Are Standard Lipid Profile Tests Enough? Advanced Cholesterol Testing

With heart disease being a leading cause of death among Americans, you may be wondering: How healthy is my heart?

You eat right, exercise and know how to manage stress. Your annual physical includes the standard blood tests, including a lipid (cholesterol) profile to evaluate heart disease risk, cholesterol (HDL and LDL) and triglycerides. Your blood pressure and electrocardiogram (ECG) results may be normal. Everything looks OK, so there’s nothing to worry about . . . right?

A standard lipid panel that tests for serum total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL) and triglycerides is a necessary part of regular blood work and a way to screen for factors that contribute to heart disease. But there are other blood tests available that provide a much clearer picture of where you stand heart-health-wise.

Listen to Life Extension’s Michael A. Smith, MD, and Crystal Gossard, DCN, CNS®, LDN, as they bring their audience up-to-date on the latest tests for cholesterol and more on the Live Foreverish Podcast.

Advanced heart tests

There’s more to cholesterol than HDL and LDL.

Cholesterol, an important fat-like substance found in all cells, is needed to produce steroid hormones and forms a part of cell membranes, among other functions. Although some cholesterol is provided by the diet, most is made by the liver. Cholesterol is transported by low-density lipoprotein to tissues, while high-density lipoprotein delivers excess cholesterol back to the liver, where it is broken down and eventually excreted. Having an HDL level of 50 mg/dL or higher, an LDL level of less than 80 mg/dL and fasting triglycerides that are lower than 100 mg/dL is optimal for most individuals without other risk factors.

What are the best blood tests for predicting heart problems?

One of the best tests you can take is the NMR Lipoprofile® test, which measures the standard lipid levels in addition to LDL particle size and number. Low-density lipoprotein should be large, fluffy and buoyant (described as pattern A) as opposed to small and dense (described as pattern B). Small, dense LDL particles are likelier to infiltrate the arterial wall, leading to plaque formation. They are therefore a good marker for predicting cardiovascular disease.1 The NMR Lipoprofile® test also provides an assessment of insulin resistance that can help detect the risk of type 2 diabetes, a disease that increases the risk of cardiovascular disease.2

Apolipoproteins bind fat and cholesterol to form lipoproteins. While there are a number of apolipoprotein classes, the ones we’re going to look at are apolipoprotein A and apolipoprotein B. Apolipoprotein B (ApoB) is a component of some of the “unhealthier” lipoproteins, including low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) particles. Apolipoprotein A1 (ApoA1) is a component of high-density lipoprotein (HDL) particles and is potentially helpful in reducing build-up of arterial plaque. The Apolipoprotein Assessment, which measures apolipoprotein B and apolipoprotein A1, is important because the ApoB-to-ApoA1 ratio has a stronger association with cardiovascular disease risk than better-known lipoprotein cholesterol fractions.3

Best Blood Tests for Heart Disease Detection: Does LDL Matter?

Yes, knowing one’s LDL level is of vital importance in assessing one’s risk of cardiovascular disease. Testing for oxidized lipoproteins is also important. Oxidized LDL can be compared to rancid fat that is likelier to trigger inflammation and plaque formation than LDL that is not oxidized. Increased serum or plasma oxidized LDL is a marker for coronary artery disease.4

Tests for inflammation are valuable in the assessment of cardiovascular disease risk. While C-reactive protein (CRP) is a better-known test for systemic inflammation, myeloperoxidase (an immune system enzyme that is a biomarker of oxidative stress) testing can assess inflammation specific to the arterial wall. Testing for CRP and myeloperoxidase may be as important as cholesterol levels to evaluate the risk of cardiovascular disease.5

Another advanced heart test is the PLAC® test for lipoprotein-associated phospholipase A2 protein (Lp-PLA2) activity. Lp-PLA2 is a vascular inflammatory marker that plays an important role in the formation of arterial plaque that is vulnerable to rupture.6 This test measures the function of Lp-PLA2 in the walls of the arteries to help predict the risk of coronary heart disease events.

Heart tests for chest pain

Chest pain should be immediately evaluated. Although it may not always be caused by a heart attack, it’s better not to take chances. An ECG is usually the first test that is administered to people complaining of chest pain. This test measures the heart’s electrical activity and can reveal damage that has occurred.

Troponin is a protein that increases in the blood in response to damage to the heart muscle. This is measured in the emergency department following an ECG assessment of suspected heart attack. Troponin testing confirms acute heart attack diagnosis but does not indicate the mechanism of damage inflicted upon the heart.7

Chest x-rays and CT scans are other tests that may be employed to evaluate individuals who report chest pain. They may be repeated at follow-up, along with ECG stress tests and/or an angiogram, which enables visualization of the heart’s arteries.

Chest pain that comes and goes

Chest pain that comes and goes over an extended period of time may not be due to a heart attack but should still be evaluated by a physician. There are a number of tests and procedures that can help identify the cause of chest pain.

Availing yourself of some of these advanced tests can provide a more complete picture of heart health than standard blood tests. If an increased risk of cardiovascular disease is identified, preventive measures can be taken. By proactively assessing your risk factors, you can act immediately to reduce the risk of becoming one of the casualties of the world’s leading cause of death.

About Live Foreverish: Join Dr. Mike as he sits down with some of today’s leading medical, health and wellness experts to discuss a variety of health-related topics. From whole-body health to anti-aging and disease prevention, you’ll get the latest information and advice to help you live your life to the fullest. If you like what you hear, please take a moment to give Live Foreverish a 5-star rating on iTunes!

  1. Ivanova EA et al. Oxid Med Cell Longev. 2017;2017:1273042.
  2. Balakumar P et al. Pharmacol Res. 2016 Nov;113(Pt A):600-609.
  3. Walldius G et al. J Intern Med. 2006 May;259(5):493-519.
  4. Holvoet P et al. Arterioscler Thromb Vasc Biol. 2001 May;21(5):844-8.
  5. Heslop CL et al. J Am Coli Cardiol. 2010; 55: 1102-1109.
  6. Kolodgie FD et al. Arterioscler Thromb Vasc Biol. 2006 Nov;26(11):2523-9.
  7. Foy AJ et al. Med Clin North Am. 2015 Jul;99(4):835-47.


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