Markers to Help Prevent Cardiac Catastrophe
By Dr. Ayo Bankole
In the United States, someone dies of heart disease every minute. Coronary artery disease (CAD)/coronary heart disease (CHD)/atherosclerosis is the number one cause of death here in the U. S. and worldwide. The presence of heart disease often goes unnoticed and undertreated. Many don’t know they have heart disease until they suffer debilitating chest pain, or worse, have a heart attack or a stroke.
Mrs. Tina (not her real name) was fifty-nine years old when we met to discuss her heart health after having triple bypass surgery. She had been faithfully taking Simvastatin, which normalized her elevated cholesterol. Otherwise, she was seemingly in good health. She did not smoke, had no diabetes or hypertension, and there was no family history of heart disease. She even had a daily routine of walking for fitness. But overtime she began to experience fatigue and chest pressure with exertion. Her symptoms led to an angiogram that found extensive disease in three of her coronary arteries. She was shocked the learn there was 90% blockage in the most severely diseased artery and 60% blockage in the remaining two effected arteries. Aside from advancing age and cholesterol that had been normalized, she had no identifiable factors associated with extensive cardiovascular disease.
Fifty percent of people who have heart attacks have normal cholesterol. Being a naturopathic doctor affords the opportunity to run simple and cost-effective markers to recognize risks that may exist, even in the absence of traditional risk factors. When tested, they may reveal several treatable risk factors for heart disease. With proper testing, I believe Mrs. Tina’s cardiovascular risks could have been identified and treated.
For years, cost effective and easy to access markers have been available for cardiologists, family practitioners, and naturopathic doctors to screen patients for heart disease and to discover more about someone’s heart disease status. But sadly the markers go unconsidered in the care of most individuals. Proper testing allows for better risk stratification and more personalized treatment.
More to lipids than your LDL value
Direct LDL
The standard LDL measure is a calculation that often underestimates true LDL values by 20mg/dL or more. An accurate measurement of “bad” cholesterol is done with direct LDL for proper risk classification.
sdLDL, %sdLDL
Determines the count and percentage of LDL cholesterol particles that are small and dense. These small dense LDL particles are far more damaging to the arterial wall than larger, less dense particles.
Lp(a)
LDL cholesterol with Lp(a) proteins attached to them are highly damaging to the arteries and thus heighten your risk of heart disease. Based on your genetics, you may have more or less Lp(a).
Assessing arterial inflammation
Fibrinogen
Elevated levels of this inflammatory plasma protein mark inflammation along with an increased risk of clotting and heart disease.
MPO
Elevations of the enzyme myeloperoxidase indicate unstable, risky, rupture prone plaque in the arterial wall.
LpPLA2
Elevations of this enzyme secreted by white blood cells, denote actively growing arterial plaque.
OxPL-apoB
Oxidation of lipoproteins such as Lp(a), LDL, VLDL are highly inflammatory. Upon uptake by the arterial wall, they heighten the risk of heart attacks, stroke and stiffening of the aortic valve.
Cardio genetics to decrease risk
ApoE
Apolipoprotein E measures defective uptake and transport of cholesterol related lipoproteins. The E4 variant is associated with higher cardiovascular risk due to elevated LDL cholesterol and informs personalized recommendations.
SLC01B1 (statin induced myopathy)
This gene determines the metabolism of statins. Its mutation increases the likelihood of statin induced muscle damage that causes pain, fatigue, weakness that ultimately lead many to discontinue the drug.
9p21 (pre-mature heart disease)
According to population studies, individuals with a double variant in the associated gene can have up to two times the risk of premature cardiovascular disease compared to non-carriers.
KIF6 (statin benefit)
This marker identifies individuals with a gene variant that conveys an increased risk of heart disease 1.5-fold and is found in 40% of the population. Some studies show enhanced response and normalized risk with statin therapy compared to individuals without the variant.
Conclusion
As a naturopathic doctor, I believe the presence of any risk factor should trigger further testing of cardiovascular risk. Measurement of vascular inflammation, cardio genetics and markers to further characterize LDL cholesterol can illuminate cardiovascular risk independent of traditional risk factors like family history, smoking, age, diabetes, cholesterol and hypertension. The above markers are a sample of some of the most important of these markers. If this type of testing had been performed early on, Mrs. Tina’s risk for arterial disease could have been recognized early, affording her a more complete and therapeutic approach whose benefits expand beyond statins and daily walks.
Dr. Ayo Bankole
Bankole is a licensed Naturopathic Doctor treating persons with heart disease, diabetes, inflammation and other environmental and lifestyle related conditions. He also possesses advanced training in environmental medicine and uses IV nutritional therapy, detoxification and chelation therapy.
He is a member of the American Academy for the Advancement of Medicine www.acam.org, the American Association of Naturopathic Physicians www.naturopathic.org, and the California Association of Naturopathic Doctors www.cand.org.
To learn more about our comprehensive approach to treating heart disease and other conditions call 909-981-9200 to schedule your FREE DISCOVERY CALL.
