone is a muscle-building hormone, and there are many
• testosterone-receptor sites in the heart. Weakening of the heart muscle can sometimes be attributed to testosterone deficiency. Testosterone is not only responsible for maintaining heart muscle protein synthesis, but it is also a promoter of coronary artery dilation and helps to maintain healthy cholesterol levels.

Most doctors and even many cardiologists do not commonly check for all of these risk factors because they may not be aware of their importance. This is unfortunate because there are simple methods to reduce these risk factors.

C-REACTIVE PROTEIN (CRP)
CRP has been shown to be twice as effective as a standard cholesterol test in predicting heart attacks and strokes. CRP is a blood protein that is a marker of inflammation occurring in the body. When coronary blood vessels are damaged, the resulting inflammation causes the liver to begin producing this protein. A normal CRP level should be negative to very low, so any elevated reading may mean trouble in the coronary arteries. In a recent study of postmenopausal women, those with the highest levels of CRP were 4.4 times more likely to have a heart attack as compared to those with the lowest levels.

Inflammation is a major player in the development of coronary artery disease because it damages the endothelium (the inner lining) of the blood vessels. The body then tries to repair this damage by forming deposits of plaque in the damaged area, which can lead to blockages. Inflammation can be due to chronic gum disease, bacterial infections such as chlamydia or helicobacter pylori, and possibly even viruses like herpes simplex and others. CRP may be elevated years before heart disease sets in.

Aspirin is an anti-inflammatory and can lower CRP. However, it makes more sense to find out what may be causing the inflammation and to eliminate the source. Also, there are more natural methods that can be used to reduce inflammation instead of, or in addition to, aspirin (see lowering fibrinogen risk).

HOMOCYSTEINE
Homocysteine is an amino acid derived from protein metabolism. It is naturally found in the body. When levels are too high, it can cause irritation to the endothelium of the coronary blood vessels. Homocysteine often causes the initial lesions on arterial walls that enable LDL cholesterol and fibrinogen to accumulate and eventually obstruct blood flow. Homocysteine damages artery wall cell directly.

Even when cholesterol and triglyceride levels are not significantly elevated, homocysteine alone has been demonstrated to promote atherosclerosis (hardening of the arteries) and thrombosis (blood clots). Levels above 9 are a problem. An excess of homocysteine is like having a silent killer lurking in your bloodstream.

Recent research shows that women who have both elevated homocysteine and high blood pressure have 25 times the incidence of stroke or heart attack. Some simple nutritional supplementation can neutralize homocysteine.

FIBRINOGEN
Fibrinogen is an inflammatory component of blood coagulation, which if elevated can cause heart attack or stroke by several mechanisms, including increased platelet aggregation, hyper-coagulation, and excessive blood thickening. Studies reported in The New England Journal of Medicine show that those with elevated fibrinogen were twice as likely to die of a heart attack. An acceptable range for fibrinogen is less than 300 mg/dl; anything over 360 is undesirable. If your level is elevated, here is what you can do:

Lowering Fibrinogen Risk
Although blood levels of fibrinogen are influenced by genetics, the most important contributor is smoking. In fact, half of all cardiovascular risk can be attributed to smoking! If you smoke and have other risk factors for heart disease such as elevated fibrinogen, you are on the path to an early grave. Smoking cessation can dramatically reduce your risk of heart attack!

Other measures to lower clotting risk from elevated fibrinogen are low dose aspirin and other more natural alternatives that can be used to make your blood less likely to clot. Blood-thinning alternatives to aspirin include Omega-3 fatty acids (found in salmon or fish oil capsules), garlic, ginger, bromelain, gingko biloba, vitamin E, vitamin C and Curcumin Extract. Consult with your doctor if you have been advised to take aspirin or other prescription blood thinners such as Coumadin, before taking any of these natural alternatives.

Lp(a)
Another toxic blood component is Lp(a) or lipoprotein (a), a strong predictor of early heart disease. It was reported in a recent issue of the medical journal Circulation that those with high levels of Lp(a) are 70 percent more likely to have a heart attack then those with lower concentrations.

Lp(a) is a "sticky" small cholesterol particle that causes inflammation and clogging of blood vessels, and is mostly genetically determined. Modifying Lp(a) is not easy, but can be done. High dosages of nutrients like Coenzyme Q10, vitamin C, L-carnitine, and niacin or niacinamide can be useful.

INSULIN
Excess insulin causes diabetes, heart disease and premature aging. Insulin is a storage hormone produced by the body to lower blood sugar by sending it into the cells. Over time, excess blood sugar and insulin stresses the system and the cells become less responsive. This condition is known as insulin resistance.

Excess insulin promotes smooth-muscle growth in blood vessel walls, which contributes to the formation of plaques. Artery walls become thickened and stiff, causing blood pressure to rise. Insulin resistance may contribute to as much as 60 percent of heart disease we find in women and 25 percent in men.

Signs of insulin resistance How do you know if you are insulin resistant? Ideally, fasting levels of insulin should be below 10. However, other telltale signs of insulin resistance include weight gain, (especially around the abdomen), elevated triglyceride and low HDL levels.

Insulin levels can be lowered by medication, but diet changes are preferred along with exercise and weight loss. We may recommend a diet that consists of 40% low glycemic carbohydrates, 30% lean protein, and 30% healthy fats. Insulin resistance is a major problem and lowering insulin levels is a goal for improved health and anti-aging.

MYELOPEROXIDASE
Myeloperoxidase (MPO) is a inflammatory enzyme that may play a direct role in the pathogenesis of cardiovascular disease (CVD). It is involved in 1) lipid peroxidation, converting LDL to an atherogenic form and HDL to a dysfunctional form; 2) destabilization and rupture of atherosclerotic plaques; and 3) vasoconstriction and endothelial dysfunction. Thus, MPO has been studied as a biomarker of CVD.

Elevated plasma levels of MPO have been linked to increased risk for

1. Heart disease in low-risk populations;
2. Major adverse cardiovascular events in patients with angiographically confirmed heart disease MPO measurements can provide prognostic insight in both primary prevention and secondary prevention of heart disease.

Higher plasma MPO concentrations are associated with poorer outcomes than are lower concentrations.

OTHER DIAGNOSTIC TESTS OF VALUE TO PREDICT RISK
Ultra Sound of Carotid Arteries – This shows if there is any plaque in the artery wall. Plaque buildup can decrease blood flow or cause a stroke if the plaque breaks off and clogs an artery. If you find plaque in the carotid arteries it may be a good bet that there is some plaque buildup in the heart arteries as well.
​
Calcium Score Test – Ultrafast CAT Scan of heart arteries that shows calcium buildup. The higher the amount of calcium buildup in the artery wall the greater the risk for heart attack.

Stress Echocardiogram – Treadmill test that looks at functions (valves opening and closing and heart muscle movement) of heart after a stressful exercise period.

Thallium Stress Test – Treadmill test where they inject a radioactive substance to tell how much blood is getting into the blood vessels that feed the heart muscle.