Understanding Your Cardiovascular Risk Beyond Cholesterol

Did you know that 50% of people who have a heart attack or stroke have normal cholesterol levels?

That means that using cholesterol to assess our cardiovascular risk is useless. Even if you have normal cholesterol levels, you are not in the clear. You are still at risk for a heart attack or stroke.

If you know your physiology, then this is not really news to you. Because cholesterol by itself is not a problem. Cholesterol is not an inherently bad substance. It is only in the presence of oxidation, inflammation, and damage to an artery that cholesterol will form a plaque, leading to a heart attack or stroke. 

So if we think about this from the perspective of physiology, to assess our cardiovascular risk, we need to know if we are forming plaques. We need to know if there is oxidative damage and inflammation in our arteries that would put us at risk of forming plaques.

The good news is that we can do this. All you need to do is get a simple blood test. You may be asking yourself, if it is that simple, then why isn't everyone doing this? Why are we still relying on cholesterol levels to assess cardiovascular risk?  To be honest, I don't really have an answer for you. All I know is that it takes about 17 years for research to trickle down and change the standards of care, the way that doctors operate. That is why I choose to use my brain instead of standards of care on many occasions. 

So find yourself a similarly minded doctor and ask them to order these tests:

Oxidized LDL

When LDL particles ("bad" cholesterol) become oxidized, this is the first step in forming a plaque. Studies have found that people with high levels of oxidized LDL are 3.5X more likely to develop metabolic syndrome in the next 5 years. Studies have also found that your level of oxidized LDL is directly related to the presence of coronary artery disease. 

hsCRP

This is a very sensitive measurement of CRP, which is an inflammatory molecule. If your hsCRP is elevated, you may be 4X more likely to develop coronary artery disease. Even if you're healthy, an elevated hsCRP is associated with an increased risk of heart attack, stroke, or death due to a cardiovascular event. 

F2-Isoprostanes

This compound measures oxidative stress in the body. The body makes this compound in response to free radicals. It acts to promote inflammation, constriction of blood vessels, and thrombus (clot) formation. Research demonstrates increased levels of this compound in people who have coronary artery disease.

Lp-PLA2 Activity

This is an enzyme that is involved in the formation of plaques in artery walls. Research has found that people with high levels of this enzyme are twice as likely to develop coronary artery disease after 7 years no matter their cholesterol levels.

Myeloperoxidase

This is an enzyme produced by white blood cells during the formation of a plaque in the artery wall. It indicates inflammation and damage to the arteries as well as plaque formation. Studies have found that elevations in this enzyme are very predictive of your heart disease risk, even if you are thought to be low-risk. 

With these labs, we can accurately asses what is happening in your arteries. Is there oxidation? Is there inflammation? Are plaques forming? And if plaques are forming, then we know that your risk of a heart attack or stroke is much, much higher. But no need to worry just yet! If you work with an ND or functional medicine doctor, we have lots of tools that can prevent and clear plaque formations.

References

  1. Holvoet P et al. Association between circulating oxidized low-density lipoprotein and incidence of the metabolic syndrome. JAMA. 2008; 299: 2287-2293.
  2. Holvoet P et al. Circulating oxidized LDL is a useful marker for identifying patients with coronary artery disease. Arterioscler Thromb Vasc Biol. 2001; 21: 844-848.
  3. Morrow JD et al. A series of prostaglandin F2-like compounds are produced in vivo in humans by a non-cyclooxygenase, free radical-catalyzed mechanism. Proc Natl Acad Sci USA. 1990; 87:9383-9387
  4. Ridker PM et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997; 336: 973-979.
  5. Ridker PM et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002; 347: 1557-1565.
  6. Rost NS et al. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: The Framingham study. Stroke. 2001; 32: 2575-2579.
  7. Ndrepepa G et al. N-terminal probrain natriuretic peptide and C-reactive protein in stable coronary heart disease. Am J Med. 2006; 119: 355.e1-355.e8.
  8. Minuz P et al. The F2-isoprostane 8-epiprostaglandin F2alpha increases platelet adhesion and reduces the antiadhesive and antiaggregatory effects of NO. Arterioscler Thromb Vasc Biol. 1998; 18: 1248-1256.
  9. Schwedhelm E et al. Urinary 8-iso-prostaglandin F2alpha as a risk marker in patients with coronary heart disease: A matched case-control study. Circulation. 2004; 109: 843-848. 
  10. Ferguson JF et al. Translational studies of lipoprotein-associated phospholipase A(2) in inflammation and atherosclerosis. J Am Coll Cardio. 2012; 59: 764-772.
  11. Oei HS et al. Lipoprotein-associated phospholipase A2 activity is associated with risk of coronary heart disease and ischemic stroke: The Rotterdam Study. Circulation. 2005; 111: 570-575.
  12. Tavora F et al. Monocytes and neutrophils expressing myeloperoxidase occur in fibrous caps and thrombi in unstable coronary plaques. BMC Cardiovascular Disord. 2009; 9: 27-33.
  13. Hazen SL and Heinecke JW. 3-chlorotyrosine, a specific marker of myeloperoxidase-catalyzed oxidation, is markedly elevated in low density lipoprotein isolated from human atherosclerotic intima. J Clin Invest. 1997; 99: 2075-2081.
  14. Fu X et al. Hypochlorous acid oxygenates the cysteine switch domain of pro-matrilysin (MMP-7). A mechanism for matrix metalloproteinase activation and atherosclerotic plaque rupture by myeloperoxidase. J Biol Chem. 2001; 276: 41279-41287.
  15. Meuwese MC et al. Serum myeloperoxidase levels are associated with the future risk of coronary artery disease in apparently healthy individuals: The EPIC-Norfolk Prospective Population Study. J Am Coll Cardiol. 2007; 50: 159-165. 5. Karakas M et al. Myeloperoxidase is associated with incident corona

Hi!

I'm Dr. Carly and my mission is to create a health revolution. I believe that another prescription is not the answer. I believe in using natural therapies that go beyond the symptoms. And I believe that doctors should spend way more than 7 minutes with a patient.