What do your blood markers say about your cardiovascular disease risk (your risk of heart attack or stroke)

A question that patients, and prospective patients ask me all the time is: which blood tests do you recommend I should have? A lot of factors play into my answer, mostly determined by

  • your age

  • your current health goals

  • your underlying risk factors for major diseases

One of the most common risk factors that I pay attention to, especially as my patients are hitting 40 years old and beyond - is the risk of Atherosclerotic Cardiovasular Disease (ASCVD). This includes the big ones that we hear most about: heart attack and stroke. Heart attacks are still one of the leading causes of death, and there is a lot we can do to lower the risk. But first - wouldn’t it be great to know more about what your current risk level is?

There is no perfect test that gives 100% certainty on your risk of ASCVD, but there are a suite of blood tests that when looked at together will help to paint a picture of all the risk factors that are relevant for you right now.

  • Lipid profile

    • Total cholesterol

    • HDL-C

    • LDL-C

    • Triglycerides

  • ApoB

  • Lp(a)

  • Homocysteine

  • HOMA-IR

    • fasting insulin

    • fasting glucose

  • hsCRP

  • Vitamin D

  • Thyroid hormone panel

    • TSH

    • fT4

    • fT3

  • Electrolytes

    • sodium

    • potassium

    • chloride

    • bicarbonate

  • Reproductive Hormones

    • estrogen

    • testosterone

    • DHEA

The optimal reference ranges I look at are more narrow than the medical reference ranges. These optimal ranges are all about how to stay well, how to address all the factors that are impacting your risk of heart disease - not just the one that your doctor may be focusing on, and not waiting until you’re already in the full blown disease state to take action. I’ll describe the most important below:

Total cholesterol - 4.5-5.5 mmol/L

There is a lot of controversy and disagrement about how high is too high and how low is too low. I am not in the “closest to zero is best” category, I typically see people be quite symptomatic once their total cholesterol becomes lower than this optimal reference range. Likewise - if it’s above this optimal reference range - you should make some significant changes to the way you’re doing things.

HDL-C >1.8 mmol/L

Often misnamed “good” cholesterol, it describes the lipoproteins that are transporting lipid particles back to your liver.

LDL-C <3.8 mmol/L

Often misnamed “bad” cholesterol, it describes the lipoproteins that transport cholesterol particles to the cells and around the body.

Triglycerides 0.5-1.0 mmol/L

One of the most important lipid markers I pay attention to. Above this optimal range and it shows that you are like over-nourished - usually too many calories!

Homocysteine 6-7 mmol/L

Jury is still out on whether homocysteine plays a causative role, or is a result of the disease process. It’s a marker of methylation, and when everything in your body is working fantastically, your homocysteine will be between 6 and 7. This means your DNA is replicating just nicely, you’re able to switch off your bad genes and turn on your good genes, and able to detoxify efficiently - among many many other things.

HOMA-IR <1.0

HOMA-IR is the Homeostatic Measure of Insulin Resistance - and tells us how far down the track you are on the progression towards type 2 diabetes and insulin resistance. Insulin resistance is a huge driver of heart disease/ASCVD.

Vitamin D >80 mmol/L

Some argue that vitamin D should be well above this optimal lower limit. Cholesterol is a precursor to vitamin D, and when your vitamin D is low - your cholesterol can creep up in response. Ready and waiting for your body to convert into vitamin D the next time you get outside into the sun. Some sun exposure is considered a vital part of our health, but it doesn’t need to be much, and you absolutely must avoid getting sunburnt at all costs!

Thyroid Hormones: TSH 0.5-1.5 | fT4 15-19 mmol/L | fT3 4.5-6.0 mmol/L

Cholesterol can increase in response to your thyroid hormone level being too low, so this is a good marker to check if your cholesterol is high and you’re considering your next steps. Addressing any underlying cause for your high cholesterol will help your body to function better, as well as making it likely that your cholesterol will come down closer to a healthy range.

Sodium 140-144 mmolL

This important electrolyte will often be low in response to low thyroid hormone, it can also be low due to under-performing adrenal glands. Low levels of adrenal hormones can lead to an upregulation of cholesterol levels in the body.

DHEA, Estrogen & Testosterone

Cholesterol is a precursor to these reproductive hormones, and if your hormone levels are low, this can be a reason your production of cholesterol is upregulated.

Almost all of these markers can change significantly over time. Improvements in these markers come as you make positive changes to your diet, your overall nutrition status, exercise and stress, supplements and medications. These markers can also deteriorate with negative factors impacting your health - increased stress, poor diet, alcohol intake, wrong supplements or no supplements, not having correct medications for your needs.

Clare Pyers