Emerging Cardiovascular Risk Factors
By Jude Emery, for Revive Your Life
Save your ticker...get screened for these alternative risk factors
Editor’s Note: This is the third article in a series on cardiovascular health. You can estimate your cardiovascular risk by utilizing our Cardiovascular Risk Calculator. As part of the continued enhancement of the Revive Your Life community, we are proud to introduce the first of what will be many professionally-designed, interactive tools meant to improve the user experience and quality of information provided by this site. While this article is somewhat technical in nature, it provides extremely important information which should be considered by those with a significant risk of developing heart disease.
By now, you’ve probably heard about the dangers of cholesterol and high blood pressure (if not, check out the first 2 posts in this series). I’d be willing to bet that most of you also know someone who has suffered a heart attack or stroke despite having normal blood pressure and cholesterol levels. So, if it’s not all about blood pressure and cholesterol, then what’s going on? Obviously, heart disease is a lot more complex than it appears at first glance.
Emerging research has identified several other factors as potential culprits in the development of cardiovascular disease. These markers may be the key to preventing countless heart attacks and strokes in the future. Even though the means by which these indicators work is not fully understood (making them difficult to treat), they can be an important factor in determining the best course of action for you. For example, if you have several of these additional risk factors, you may decide to take steps to keep your cholesterol under control even if it’s not currently high. Each of these indicators is easy to check with a simple blood test. Unfortunately, your insurance company may not pay for all of these tests (as I found out a few hundred dollars too late) since some are considered to be “experimental” from an insurance standpoint.
1. Lipoprotein a [Lp(a)]
Lipoprotein a, also known as Lp(a) or lipoprotein “little a”, is basically an LDL (bad cholesterol) molecule attached to a blood protein called Apo a. Researchers aren’t exactly sure how Lp(a) contributes to the progression of heart disease, but one theory suggests that it may inhibit the body’s ability to break down blood clots. Lp(a) has a similar structure to a protein called plasminogen, which helps our bodies dissolve blood clots. Undissolved blood clots can cause blockages in the arteries, triggering a heart attack or stroke. An Lp(a) level above 30 mg/dl has been shown to increase your cardiovascular risk 6 times over.
Most often, high Lp(a) is a trait that you are born with. Because it is genetic in nature, changing your lifestyle has little effect on lowering Lp(a) levels (unfortunately). Even the most powerful cholesterol-lowering drugs, statins, don’t do much to remove Lp(a) from your body. It seems that LDL molecules bound to Lp(a) are “camouflaged” from the drugs, so they get left behind when other LDL molecules are removed.
2. Fibrinogen
Fibrinogen is a protein that plays a key role in blood clotting. Researchers believe that people with too much fibrinogen are at an increased risk because their blood clots too easily. When you consider that many heart attacks are caused by the sudden formation of a clot where there is plaque in the artery, the case against fibrinogen makes sense. While the recommended level for fibrinogen varies depending on the source, it appears that levels above 300 mg/dl are associated with an increased risk of cardiovascular disease. Some studies suggest that individuals with high fibrinogen levels are more than twice as likely to suffer a fatal heart attack or stroke.
Your body naturally produces more fibrinogen as you age. Hypertension, obesity, smoking and stress are all related to higher levels as well. Regular exercise and alcohol use seem to correspond with lower amounts of fibrinogen. In fact, some studies indicate that moderate alcohol consumption may decrease fibrinogen by as much as 20% (keep in mind the host of health conditions associated with drinking too much alcohol…remember the study says moderate).
3. Homocysteine
Homocysteine is a common amino acid found in the blood (amino acids are the building blocks of proteins). High levels of homocysteine are associated with the early development of cardiovascular disease as excess homocysteine can irritate your blood vessels and promote atherosclerosis (hardening of the arteries). It is generally recommended that you keep your homocysteine below 10 μmol/L, but some studies suggest that levels as low as 6.5 μmol/L translate to an increased risk. Fortunately, diet appears to play an important role in keeping your homocysteine levels down. Individuals with high homocysteine levels often have a low intake of the B vitamins folate, B6 and B12. Getting enough fruits and vegetables, especially leafy greens, can boost the amount of B vitamins in your diet and help to keep your homocysteine in check.
4. C-reactive Protein (hs-CRP)
C-reactive protein is released into your blood stream whenever there is inflammation in your body. Inflammation is your body’s natural response to injury or infection. Evidence from several studies indicates that inflammation plays an important role in the build-up of fatty deposits in your arteries as well. A CRP measurement above 3 mg/L is associated with a high risk of developing cardiovascular disease. Some experts think that CRP testing provides a more accurate measure of risk than traditional blood tests.
Basic lifestyle changes such as stopping smoking, getting enough exercise and losing weight can be effective ways to lower your CRP level. Interestingly, a common cause of elevated CRP is inflammation associated with gingivitis, or gum disease. Ongoing research shows that poor oral hygiene corresponds to an increased risk of developing cardiovascular disease.
5. Apolipoprotein B (Apo B)
Apolipoprotein B is a major component of LDL cholesterol particles. It is believed that people with high levels of Apo B clear cholesterol from their bodies more slowly than normal. Apo B may also make it easier for LDL particles to bind to artery walls by “unlocking” receptors on those cells. The buildup of plaque on the arteries is a major step in the progression of cardiovascular disease. Some researchers believe that Apo B testing provides a better indication of cardiovascular risk than measuring LDL cholesterol alone. Apo B levels above 100 mg/dL put an individual in the high risk category. Fortunately, many of the same treatments that are effective at lowering your LDL (diet, exercise, etc.) will bring down your Apo B level as well.
With all of the research that goes into discovering the cause(s) of heart disease, even more time and effort is spent seeking effective treatments. In the final installment of this series, we’ll take a closer look at which supplements may be effective in the prevention and treatment of cardiovascular disease.
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