Cardiovascular Disease Uncovered Beyond the Lipid Panel – Part Four

July 21, 2022

In the first article in the series ‘Beyond the Lipid Panel’, we discussed the differences between the Cardio IQ panel and the standard lipid panel. The importance of cholesterol particle size was explained. In the second and third articles, we discussed specific cardiac biomarkers tested via the Cardio IQ panel and how to treat those abnormalities.

In this last article of the series, we will complete the review of the Cardio IQ panel discussing the following:

Cardiovascular Markers:

Omega-3 Fatty Acids
Omega-6 Fatty Acids
Omega-6/Omega-3 Ratio
AA/EPA Ratio

Omega-3 Fatty Acids (EPA, DPA, DHA)

EPA, DHA and DPA are omega-3 fatty acids vital to every cell of the body playing critical roles in heart disease, decreasing inflammation, cancer, immune strength, brain health, pregnancy, visual and cognitive development and more! Omega-3s have been shown to reduce the risk of cardiovascular events and mortality by stabilizing cell structure, decreasing inflammation, reducing triglycerides, inhibiting clotting and preventing the heart from deadly arrhythmias.1,2

One of the most comprehensive reviews of omega-3 fatty acids involved 19 studies in 16 countries among 45,637 study participants. This paramount study showed Omega-3 fatty acids had beneficial effects on major cardiovascular risk factors such as heart rate, blood pressure, triglyceride levels and heart oxygen demand. 3 Higher omega-3 levels reduced coronary heart disease and fatal heart attacks. In conjunction, EPA, DHA and DPA were found to lower risk of fatal heart attacks by 11%. DPA alone was shown to decrease the risk of total coronary heart disease.

Our bodies are not capable of producing omega-3s so we have to rely on food as our source. The best source of Omega-3s is fatty fish. Mackeral is the best, followed by salmon, cod liver oil, herring, oysters, sardines and cavier. Most people take fish oil in supplement form. Fresh fish oil has no fishy taste of smell. Also, all 3 fatty acids should be included in the supplement.

Omega-6 Fatty Acids (arachidonic acid, linoleic acid) AA/EPA Ratio

Arachidonic acid and linoleic acid are omega-6 fatty acids. Omega-6s, like omega-3s, are also beneficial for brain, bone, metabolic and heart health. Problems arise when excess omega-6s are present, promoting inflammation and clotting in the body. Omega-6s dominate the standard American diet found in processed foods, meats and vegetable oils. Excess omega-6s from processed vegetable oils have been associated with cardiovascular disease.4

Processed vegetable oils, found in most salad dressings, promote inconsistent and elevated levels of linoleic acid (LA). Instead of a salad being good for you, the addition of a vegetable oil based salad dressing makes the salad “bad” for you. Elevated levels of LA stimulate fat cells to grow and stick around. More fat build-up in the body promotes inflammation and blockages in arteries leading to cardiovascular disease.5 Another issue with excess LA is the conversion to arachidonic acid.

Arachidonic acid (AA) can be obtained through food alone or created by the conversion of linoleic acid. The function of AA is inherently protective as it is part of a normal inflammatory response that helps restore and heal tissues. However, when there is excess AA, the inherent protective mechanisms go haywire as it then converts into molecules promoting inflammation, clotting, and pain syndromes.6 AA can go down three pathways which have been associated with multiple disease processes including cardiovascular disease and cancer.7

Assessing the AA/EPA ratio is also an important predictor of cardiovascular risk as EPA competes with AA to lower inflammation. A higher ratio is associated with increased risk of stroke, heart attack, coronary artery disease and acute coronary syndrome.10

Omega-6/Omega-3 and AA/EPA Ratio

The balance of omega-6 and omega-3 is critical to optimal health and the prevention of cardiovascular events. This ratio is not often talked about but is found as a cardiovascular marker on the Cardio-IQ.

The human diet has evolved from an omega-6/omega-3 ratio of nearly 1/1 during the Paleolithic period to about 20/1 today. The following image8 demonstrates this change in dietary fatty acid content with the advent of modern vegetable oils, grain fed livestock and the resultant increase in inflammation and disease.

Excess omega-6s and deficient omega-3s in the diet play a role in the development of inflammation and cardiovascular disease especially in the United States.

A lower omega-6/omega-3 ratio has been demonstrated to reduce the risk of cardiovascular disease.9

Remember: A diet high in omega-3 and little omega-6 will reduce inflammation; a diet high in omega-6 and little omega-3 will increase inflammation.

How to balance Omega-6/Omega-3

Making dietary changes is critical for proper balance:

Eliminate processed foods
Swap out omega-6 oils (soy, corn, sunflower, safflower, canola)
Increase consumption of pasture eggs, wild-caught, low mercury fish, grass-fed meats and butter

Supplementing with a high-quality omega-3 fish oil can be critical to maintaining omega-6/omega-3 balance. A meta-analysis involving 127,477 participants from 13 randomized controlled trials demonstrated the positive effect of omega-3 fish oil supplementation.11 In a linear pattern, omega-3 supplementation lowered the risk for heart attack, total coronary heart disease, total coronary heart disease deaths, total cardiovascular disease and cardiovascular disease deaths.

Other lifestyle changes such as weight loss, smoking cessation and aerobic exercise can aid in normalizing and balancing omega levels.

What if I’m vegan?

Vegans have a harder time maintaining proper omega-3 levels. In studies, the majority of vegans have an omega-6/omega-3 ratio that is unbalanced and consume little to no amounts of EPA and DHA unless using supplementation.12 The same dietary modification strategies of eliminating processed foods and linoleic acid promoting omega-6 oils applies to vegans also.

Alpha-linolenic acid (ALA) is a type of omega-3 fatty acid found in plants and is high in the vegan diet. Many people believe they are getting enough omega-3s from the diet by consuming plant-based foods high in omega-3s such as flaxseeds and chia seeds, but then run into cardiovascular problems later in life.

While flaxs and chia do contain omega-3s, they do not contain EPA and DHA like fish oil. Rather, they contain ALA which requires the body to convert it into EPA and DHA.

The problem is the body has an inefficient conversion capacity to turn ALA into the necessary EPA and DHA omega-3s. Research indicates the conversion of ALA to EPA is less than 5% and less than 0.5% to DHA.13 The optimal levels of DHA, therefore, cannot be met by ALA supplementation nor plant sources such as flax and chia in the diet alone.

The best option for vegans unwilling to consume fish oil is to obtain direct plant-based DHA and EPA by supplementing with microalgae or algal oil. It is important to note that algae omega supplementation can take as long as four months to raise DHA levels into optimal territory.14

Cardio IQ Uncovered

This completes the review of the Cardio IQ panel and all of its biomarkers. The Cardio IQ test may save your life by uncovering hidden risks and underlying inflammation allowing you the opportunity to prevent major adverse events and reverse processes that may have already begun.

While Cardio IQ offers major insight into your cardiovascular health, cardiovascular evaluation can be taken another step further. A quick and informative test called a Coronary Calcium Scan is essentially a snapshot of your heart that visualizes calcifications in your blood vessels. The next blog post will review this test and how it may provide even greater insight into your cardiovascular health when used in conjunction with the Cardio IQ panel.

Have an awesome day! Dr. D

Posted in Cardiovascular Disease