The New Beat on Heart Disease

© 2014 Dr. Sharon Norling

Preventing heart disease requires much more than simply screening for high cholesterol. Fifty percent of all people who have a heart attack have normal cholesterol. What’s more, an estimated 80 percent of patients who develop coronary artery disease have cholesterol levels comparable to those in healthy individuals, according to the Framingham Study published in the American Journal of Cardiology.

Even among patients who have high cholesterol, a significant number do not respond to routine lipid reduction strategies, or they experience a cardiac event despite drops in cholesterol.

“About three-quarters of the population older than 30 years has some lesion related to atherosclerosis in the arterial tree. This lesion gets worse almost every day in all these people and will eventually result in closure of a vital artery in half of them, causing their death,” said William P. Castelli, MD, director Framingham Heart Study.

Coronary artery disease (CAD), one type of heart disease, is the leading cause of heart attacks. The most common cause of CAD is atherosclerosis, a condition that occurs when plaque builds up in the arteries that supply blood to the heart.

This evidence underscores the urgency of assessing patients with more advanced cardiovascular risk biomarkers than those included in standard lipid panels. Cholesterol is carried throughout the body in little balls called lipoproteins. It is the lipoproteins, not the cholesterol in them that leads to clogged arteries. Standard cholesterol testing provides only part of the picture, leaving many people with “normal” cholesterol numbers unaware they are still at risk for a heart attack.

Research has revealed different particle sizes of LDL (“bad cholesterol”) and some are much more dangerous than others. There are also five subtypes of HDL (“good cholesterol”), and some are more protective than others. Having a detailed lipoprotein particle profile specialty test gives you and your doctor the information needed to make effective treatment decisions to reduce your risk of heart disease and even a heart attack. This test could save your life.

Facts about heart disease

See below for some key facts about heart disease that will help you understand the importance of gaining knowledge about this subject.

Heart disease is the term for all diseases and conditions affecting the heart.

Cardiovascular disease (CVD), which includes heart disease and stroke, claims more lives each year than the four leading causes of death combined: cancer, chronic respiratory diseases, accidents and diabetes.

Detection Tests for Heart Disease

  • Specialty tests for CVD include lipoprotein particle profiles and other biomarkers.
  • Total cholesterol.
  • LDL (“bad cholesterol”), Dense LDL III, Dense LDL IV, LDL Phenotype/Density.
  • HDL (“good cholesterol”), HDL 2b is the most protective HDL particle.
  • VLDL (“very low LDL”).
  • RLP (Remnant Lipoprotein) is very atherogenic and increases risk of clots.
  • Lp(a) is influenced by heredity and is linked to earlier and more severe CVD.
  • Homocysteine is implicated in heart attacks, diabetes, dementia, depression, degenerative diseases and linked to nutrient deficiency, inflammation and genes.
  • Hs C-Reactive Protein is a powerful predictor of first heart attack and a marker of inflammation.
  • Insulin is an indicator of elevated blood sugar and increased risk for CVD.
  • Lp-PLA2 doubles the risk of CVD and vascular inflammation.

Lp-PLA2 is independent of traditional cardiovascular (CV) risk factors and is used to identify the “hidden risk” for heart attack and stroke. Increased levels of Lp-PLA2 have been associated with increased CV risk in large clinical trials. This enzyme, which is associated with inflammation in your arteries, is produced by the plaque itself, making it a more specific test than other inflammatory markers that measure systemic inflammation. High Lp-PLA2 in combination with high hs C Reactive Protein (CRP) increases the risk of CV fourfold!

A consensus panel recommendation for testing Lp-PLA 2 was recently published in the American Journal of Cardiology, 2008, June 16. This test should be considered not only in patients at risk for cardiovascular disease but also patients with no risk factors, such as a family history of CVD or high blood pressure, even if their overall lipid panel looks normal. The Lp-PLA2 is a simple blood test which can help physicians identify patients at high risk for strokes or coronary artery disease. Sixty-eight percent of all heart attacks and strokes occur from clots, not from narrowing of the arteries. In a recent study, patients with elevated Lp-PLA2 and high blood pressure had more than 6 times the increased risk for strokes. This could be your wake-up call.

Prevention of heart disease really means “preventing” disease and should not be confused with early detection. In addition to blood tests, other tests are available for early detection of CVD. These tests often diagnose “after the fact,” documenting the extent of the disease or functional impairment.

