Other biomarkers and clinical conditions may help to determine individual risk for heart disease.
Lipoprotein(a) – also known as Lp(a) – is a cholesterol- carrying particle in your bloodstream that is genetically determined (inherited). High levels of Lp(a) promote cholesterol build-up in your arteries and interfere with the breakdown of blood clots (thrombolysis), which increases your risk of suffering a heart attack or stroke. Lp(a) levels greater than 30 mg/dl (300 mg/L) are associated with an increase in the risk of heart disease and stroke. The risk increases even more with levels above 50 mg/dl. Because Lp(a) levels are dependent on genetics, lifestyle changes have little effect on reducing Lp(a). Your Lp(a) measurement can help your doctor determine whether earlier treatment of other heart disease risk factors is indicated. An Lp(a) Atherosclerosis (plaque build-up in the arteries) due to lipid accumulation) results in an inflammatory process that promotes progression and plaque rupture. The inflammatory marker C-reactive protein (hs-CRP), which is determined by a blood test, may reflect an inflammatory state and increased heart disease risk.Your doctor may measure hs-CRP to assess your future risk of CVD or to decide if you may benefit from treatment with a statin drug even if you are apparently healthy and have no signs or symptoms of heart disease.
Metabolic syndrome is a group of risk factors that together raise the risk for coronary heart disease significantly. The metabolic risk factors that make up this syndrome are:
• excess fat around the middle (abdominal obesity)
• high triglycerides
• low HDL-C
• high blood pressure
• high blood glucose
• chronic inflammation (high hs-CRP).
Many people with metabolic syndrome eventually develop diabetes.
Diabetes is a disease of poor blood sugar control. Blood sugar (glucose) is derived from the carbohydrate-rich foods in your diet. Insulin production by the pancreas and normal insulin action in skeletal muscle, fat tissue and the liver, maintain normal levels of blood sugar. Insulin resistance (or poor insulin action) can be caused by obesity and genetic factors. When the pancreas cannot produce enough insulin, type 2 diabetes develops. Diabetes increases the risk for heart disease, claudication (poor blood flow to the legs), gangrene, kidney failure, blindness, and erectile dysfunction in men. Pre-diabetes is also a risk factor for vascular disease and often progresses to full blown diabetes.
A1c is used to diagnose diabetes and prediabetes.
A1c < 6.0 % normal (but lower is better)
A1c 6.0-6.5 % pre-diabetes
A1c >6.5 % diabetes
Impaired Kidney Function
Chronic kidney disease (CKD) is an important risk factor for heart disease and stroke. CKD may result from diabetes, high blood pressure, vascular disease, infection or genetic causes. An increased blood creatinine level as a marker of decreased kidney function (eGFR below 60) or an increased excretion of protein in the urine (albumin to creatinine ratio) ACR > 3.0mg/mmol is an indication for statin treatment.
For women only…
Cardiovascular disease is a significant cause of ill health for post-menopausal women. Statistics show that one in nine women aged 45 to 64 has cardiovascular disease. This increases to one in three women over the age of 65.
The risk of CVD increases with age for both men and women, but menopause – and the changes associated with it– cause a woman’s risk of heart disease to more than double. Estrogen replacement appears beneficial for heart health in women if started in early menopause but is generally not recommended for women more than 5 to 10 years post menopause. Trans-dermal estrogen is preferable.