Cardiovascular Disease Uncovered Beyond the Lipid Panel – Part Two

June 29, 2022

Cardiovascular Disease Uncovered Beyond the Lipid Panel (Part 2)

It is estimated 80% of premature heart attacks and strokes are preventable.1

At RMC, an advanced blood test panel called Cardio IQ is ordered on patients to help identify early cardiovascular risks to prevent high blood pressure, heart attacks, and strokes.

Last week’s blog post, “Cardiovascular Disease Uncovered – Beyond the Lipid Panel (Part One),” explained the difference between cholesterol results on the standard lipid panel and the Cardio IQ panel. As a refresher, the key takeaways were:

“Normal cholesterol” on a standard lipid panel does not fully assess cardiovascular risk as many people who have suffered heart attacks had normal cholesterol levels.
Cholesterol particle size is another risk of great importance when assessing cardiovascular risk.
These risk factors are broken down on Cardio IQ, but not on the standard lipid panel.

While the breakdown of cholesterol particle size is important in assessing cardiovascular risk, there are many other risk factors to be considered. These additional cardiac risk markers included in the Cardio IQ panel are discussed in the next two blogs of this series.

Today’s blog covers the Cardiovascular Risk Factors and treatment of:

Apolipoprotein A1
Lipoprotein(a)
High-Sensitivity C-Reactive Protein (HS-CRP)
Fibrinogen

Apolipoprotein A1

Cholesterol requires a protein attached to it for transport. These transport proteins are called apoproteins. Apolipoprotein A1 (Apo A-1) is a major component of HDL, accounting for 60-70% of its protein content.

Apo A-1 helps prevent cardiovascular disease by driving cholesterol from the tissues into the liver for processing.

Apo A-1 has been shown to be an independent risk factor for coronary artery disease and is a more accurate predictor of coronary artery disease than HDL and LDL levels. It has cardioprotective, anti-inflammatory, and anti-tumorigenic effects.2 Low levels indicate an increased risk of cardiovascular disease. High levels are protective.

Treatment: Optimizing estrogen levels, increasing physical activity, smoking cessation, and alcohol reduction can increase Apo A-1 levels. Omega 3s have been shown to increase the expression of Apo A-1.

Lipoprotein(a)

As the name suggests, lipoprotein is made up of Lipid (fat) and protein. Lp(a) is essentially LDL cholesterol linked to apolipoprotein(a). It is similar in structure to plasminogen which is essential in dissolving clots. As Lp(a) competes with plasminogen, it can inhibit plasminogen’s activity and in turn promote clotting in the body.3

This means Lp(a) has both the ability to cause plaque build-up while promoting clotting at the same time.

Elevated Lp(a) has definitely been shown to play a causal role in premature cardiovascular disease.4

Genetically, 80-90% of the Lp(a) you express is inherited. Other factors such as inflammation can cause Lp(a) levels to rise further. High Lp(a) levels have been associated with an increased risk of heart attack, stroke, all-cause mortality, heart failure, and heart valve disorders.5

It has been shown to predict cardiovascular risk even among patients with target LDL levels after statin therapy.

Everyone produces Lp(a) but the problem comes when it is produced in excess.

“About 20% of people have ‘high’ Lipoprotein (a) levels, making high Lp(a) the most common genetic cholesterol abnormality leading to an increased risk of early vascular disease.”6

Treatment: Omega 3 fatty acids and niacin have been shown to reduce Lp(a) levels. Statins may negatively affect some individuals and cause an increase in Lp(a) levels.

High-Sensitivity C-Reactive Protein (HS-CRP)

Whenever your body experiences systemic inflammation, the liver produces C-reactive proteins. Therefore, HS-CRP is used as a marker of inflammation. Your body may have an elevated CRP in response to trauma, infection, burns, cancer, autoimmune disease, or any insult to the body. At one point it was used to diagnose pneumonia in the ER.

The high sensitivity test for CRP is more accurate than other CRP tests as it can detect and pick up slight increases in CRP levels. This makes it more accurate when determining cardiovascular risk.

Most patients with heart attacks had elevated HS-CRP levels. Continued elevation of HS-CRP after a heart attack increased the risk of another cardiovascular event.7

Treatment: Treat infection, Omega 3s, weight loss, cholesterol-lowering fibrates, statins, and niacin have been shown to reduce HS-CRP levels.

Fibrinogen

Fibrinogen is a protein produced in the liver that helps your blood to clot. It is another inflammatory marker and can increase in acute or chronic inflammatory states and infections. Low levels may lead to difficulty clotting blood and bleeding, while excess levels can lead to too increased clotting and thick blood. When the blood is thick, it doesn’t flow normally and increases cardiovascular risk and stroke.

Fibrinogen has been identified as a major cardiovascular risk factor and levels have been found to be higher among those with cardiovascular disease compared to those without.
It is a strong predictor of new or recurrent cardiovascular heart disease and mortality.8

Treatment: Treat infection, increasing physical activity, weight loss, smoking cessation, niacin, omega-3, and fibrates have been shown to decrease fibrinogen levels.

Cardio IQ cardiovascular risk biomarkers

The Cardio IQ panel offers a comprehensive review of cardiovascular risk beyond evaluating the lipid panel. Addressing inflammation is key to defining and treating cardiovascular risk which is why this panel includes extensive direct and indirect markers of inflammation. With this information, specific abnormalities can be addressed, and cardiovascular risk can be decreased.

The next blog post will continue the review of biomarkers on the Cardio IQ panel.

Have an awesome day! Dr D

Posted in Cardiovascular Disease