Peripheral artery disease, peripheral artery disease support
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Cutting-Edge Cardiovascular Bloodwork

Getting to the heart of what's damaging your arteries.

· Heart of Innovation

Are your arteries on fire? Are there hidden (or obvious) correctable risk factors that are fueling the fire? In most cases specialized blood testing, along with a careful evaluation by a knowledgeable healthcare provider, can uncover multiple addressable areas that can reduce your risk of ongoing artery damage. 

On this week's The Heart of Innovation, hosts Kym McNicholas and Dr. John Phillips are joined by Dr. Michael Dansinger, Medical Director at heart-health company Boston Heart Diagnostics, that does specialized blood testing to help doctors and patients manage and prevent vascular diseases including peripheral artery disease. Boston Heart also provides ultra-personalized nutrition and lifestyle prescriptions for patients based on their blood test results and other factors specific to each patient. Blood tests must be ordered by healthcare providers and are partially covered by medical insurance in most cases.

They discuss a variety of different advanced blood tests for cardiovascular health and what they mean. Why is it important to perform advanced bloodwork? It's for:

  • Uncovering obvious and hidden risk factors for ongoing cardiovascular damage
  • Designing an optimal eating strategy based on an individual’s specific blood test results, medical issues, and food preferences
  • Identifying appropriate treatments including lifestyle recommendations, medications and/or supplements
  • Measuring improvements resulting from treatments including lifestyle habits, medications, and/or supplements

There are seven different categories of specialized cardiovascular blood tests offered through Boston Heart Diagnostics:

  • Particles that cause artery damage
  • Cholesterol source 
  • Cholesterol elimination
  • Fatty acid balance
  • Diabetes risk
  • Inflammation
  • Genetics

During this show, we focused mainly on particles that cause artery damage, cholesterol source, cholesterol elimination, inflammation, and diabetes risk. More specifically:

1. Particles that cause artery damage

LDL cholesterol: The concentration of cholesterol in LDL particles. Levels around 60-70 mg/dL are optimal for artery health, especially in people with known cardiovascular disease or peripheral vascular disease. It usually requires statin medications to get that low. Levels of 70-100 mg/dL are reasonably good for people without known vascular disease.

ApoB: This measures the concentration of LDL particles rather than the concentration of cholesterol contained in LDL particles. ApoB levels predict cardiovascular risk slightly better than LDL cholesterol.

LDL-P: This is an alternative way to measure the concentration of LDL particles. 

Small-dense LDL cholesterol: Most of the damage caused by the smallest and densest LDL particles. Boston Heart measures the amount and percentage of cholesterol specifically in small-dense LDL particles. Publishes studies show this test is a superior predictor of cardiovascular disease, and you want the levels to be as low as possible. Along with appropriate medications and/or supplements, lifestyle changes such as weight loss, eating less refined sugars and starch, and daily exercise can reduce small-dense LDL cholesterol.

Lipoprotein (a): This is an artery-damaging particle that is too high in about 20% of men and women. High levels can run in families since it is genetically determined. 

2. Cholesterol Source Testing

Cholesterol production: The liver makes cholesterol. In some people the liver makes too much cholesterol leading to high levels of LDL particles, including small-dense LDL particles. This may happen for genetic reasons, or because there is a lot of fat accumulated in the liver, or for other reasons. There are blood tests that identify whether high cholesterol levels are due to overproduction. Weight loss can reduce fatty liver and cholesterol overproduction. Statin drugs (for example Crestor or Lipitor) reduce cholesterol production from by the liver. Repeat testing of cholesterol production levels can demonstrate the effectiveness of treatments. 

Cholesterol absorption: The intestines absorb cholesterol. In some people (about 25-30%) the main source of high LDL cholesterol levels is from over-absorption rather than over-production of cholesterol. These people are more sensitive than others to dietary cholesterol, and they do not respond as well to statin drugs. They respond well to medications (like ezetimibe) and supplements (like fiber and plant sterols/stanols) that block cholesterol absorption by the intestines. In this way, knowing the source of high LDL cholesterol can guide treatment decisions by doctors and patients.

3. Cholesterol Elimination

HDL cholesterol: Most people call this “good cholesterol” but it is actually a way to measure the level of HDL particles. HDL particles help remove excess cholesterol from the body. Higher levels of HDL cholesterol indicate lower risk of heart and vascular diseases. Exercise raises HDL cholesterol; smoking lowers HDL cholesterol. 

Large HDL particles: You want your HDL particles to be large. The large HDL particles are the ones that remove cholesterol most effectively. Unfortunately unhealthy refined sugars and starches, abdominal obesity, and insulin resistance prevent the HDL particles from becoming large and mature. Think of apples on a tree that never become large and ripe because the tree is not getting what it needs. People with cardiovascular disease often lack the large HDL particles, which can be measured most effectively with the “HDL Map” test by Boston Heart. Studies show the HDL map test is very effective at measuring improvements caused by favorable lifestyle changes.

4. Diabetes Risk

Studies show that among people age 65 and older in the U.S., about 25% have diabetes, plus another 50% have prediabetes! We are all at risk for diabetes in our lifetime, and there are blood tests for measuring that risk. Healthy lifestyle choices and certain medications can delay the progression from prediabetes to full type 2 diabetes, or potentially improve type 2 diabetes to the point of remission.

Hemoglobin A1c: this simple blood test is in common use, and can be used to measure the risk or extent of prediabetes or diabetes. It provides a 2 to 3 month average blood sugar reading by showing how “sugar coated” your blood is. 

Insulin testing: This simple blood test is done after an overnight fast. Insulin is a hormone made by the pancreas to move sugar (glucose) from the blood into tissues to be used for energy. Some people have abnormally high or low insulin levels in the blood, which an be used to provide measures of diabetes risk. Improvements in insulin levels can be used to measure improvements in diabetes risk. At Boston Heart we offer a test called the “Beta Cell Function and Risk Index” which uses fasting insulin and glucose levels to monitor diabetes risk and recommend treatments based on the specific results.

Prediabetes assessment testing: This test offered by Boston Heart gives doctors and patients a measure of how rapidly a patient is moving from prediabetes toward prediabetes toward type 2 diabetes. The test uses a combination of multiple blood tests and clinical factors that have been shown to predict (with an accuracy of 92%) the 10-year risk of diabetes in patients with prediabetes.

5. Inflammation

When we talk about “fire” in the arteries that is another way saying “inflammation” in the arteries. We can use special blood tests to measure different aspects of inflammation. 

C-reactive protein (CRP): This is the most common test for inflammation. Increased blood levels means there is inflammation somewhere in the body, from any cause. If there is no sign of infection, injury, or illness that could cause inflammation, then an increased blood level is often a measure of the intensity of ongoing artery damage from any cause.

MPO: This is also known as “myeloperoxidase”. It is a general measure of active white blood cells and inflammation. In someone with known coronary artery disease, high levels of MPO can signal “hot plaque” that is at risk to cause a heart attack.

LpPLA2: This is also known as the “PLAC test”. It is a measure of inflammation caused by cholesterol plaque inside the artery walls. It is more specific to artery health than C-reactive protein or MPO.