Markers Used to Assess Risk of Cardiovascular Disease
Lipoprotein Factors
- Total Cholesterol - Elevated levels have long been associated with increased CVD risk in large population studies.
- HDL Cholesterol (direct) - A low HDL level accelerates the development of atherosclerosis due to impaired reverse cholesterol transport.
- LDL Cholesterol (direct) - LDL is the most atherogenic of the lipoproteins. Major prevention trials have demonstrated a linear relation between LDL levels and the coronary event rate.
- Triglycerides - Elevated levels are linked to coronary heart disease. Elevated triglycerides may also be a consequence of other disease, such as untreated diabetes mellitus.
- Lipoprotein(a) [Lp(a)] - High Lp(a) is a risk factor for coronary heart disease, cerebrovascular disease, atherosclerosis, thrombosis, and stroke.
Lipoprotein Ratios
- LDL/HDL Ratio - Lowering the LDL/HDL ratio is associated with a lower incidence of cardiovascular disease events, even in patients with a high HDL level.
- Total Cholesterol/HDL Ratio - The higher the ratio the greater the risk. The goal is to keep this ratio below 5:1, with the ideal being below 3.5:1.
Chronic Inflammatory Markers
- C-reactive Protein (hs-CRP) - A general marker of inflammation which is important in the development of atherosclerosis. Scientific studies have found that higher hs-CRP levels lead to higher risk of a first heart attack. The risk in people in the upper third of hs-CRP levels is twice that of those in the lower third.
- Ferritin - The best measure of iron deficiency, elevated ferritin is also an important marker of cardiovascular health. High levels are found in ischemic heart disease, iron overload, and hemo-chromatosis.
- Fibrinogen - In states of tissue injury/inflammation, elevated fibrinogen is correlated with early CVD, and is a better marker of risk for a coronary event than elevated cholesterol.
Oxidant Stress Factors
- Homocysteine - Elevated levels indicate higher risk of coronary heart disease, stroke, and peripheral vascular disease. Elevated homocysteine responds to doses of B6, B12, and folate.
- Coenzyme Q10 (CoQ10) - Critical to mitochondrial ATP generation and known to be highly concentrated in heart muscle. Studies support the use of CoQ10 in congestive heart failure.
- Lipid Peroxides - As the products of chemical damage done by oxygen free radicals to the lipid components of cell membranes, assessment of serum lipid peroxides monitors the balance between sufficient oxygenation and oxidative stress.
- Vitamin E - Now measured with two markers, alpha-tocopherol and gamma-tocopherol, vitamin E is well recognized for its cardioprotective antioxidant role. It is thought to help prevent the oxidation of LDL.
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