1. Insulin resistance test
Dr. Joseph Kraft, former chairman of the department of clinical pathology and nuclear medicine at St. Joseph’s Hospital, wrote the book “Diabetes Epidemic and You: Should Everyone Be Tested?” Based on data from some 14,000 patients, he developed a test that is a powerful predictor of diabetes.
Interestingly, he noticed five distinctive patterns suggesting that a vast majority of people were already diabetic, even though their fasting glucose was normal. In fact, 90 percent of hyperinsulinemic patients passed the fasting glucose test, and 50 percent passed the glucose tolerance test. Only 20 percent of patients had the type 1 pattern signaling healthy post-prandial insulin sensitivity and low diabetes risk.
Using Kraft’s test, about 65 percent of Americans or more probably would have hyperinsulinemia or “diabetes in situ.” And, according to Kraft, “Those with cardiovascular disease not identified with diabetes … are simply undiagnosed.”
2. F2 Isoprostanes
We’ve nicknamed this blood test as “The Lifestyle Lie Detector” because it can reveal whether or not our patients are practicing heart-healthy habits.
Because lifestyle is the most important therapy for heart attack and stroke prevention, this test helps motivate patients to actually practice healthy habits, rather than just pretending they do, in the hope of avoiding a lecture from their healthcare provider. The test isn’t just a lifestyle lie detector, however: it also reveals how fast your body is aging—and you might be on the fast track to a heart attack or stroke.
The test measures F2 isoprostanes, a biomarker of oxidative stress, an imbalance between the formation of free radicals and protective antioxidant defenses. Increased oxidation puts you at risk for accelearated aging, cancer and cardiovascular disease. One study found that people with the highest level of F2 isoprostanes were nine times more likely to have blockages in their coronary arteries than those with the lowest level.
Essentially, the goal of the test is to find out how fast your body is oxidizing, or breaking down. The normal F2 isoprostanes level is less than 0.86 ng/L, while an optimal resut is less than0.25 ng/L.
This blood test measures your level of Fibrinogen, a sticky fibrous protein produced by your liver. Fibrinogen helps stop bleeding by causing blood to clot. While fibrinogen’s clotting effects can be lifesaving after an injury, abnormally high levels in the bloodstream can be dangerous, by contributing to the clotting cascade that leads to heart attacks and strokes. Fibrinogen is also a marker of inflammation, but other factors can boost levels, so this test shouldn’t be used as the sole method for checking for fire in the arteries.
The higher your blood level of fibrinogen, the greater risk of cardiovascular events. One large study called the EUROSTROKE project reported that “fibrinogen is a powerful predicter of stroke”, including both fatal and nonfatal strokes, as well as first time strokes, ischemic strokes, and hemorrhagic strokes (those caused by a torn or ruptured blood vessel).
High fibrinogen has also been linked to other diseases including diabetes, cancer and high blood pressure, and is frequently elevated in people with insulin resistant conditions, such as metabolic syndrome. And for people with coronary artery disease, elevated fibrinogen increases the risk that a clot will form if plaque ruptures, setting the stage for a heart attack.
4. High Sensitive C-reactive Protein
5.Microalbumin Creatinine Urine Ratio (MACR)
This test detects small amounts of albumin, a blood protein, in the urine. The term “microalbumin” refers to amounts of albumin that are too small to detect in a urine dipstick test used for routine urinalysis during annual physicals. Having protein in the urine is abnormal, because albumin is a large molecule that circulates in blood and shouldn’t spill from capillaries in the kidney into urine. Therefore, the test checks for a biomarker of endothelial dysfunction, as an indication of vascular disease. The urine ratio compares the amounts of microalbumin with those of creatine (CR), a waste product produced by muscles.
Although this simple urine test costs just pennies, is covered by virtually all health plans, and provides valuable information about arterial wall health, health care providers rarely use it for this purpose, even though it’s an extremely cost effective way to check for arterial disease. Instead, MACR is most commonly used to screen people for diabetes, high blood pressure, or kidney disorders for kidney damage.
6.Lipoprotein-Associated Phospholipase A2 (Lp-PLA2)
This blood test measures Lipoprotein-Associate Phosploipase (Lp-PLA2), a blood vessel specific enzyme that’s mainly attached to LDL “bad” cholesterol. Levels of Lp-PLA2 rise when arterial walls become inflamed, which may indicate that plaque is more likely to rupture, which could lead to a heart attack or stroke. The Lp-PLA2 test was FDA approved for coronary heart disease assessment in 2003 and ischemic stroke assessment in 2005.
This enzyme is now emerging not only as a biomarker of arterial wall inflammation, but also as a direct player in the atheroscierotic disease process, with a recently published study suggesting that Lp-PLA2 plays a key role in cholesterol plaque formation and vulnerability (risk that the plaque may rupture explosively and tigger a heart attack or stroke.) The researchers note that their fndings support reducing Lp-PLA2 as a strategy for preventing CHD. Evidence based guidelines from the AHA and other groups also endorse the test as reasonable to screen symptom-free people who are at intermediate risk for heart disease or increased risk for stroke.
This test asks is there fiery plaque hidden inside the artery wall that might erupt like a volcano?
Lp-PLA2 values of less than 200 ng/mL are considered normal. IN THE Mayo Heart Study, 95 percent of patients with scores under this threshold did not have a heart attack or stroke in the next four years, even though they had coronary artery disease (CAD). The researchers also found that the higher Lp-PLA2 levels, the greater the risk of a first heart attack, stroke, or major CV event. Compared to patients with normal levels, those with scores of 200 to 266 ng/ml had a 70 percent higher risk of these events over the next four years, while a level of of 267 or above more than doubled the risk.
This FDA approved blood test measures myeloperoxidase, an enzyme the immune system uses to fight infection. We call it “the joker” because if its elevated throughout the body—as occurs in about two in fifty people—a similar distribution to the jokers on a deck of cards—all bets are off. Of all the inflammatory biomarkers, it’s the worst: if this wild card, which appears to be genetically influenced, gets played, without the right treatment your game of life might be over.
One reason that MPO is so dangerous is that it produces numerous oxidants that make all cholesterol compounds more inflammatory. This includes HDL, the “good” cholesterol that normally helps clean the arteries, protecting against plaque buildup. If your blood levels of MPO are high, HDL goes rogue and joins the gang of inflammatory thigs. The joker also interacts with hydrogen peroxide in the bloodstream to produce hypochlorous acid (the active ingredient in bleach). Inside the blood vessels, this acid attack can eat holes in the tennis court, making it easier for cholesterol to penetrate and form plaque.
Another of MPO’s nasty tricks in reducing the body’s protection of nitric oxide (NO) the best food to nourish the endothelium and protect its health. Lowering NO weakens the integrity of the tem=nnis court, which can either promote atherosclerosis, or for people who already have plaque in ther arteries, magnify the risk that the cat will leap out of the gutter and cause a heart attack or stroke. The joker also contributes to creating vulnerable plaques by making the normally protective fibrous cap that covers the plaque more prone to rupture. The normal value is less than 420 pmol/l. Elevated MPO predicts future risks for coronary artery disease and cardiovascular events, including fatal heart attacks and strokes. In a recent study, people with high levels of the joker were 2.4 times more likely to die from heart disease over the next 13 years.
8.LDL Particle size