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“Empoweringpatientsinthepursuitofoptimalhealthbyprovidingcompassionatecardiovascular careaddressingtheCauses,Prevention,Treatment,andReversaloftheDisease.” CARDIOVASCULARHEALTHTESTS LipidProfile Cholesterol Totalserumcholesterolanalysisisusefulinthediagnosisof hyperlipoproteinemia,atherosclerosis,hepaticandthyroiddiseases, aswellastheriskofdevelopingcardiovasculardisease. LDLDirect LDListhe“bad”cholesterol.Evenwithinthenormalrangeoftotal cholesterolconcentrations,anincreaseinLDLcholesterolcan produceanassociatedincreasedriskforcardiovasculardisease.LDL cholesterolbindstoreceptorsitesonmacrophagesinbloodvessel wallsincitingseveralchangestothebloodwall,whichenhance atheroscleroticplaquedevelopment. HDLDirect HDL(the“healthy”or“good”cholesterol)isinverselyrelatedtothe riskforcardiovasculardisease.Itincreasesfollowingregular exercise,moderatealcoholconsumptionandwithoralestrogen therapy.Decreasedlevelsareassociatedwithobesity,stress, cigarettesmokinganddiabetesmellitus. Triglycerides Triglyceridesarefatsfromthefoodweeatthatarecarriedinthe blood.Mostofthefatsweeat,includingbutter,margarinesandoils, areintriglycerideform.Excesscalories,alcoholorsugarinthebody turnintotriglyceridesandarestoredinfatcellsthroughoutthe body.Thistestwillmeasuretheamountoftriglyceridesinthe blood. Apolipoproteins ApolipoproteinB ApoBcarriesthe“bad”cholesterol,solowerlevelsarebest.The majorproteinfoundinthehighrisklipoproteinparticlesLDL,Lp(a) andVLDL.TheApoBisareflectionofthenumberoflipoprotein particlescarryingbadcholesterolintheblood.HighApoBlevels showanincreasedCVDrisk.ApoBismorereliablethanLDL-Casa CVDriskfactor. ApolipoproteinA-1 ApoA-1representsthe“good”cholesterol,sohigherlevelsarebest. ApolipoproteinA-1(ApoA-1)hasbeenreportedtobeabetter predictorthanHDLcholesterolandtriglyceridesforcoronaryartery disease.LowlevelsofApoA-1inserumareassociatedwith increasedriskofcoronaryarterydisease.MeasurementofApoA-1 maybeofvalueinidentifyingpatientswithatherosclerosis. Inflammation LpPLA2 Thisenzymeplaysaroleintheinflammationofbloodvessels.A build-upofunstablefattyplaquedepositsinthearteriescauses inflammationandleadstoblockagesinthebloodvesselsandmay eventuallycauseaheartattack,braindamage,orstroke.LpPLA2is anindependentriskmarkerforcardiovasculardiseaseandother heartdiseases. Homocysteine Homocysteineisorderedaspartofascreenforheartattackor stroke.Elevatedlevelsdamagethebloodvessels.Highlevelscanbe causedgenetics,nutritionaldeficiencyoffolateandBvitamins, certainmedicationsorkidneydisease. hs-CRP C-reactiveprotein(CRP)isaproteinthatthelivermakeswhen thereisinflammationinthebody.It’salsocalledamarkerof inflammation,andcanbemeasuredwithanhs-CRP(high-sensitivity C-reactiveprotein)test.Inflammationisawayforthebodyto protectitselffrominjuriesorinfections,andinflammationcanbe causedbysmoking,highbloodpressure,andhighbloodsugar. Elevatedlevelsmaybeevidenceofinflammationlinkedtoheart disease. OxidizedLDL OxidizedLDLisLDLcholesterol(the“bad”cholesterol)thathas beenmodifiedbyoxidation.OxidizedLDLtriggersinflammation leadingtotheformationofplaqueinthearteries,alsoknownas atherosclerosis.OxidizedLDLmayalsoplayaroleinincreasingthe amountoftriglyceridesthebodyproduces,aswellasincreasingthe amountoffatdepositedbythebody.Inturn,fattissuecanenhance theoxidationofLDL,creatingaviciouscycle. UricAcid Thesubstanceproducedbybreakdownofprotein.Highlevelscan leadtogout,atypeofinflammationandarthritisoftenatthebaseof thelargetoe.Elevateduricacidlevelsinthebloodstreamhavealso beenassociatedwithincreasedCVDrisk. MyocardialStress NT-proBNP NT-proBNPisprimarilysecretedfromthecardiacventricular myocytesinresponsetocardiacstress.NT-proBNPisauseful diagnosticandprognostictoolaselevatedlevelsmayindicatethe presenceofanunderlyingcardiacdisorder. LipoproteinMarkers Lp(a) Lp(a)isresistanttotreatmentanditisimportanttoaggressively treatallassociatedatherogeniclipopoproteinabnormalities. REFERENCES MurphySL,XuJQ,KochanekKD.Deaths:Finaldatafor2010.NatlVitalStatRep. 2013;61(4).http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf[PDF-3M] GoAS,MozaffarianD,RogerVL,BenjaminEJ,BerryJD,BlahaMJ,etal.Heartdiseaseandstroke statistics—2014update:areportfromtheAmericanHeartAssociation.Circulation.2014;128. HeidenreichPA,TrogdonJG,KhavjouOA,etal.Forecastingthefutureofcardiovasculardiseasein theUnitedStates:apolicystatementfromtheAmericanHeartAssociation.Circulation. 2011;123:933-44.Epub2011Jan24. HeronM.Deaths:Leadingcausesfor2008.[PDF-2.7M]Nationalvitalstatisticsreports.2012;60(6). CDC.DisparitiesinAdultAwarenessofHeartAttackWarningSignsandSymptoms—14States, 2005.MMWR.2008;57(7):175–179. CentersforDiseaseControlandPrevention.StateSpecificMortalityfromSuddenCardiacDeath: UnitedStates,1999.MMWR.2002;51(6):123–126. CDC.MillionHearts:strategiestoreducetheprevalenceofleadingcardiovasculardiseaserisk factors.UnitedStates,2011.MMWR2011;60(36):1248–51.