An ECG (electrocardiogram) can detect current and past heart attacks, blockages, a thick heart wall, certain electrolyte imbalances and even changes brought on by certain medications. A Holter monitor records signals similar to an ECG, but over a 24-hour period. A treadmill is an exercise test used to evaluate your heart function along with your pulse and blood pressure responses to activity. A thallium stress test shows the working of the heart muscle and is especially effective in noting changes in women’s hearts.

An echocardiogram (echo) can diagnose valve disorders, cardiomyopathy, congestive heart failure, an enlarged heart and a heart attack. A duplex Doppler ultrasound diagnoses the presence of blood clots or blood flow problems in arteries or veins. An electron beam computed tomography (EBCT) can identify and measure calcium buildup in and around the coronary arteries. Calcium build-ups can indicate an increased risk of heart disease. An angiogram shows blockage caused by heart disease or other problems.

Preventing Heart Disease

Studies show that not everyone benefits from low-dose aspirin, and some people may develop aspirin resistance. Patients with a poor response to aspirin therapy have a higher incidence of a second heart attack, stroke or death compared to patients with a good response. The aspirin response test will help you to determine if you are responsive to aspirin therapy and at what dose.

Research continues to document that good nutrition and appropriate supplements can improve health and decrease the risk of CVD, chronic illnesses and cancer. Taking vitamins, minerals and other supplements orally may result in only about 35 to 40 percent absorption. For your CVD heath and overall health, consider intravenous (IV) nutritional therapies. They are given in higher doses, work faster and are 100 percent absorbed.

A low-calorie diet associated with weight loss in obese women resulted in the significant reduction of Lp-PLA2. Moderate alcohol consumption did not lower Lp-PLA2. A high Lp(a) indicates a heredity factor and does not respond to diet, exercise or statins (lipid-lowering drugs that reduce serum cholesterol levels by inhibiting a key enzyme involved in the biosynthesis of cholesterol). However, Lp(a) can be lowered with high doses of non-flushing niacin.

Weekly use of folic acid plus vitamin B12 may be as effective as daily supplementation in improving folate and lowering homocysteine concentrations in healthy women of reproductive age. Homocysteine is an amino acid produced during metabolism (usually metabolism of meat) that appears to be an indicator of increased risk of CVD when occurring at high levels in the blood. Homocysteine injures the cells lining the arteries and stimulates the growth of smooth muscle cells. It can disrupt normal blood-clotting mechanisms, increasing the risk of clots that can bring on a heart attack or stroke. Elevated levels also appear to increase the risk of Alzheimer’s disease.

Risk Factors for CVD

Knowing the risk factors and understanding the disease can often help you make decisions regarding healthful changes in your lifestyle. Significant risk factors for cardiovascular disease are:

  • Cigarette smoking
  • Overweight
  • Diabetes
  • High blood pressure (BP >140/90 or on anti-hypertensive medications)
  • Low HDL cholesterol (<40 mg/dl)
  • Family history of premature CVD (in first-degree male relative <55 years; or in first degree female relative <65 years)
  • Age (men >44years; women >54 years)

A recent article published in 2008 in Arthritis Rheumatism noted, “Overall, there was a 50 percent increased risk of CVD death in patients with rheumatoid arthritis (RA). When looking at causes of specific deaths, patients with RA had a 59 percent increased risk of dying from ischemic heart disease (heart attack) compared with the general population and a 52 percent increased risk of death due to strokes.”

The list of risks is long and varied but laboratory testing provides us with options to better define our risk. A simple comprehensive blood test determining lipoprotein particles and other biomarkers is a specialty test covered by most insurance. This important information can help you prevent CVD and may save your life or that of a loved one.

In our efforts to provide the best possible care both for patients with established CVD and those interested in CVD prevention, it is critical to recognize the positive impact of a healthy lifestyle. A combination of achieving ideal body weight, eating good, quality natural food and less of it, exercising two to three hours (at least) each week, having no addictions and regularly enjoying happiness — the best medicine in the world — will reduce your risk for all diseases by 70 percent, with no side effects. Making good choices and seeking support to help guide you is a great investment.

Key Facts about Heart Disease

  • Approximately 16 million Americans have heart disease.
  • Heart disease is the #1 cause of death for both men and women.
  • 50% of men and 64% of women who experience sudden death had no previous symptoms.
  • 68% of all heart attacks and strokes occur from clots, not from the narrowing of the arteries.
  • One-third of all strokes affect individuals between 45 and 65 years of age.
  • Cholesterol is not a reliable predictor of strokes.

Written By: Dr. Sharon Norling, MBA