The two key biomarkers that reveal your Cardiovascular risk.
Cholesterol blood tests are a very common part of routine medical check-ups. Most people understand that we are aiming avoid high cholesterol to reduce our risk of atherosclerosis and heart disease. It is also recognised that heart disease and heart attacks are the number one killer in the developed world. Hence, cholesterol gets a lot of attention and rightly so!
In this article I will explain there is more we MUST consider when testing an individual’s risk of heart disease. I aim to highlight that despite the positive change that is fast approaching in our medical clinics, you need not wait. You have the ability to dive deeper into your cardiovascular risk factors TODAY!
When studying the topic of lipids (fats) and cholesterol physiology, I felt privileged to hear directly from the esteemed Dr Peter Attia on this topic. Given the alarming statistics associated with Cardiovascular disease (CVD) I felt compelled to thoroughly understand this topic to the best of my ability. “Prevention is cure” is a belief system amongst integrative medical practitioners and in line with this, we have the ability to understand an individual’s risk and the tools to proactively intervene.
Given the sheer complexity and level of knowledge required, you will not find a lesson in lipidology metabolism here. What I want to discuss is how I treat a patient whose ultimate goal is to prevent disease and optimise health.
Blood Testing
A comprehensive blood test is the first stop when gaining insight into our health status. Cholesterol markers such as total cholesterol, LDL-C, HDL-C and Triglycerides are commonly tested and while these are important there are more revealing markers I typically discuss with my patients. They are:
1. ApoB
ApoB (Apoliprotein B) has been described as the most accurate marker for the total amount of LDL particles circulating in the blood. This is more relevant to atherosclerotic risk than the commonly used LDL-C marker, which looks at the amount of cholesterol in the LDL particle.
Studies have proven the importance of lowering ApoB in reduction of Cardiovascular risk. It is also considered the most important marker to monitor in response to treatment. ApoB testing is currently available for Australian patients if you have a history of high cholesterol but I believe that this will soon become the main focus of discussion when understanding an individual’s CVD risk.
2. Lp(a)
Lp(a) (lipoprotein little a), is associated with risk of CVD and is largely hereditary. According to the Family Heart Foundation of Canada, high Lp(a) occurs in 1 out of every 5 people but alarmingly fewer than 1% know they have it.
It is the structure of Lp(a) that makes it so dangerous. In essence Lp(a) is able to carry bits of oxidised lipid molecules (harmful lipid junk) which can lodge in the artery wall and increase the speed of arterial plaques formation. It’s the formation of this plaque that ultimately leading to sudden events such as cardiac arrest. If there is any family history of premature heart attacks, I’d encourage patients to get their Lp(a) tested. As it’s largely genetic you only need to test for this once in a lifetime to know your answer. Unfortunately, the Australian medical guidelines do not fund the test for Lp(a) under Medicare. However many experts are calling for testing to be expanded.
Professor of general practice at the university of Tasmania, Mark Nelson, stated that; “There is good evidence for Lp(a) as a significant risk factor. However, it is not standard screening nor rebated as such. The critical thing at the moment is for GPs to adopt risk algorithms and treat accordingly.”
There is no denying that Lp(a)’s involvement in increasing CVD risk, but, until clear guidelines and treatment protocols are adopted, it is not offered in regular cholesterol screening.
Integrated Medicine Approach
The good news, both ApoB and Lp(a) can be tested for privately. If there is any question around your CVD risk, I would strongly encourage you to be proactive and discuss this with your treating practitioner as knowing your results is the first step.
From my perspective the treatment approach will always include a discussion around diet and lifestyle such as, reducing saturated fat and incorporating cardiovascular exercise. There is evidence that supplements such as fish oil, red yeast rice extract, pantetheine (B5), delta and gamma tocotrienols and vitamin K2 have the ability to lower ApoB, however, it is imperative that you seek a personal treatment plan with an experienced partitioner.
Referral for CT angiogram (via Cardiologist) and coronary artery calcium score (via primary care practitioner) would be high on my list for anyone found to be at an increased risk. Given the lack of symptoms in the lead up to severe cardiac events it’s just too important not to follow up this line of physical testing.
Prescription medication such as statins and PSK9 inhibitors may often be prescribed by a Cardiologist and in certain cases I would agree with this approach.
To conclude, I hope this helps you to understand that prevention, in this case, is the only cure!
To read more about the current Australian guidelines and CVD risk calculator go to:
If you would like to discuss this with me further, please reach out via the contact page.