I hope everyone had a lovely Valentine’s day. In honor of heart month, I wanted to empower you with some tools to understand cardiovascular disease and how to assess your risk. Before you think that you’re too young or too healthy to continue reading, signs of heart disease aren’t always obvious. The statistics are are alarming. Cardiovascular disease (CVD) is the leading cause of death in the US (1), with 1 out of every 3 deaths in the US being caused by CVD. So odds are you or someone you know will be affected by it in some way.
The good news is we aren’t all doomed to get CVD, it’s highly preventable. With the right lifestyle choices and proper diagnostic testing, in most cases, you can reduce your risk. Cardiovascular disease isn’t something that happens to us or is out of our control, it’s largely caused by the choices that me make every day. It’s estimated that around 90% of heart disease is caused by diet and lifestyle factors that can be avoided (2). It’s never too late to start taking care of you. Love your heart. It will love you back.
Before we dive in, let’s cover the basics. Cardiovascular disease, also known as heart disease, is a group of diseases that affect the cardiovascular system including the heart and blood vessels (arteries and veins). CVD includes high blood pressure, heart attacks (a blood clot in the heart), strokes (a blood clot in the brain) and structural problems.
The main issue I wanted to discuss here is that high cholesterol has been long demonized as one of the major risk factors of cardiovascular disease. However, we repeatedly see that cholesterol isn’t enough to assess risk. A study conducted by UCLA found that 75% of people hospitalized for a heart attack had cholesterol levels that would indicate that they were not at risk for a heart attack (3). Wow. This certainly begs the question: what’s actually happening?
You’ve probably had your LDL (bad) and HDL (good) cholesterol tested before, it’s part of routine lab testing. If your levels were normal, you were sent on your way. If your LDL was elevated, a statin may have been recommended. The problem is assessing risk for CVD is much more complicated than whether or not you have high LDL cholesterol. As the study mentioned above shows, you can be at risk for heart disease even if you have normal cholesterol. The other issue I have with this conventional approach is that high cholesterol isn’t a disease, but rather a symptom that there is a bigger underlying issue that needs to be investigated and treated. I put together a list of additional lab testing to request from your naturopathic or functional medicine practitioners.
Lab tests to assess risk for heart disease:
LDL particle numbers: What is traditionally tested on a lipid panel is LDL-C (LDL cholesterol). The LDL particle test is different and is called LDL-P. LDL molecules don’t float around in the blood stream individually, but rather group themselves into LDL particles. Let me explain. Think of your blood vessels as roads. The LDL-P are the cars on the road and LDL are the passengers in the car. Traditional methods of cholesterol testing just count how many passengers there are in your car, not how many cars are on the road. Recent studies have found that LDL-P (cars on the road) is more indicative of heart disease risk than LDL-C (passengers in the car). The more cars there are on the road the more likely they are to cash into the lining of the blood vessels and create plaque and hardening.
Again, if your LDL-P is high this could be a symptom of a bigger issue. There are a number of underlying causes that could be contributing which can often be reversed without medications.
Diet and lifestyle
Poor gut health: Gut dysbiosis (imbalance in the probiotics vs. pathogenic bacteria, yeast overgrowth, parasitic infections, small intestinal bacteria overgrowth (SIBO) and intestinal permeability (also known as leaky gut)
Hypothyroid and subclinical hypothyroidism (4)
Environmental toxins and heavy metals
Lastly genetics. However, even if you have a genetic predisposition to high cholesterol, there could also be one or more of the above factors contributing as well.
Lp(a): this is a lipoprotein (a protein attached to a lipid molecule for transport) that is a genetic risk factor associated with cardiovascular disease, even more so than LDL-P. Lp(a) elevation has historically been thought to be mostly influenced by genetics. However, I’ve seen these levels decrease with diet, lifestyle and natural interventions.
ApoB: this is another type of lipoprotein that is associated with CVD and can be measured.
Inflammatory markers: Inflammation in the blood vessels drives more cholesterol into the blood vessel lining. The tests for inflammation include CRP and homocysteine.
Insulin resistance (high blood sugar) and diabetes: High blood sugar is extremely inflammatory to our blood vessels. Tests include Hemoglobin A1c (HcA1c), fasting glucose, and fasting insulin.
Coronary Calcium Scan: This test looks to see how much calcium has built up in the walls of the arteries of the heart (coronary arteries). It’s used to check for CVD and measure severity.
Carotid Intima-Media Thickness (CIMT): This test uses ultra sound to determine the thickness of the carotid arteries (arteries of the neck). The thicker the arteries the more plaque that has built up.
Other risk factors for cardiovascular disease:
Stay tuned for more heart healthy facts...