Like creeping rust, silent inflammation corrodes and erodes the linings of blood vessels that feed vital oxygen and nutrition to your heart, brain, organs and your extremities. And even though such inflammation is the primary cause of cardiovascular disease, many doctors simply do not order an effective-enough range of heart tests that can indicate present abnormalities and future trouble.
These doctors are still fixated on cholesterol as the monster of cardiovascular disease. It’s not, as I have argued in The Great Cholesterol Myth. A standard cholesterol blood test can provide clues, but there’s hundreds of other, more important risk factors to identify, and doing so requires going beyond the standard in order to avoid heart attacks and strokes that seemingly come out of the blue.
Following is a list of the most important blood tests beyond the standard heart disease tests. If you have a family history of cardiovascular problems at a young age, you need periodic testing starting at 30. Otherwise, start getting checked out at 50. If you develop cardiovascular symptoms, see a doctor at once, no matter what your age.
I’ve also listed several of the key imaging tests that doctors order when they are suspicious of heart disease or when a patient complains of symptoms.
Essential Heart Tests: Bloodwork
- A standard cholesterol blood test of total levels of cholesterol, LDL, and HDL is basically meaningless for identifying risk and best treatment options. You need to ask your doctor to order one of the new generation of advanced blood lipid tests, like the Lipoprotein Particle Test (LPP) or the NMR LipoProfile Test. These tests neatly fractionate cholesterol elements into percentages based on particle size (i.e. are they dense and potentially dangerous, or large and less harmless?) so your doctor can more accurately determine whether there is reason for concern or not. These tests also cover another risk factor: triglycerides (a type of blood fat). Ideally, you want a triglyceride level under 100 mg/dL.
- Lipoprotein(a), or Lp(a), is an inflammatory, dangerous cholesterol particle when elevated, and a heart disease risk factor. Hydrogenated oils and trans fats (and potentially sugar) raise Lp(a). If you have a family history of early heart attacks or elevated Lp(a), you need to monitor this factor periodically. If you have a known Lp(a) elevation, you must avoid trans fats at all costs because trans fats will raise it and Lp(a) is the most dangerous risk factor. Normal ranges vary in different laboratories.
- Glycohemoglobin (HbA1c) – this test measures the amount of blood sugar (glucose) attached to hemoglobin, the red blood cell pigment that carries oxygen. As an effective indicator of the average glucose level over several months, this test is a primary tool in monitoring and managing diabetes. A normal level is below 5.7 percent; pre-diabetes below 6.4; and diabetes 6.5 and above. Routine blood glucose tests are useful for measuring glucose control on a day-to-day basis.
- C-reactive protein is a potent indicator, not just of inflammation, but also of high blood sugar, antioxidant deficiency, thick blood, and overweight status, all important issues that contribute to arterial disease. An optimal blood level is under 0.8 mg/dL.
- Homocysteine is an amino acid that is produced in your body by the normal breakdown of protein. However, if you’re deficient in the B vitamins folic acid, B-6, and B-12, which are needed for this breakdown, you can have a high homocysteine level. High homocysteine is dangerous because it can trigger arterial plaque and blood clot formation. Optimal level: less than 9 µmol/L.
- Fibrinogen, a coagulation-regulating protein, is intimately involved in blood clotting and blood thickness (viscosity). Having too much fibrinogen can speed up the clotting process and make you more vulnerable to a cardiovascular event. Smoking raises fibrinogen dramatically; genetics, oral contraceptives, insulin resistance, and postmenopausal status are also factors that can elevate your fibrinogen level. Optimal level: 180 to 350 mg/dl.
- Ferritin is a protein that acts as an iron carrier in the blood. Diagnostically, it serves as an indicator of iron stored in the body. Your body needs some ferritin to make hemoglobin, the red blood cell pigment that carries oxygen. And while too little could be an indicator of anemia, too much ferritin can promote inflammation, oxidation of cholesterol, and plaque. Optimal level: under 80 mg/L (women) and 90 mg/L (men).
Imaging and Other Heart Tests
- The electrocardiogram (EKG) is a routine heart test, usually performed at the first visit to a cardiologist. The EKG shows the electrical activity of the heart and provides vital information about cardiac rhythm and rate, coronary blood flow, and pump action.
- The echocardiogram is an ultrasound exam that doctors employ to check for blood flow patterns and abnormalities in the heart muscle, and the performance of the cardiac valves.
- For individuals who are symptomatic, a cardiologist will order a routine or a nuclear stress test. This procedure combines the treadmill with images recorded by a computerized camera to pinpoint arterial blood flow restriction to parts of the heart.
The heart tests I have listed here can make a big difference in whether you need treatment or not, and what kind. You can find more information about heart function tests, blood inflammation tests and other tests at Drsinatra.com.
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