Heart Disease: Do you Know Your Risk?
Heart disease: It’s not just about cholesterol.
Get the facts.
Heart disease is the number one killer, not only in the US but the whole world.
While many of us are feeling deeply concerned these days about threats from the physical. social, or political world, the truth is that for the vast majority of us:
...we are statistically far more likely to die of heart disease than any other cause.
Add to it that the majority of other top health conditions and causes of death are related to, or caused by similar factors as heart disease. This includes diabetes, stroke, kidney disease, COPD and Alzheimer’s/dementia. It is plain to see that the best thing you can do to ensure a healthy and long life is to assess and address your heart disease risk variables.
How can you understand our health risks for heart disease? High cholesterol numbers does not begin to tell us the full picture.
Only if we can understand our whole body can we address the drivers of heart disease and life our best life.
What do you need to know to properly evaluate your risk of heart disease?
Let’s start with understanding what we are measuring.
What is Heart Disease?
Step 1: Lipids
Most of us know that we need to get our cholesterol numbers checked. Cholesterol are a form of lipids and are the material of heart disease and includes triglycerides and lipoprotein subtypes such as LDL and HDL (low- and high- density lipoproteins, respectively).
Lipids aren’t themselves heart disease though. They make up something called atherosclerotic plaques on the inner lining of our arteries. These plaques are what occlude arteries or break off and cause things like heart attacks, strokes and embolisms.
It’s not just the total amount of lipids you have, but the size and density. The lower density, smaller particles are the ones that are most likely to become plaques, because they are the most likely to become oxidized and inflamed (more on that, below).
So that’s step one: getting a better understanding of how many and what size of the low-density (LDL) particles you have. And if you have a healthy amount of the relatively protective high density (HDL) kinds.
Step 2: Inflamed, oxidized lipids make atherosclerotic plaques.
While lipids are the material of heart disease, they won’t become dangerous plaques unless they become oxidized or inflamed. The smaller and more dense the lipid are more likely to become oxidized and inflamed. Also, if we overall have a lot of inflammation and oxidative stress, that also increases the likelihood of developing atherosclerotic plaques and heart disease.
When our lipids get oxidized and inflamed, our body’s immune system recognizes them as dangerous and wants to get them the heck out of our blood stream! It does this by stashing these oxidized/inflamed lipids into the inside of our artery wall, creating arthersclerotic plaques.
“Atherosclerosis is the buildup of fats, cholesterol and other substances in and on your artery walls. This buildup is called plaque. The plaque can cause your arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.”
These plaques then release extra inflammatory signalling and continue to build up and block our arteries.
SUM:
The processes that drive lipids turning into artherosclerotic plaques and hence, heart disease, are:
small, dense lipids
inflammation
oxidative stress
Step 3: Stopping or Reversing Heart Disease
So just knowing your cholesterol numbers won’t tell you your full risk factors for heart disease, nor how you specifically may be more or less at risk. Are your lipid numbers ok, but you have a lot more of the very dense, small particles? Or do you have a lot of inflammation and oxidative stress, driving dyregulations in your lipid numbers and increasing athersclerotic plaque number?
Especially if your cholesterol numbers are borderline high or only a little elevated, knowing the difference can mean radically different -and more successful -interventions to save you from heart disease.
Foundationally, stopping or reversing heart disease always means focusing on healthy lifestyle factors such as diet, exercise, sleep and mindfulness/stress management, -there really is no substitute, pharmaceutical or natural.
And keep in mind that some of us may be genetically predisposed to more of these factors and will need to do some extra legwork to prevent or reverse these risk factors on top of diet and lifestyle.
How do we assess heart disease risk
Testing to help determine what and where your risk factors are.
Lipids: The Basics
Who should check these:
All of us below 40 every ~5 years if we don’t have other risk factors (see below)
At any age if you have a family history of heart disease, especially at a younger age (<65).
Anyone 40 years old or older, annually or every ~3 years if no other risk factors and prior normal heart disease marker testing.
What testing should you receive?:
A basic lipids panel: Cholesterol, LDL, HDL, triglycerides (also, VLDL, Chol/HDL ratio).
These are the basic markers that tell us how many of several different types of lipids we have in our blood. It is far from a complete picture of the variables that can contribute to or indicate heart disease processes that are occurring in your body, but is the basic panel most of us will get at your annual physical exam.
If you have family or lifestyle factors that put you at a higher risk of heart disease or your basic panel is borderline high, then consider the expanded panel (below).
Lipids: Advanced markers
Who: If you fall into a high(-er) risk category, you’ll want to have a more advanced assessment of your heart disease risk factors and other health markers. Higher risk categories include:
Established heart disease or previous cardiac event (heart attack or stroke).
Borderline basic lipid panels:
Total Cholesterol at the high end of, or above range (total cholesterol >200 mg/dL, LDL >100, HDL < 50, VLDL >30)
Family history of heart disease
Smoker
Obese or overweight
Sedentary (“sitting is the new smoking”)
Men: 15+ drinks/week
Women: 8+ drinks/week)
High blood pressure
Depression, anxiety
High stress
Post-menopause or andropause (after ~50 yo)
Why consider advanced markers?:
Advanced markers consider not just basic lipid types and counts, but their size and density as well as other risk factors such as clotting, inflammation, insulin resistance (a major driver of heart disease, among other conditions), oxidized particles, thyroid health, fatty acids, gut microbiome health, nutrient status and a real-time look at how much atherosclerotic plaques are already built up in your arteries.
Advanced markers for heart health status:
Calcium score or CIMT (carotid intima media thickness test): a direct assessment of the amount of atherosclerotic plaque in your arteries.
Lipid size and density (LDL-C, LDL-P, HDL-C, HDL-P, non-HDL)
Markers of inflammation and clotting (Fibrinogen, hsCRP, ferritin, homocysteine)
Insulin resistance (HgA1c, LP-IR)
ApoB, Apoa1, Lp(a)
Full thyroid panel (TSH, free and total T4 and T3, reverse T3)
Organic acids (urine) for nutrient and antioxidant status
Amino acids (plasma)
Minerals and other nutrients such as CoQ10
Fatty acids (Omega 3, 6 and 9)
Conclusion: The Power of Knowing
You can’t fight what you don’t know. And since heart disease and related conditions such as diabetes, kidney disease, strokes, Alzheimer’s/dementia and obesity continue to be our top health issues, it is clear that medications and surgical interventions are not helping us win the battle against these diseases. Even when they are able to save lives, they do little to address the main underlying drivers or help people truly feel well.
Working with your Functional medicine provider to understand what advanced test markers you’ll benefit from and create personalizing targeted interventions to address those that are out of healthy ranges. Not only will this allow you to specifically understand and address your disease risk factors but it will support you in feeling your best and living a long and active life.