Cholesterol tests and blood pressure checks were once thought to provide sufficient information about our heart's health. Yet, these may not be enough.

The Heart

The heart functions to pump blood through the circulatory system. At each beat, the heart pumps about 60 to 90 milliliters of blood. In a day, the heart pumps a total of 7,600 liters of blood.

The blood (from the circulation) that goes through the heart is pumped to the lungs, where blood is oxygenated, then it goes back to the heart which pumps the blood back to the circulation, to nourish the tissue cells of the body.

The Vascular System

The vascular system (blood vessels) carries the blood that is pumped by the heart to the tissues of the body and carries the blood from the tissues or organs back to the heart.

A damage in the vascular system can also result in damage to the heart. The two affect each other since they function together. That is why, most often, heart diseases are cardiovascular diseases.

Role of Atherosclerosis

Atherosclerosis, a condition that predisposes one to heart disease, is the buildup of plaque inside the arteries. When the hardened plaque breaks, it can block the flow of blood in the artery, at the same time it brings about clot formation.

The plaque formation is brought about by excess cholesterol (particularly LDL or “bad” cholesterol) in the blood. Plaque formation then narrows the lumen of the arteries, which increases blood pressure. An increased blood pressure brings increased workload to the heart which can later damage the heart. These explain the rationale behind cholesterol testing and blood pressure monitoring in evaluating risk for heart attack or heart disease.

Inflammation and Blood Clot Formation

However, a person can have normal total cholesterol and no hypertension, yet he can suffer a heart attack. Tests which are inflammatory markers can detect this risk.

Inflammation, a body’s response to injury, is involved in atherosclerosis. During the inflammation process, plaque ruptures and blood clot forms. Clot formation in the area blocks blood flow to the heart. A block in the blood flow in the coronary artery can result in heart attack.

THE TESTS

Inflammatory markers which detect the risk of heart attack are:

• C-Reactive Protein Test

C-reactive protein is a protein produced by the liver in response to injury or infection, and quickly disappears after injury, infection or inflammation. While raised levels of c-reactive protein may be associated with injury or inflammation in other parts of the body, it can predict inflammation in the arteries which can put a person at risk of heart attack.

• Fibrinogen Test

Fibrinogen is a protein produced by the liver that aids in clotting, to prevent further blood loss. High levels of this coagulation factor allows more blood clotting, including the clotting on ruptured plaque. A high fibrinogen level can also increase blood viscosity, which also increases risk of heart attack.

• Homocysteine Test

Homocysteine is an amino acid which affects atherosclerosis and contributes to blood clot formation on ruptured plaque.

The tests above are not specific for cardiovascular evaluation. However, when taken in conjunction with the other tests, such as when cholesterol level is near borderline, or other features like smoking, they can provide a better picture of the risk of heart attack.

How to Lower the Values

C-reactive protein can be lowered by:

• Eating fish high in omega-3 fatty acids
• Moderate exercise

Fibrinogen levels can be lowered by:

• Taking B-complex vitamins
• Moderate exercise
• Eating fish high in omega-3 fatty acids

Homocysteine levels can be lowered by:

• Taking plenty of vitamins B6 and B12, and folic acid

References:

1) Braverman, Eric and Dasha Braverman. “The Amazing Way to Reverse Heart Disease Naturally.” Copyright 2004.

2) Torelli, Julius and George Ryan. “Beyond Cholesterol – Seven Life-saving Heart Disease Tests that Your Doctor May Not Give You.” Copyright 2005.

3) American Academy of Family Physicians. “Inflammatory Markers in Coronary Artery Disease.” 1 March 2004. 20 December 2007 <http://www.aafp.org/afp/20040301/tips/10.html>.

4) Health World Online. “Heart Disease: Beyond Cholesterol.” 1999. 20 December 2007 <http://www.healthy.net/scr/Article.asp?Id=2967&xcntr=1>.