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Heart is a muscular organ located in the chest. The heart and blood vessels comprise the cardiovascular system. The heart pumps blood throughout the body. In spite of the fact that all of the body’s blood flows through it, it needs to be supplied with life-giving blood by its own set of blood vessels. These blood vessels, called coronary arteries, deliver the oxygen that allows the heart to perform its function. When a disease known as atherosclerosis reduces the blood flow from the coronary arteries to the heart, it can cause chest pain, which is called angina. If the blood flow is severely reduced, it can cause death of some of the heart muscle and may lead to a heart attack.
Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease. Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and a substance called plaque builds up on the walls of your arteries. This causes them to get narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop, causing chest pain (stable angina), shortness of breath, heart attack, and other symptoms.
Source: The Framingham Study for developing chronic heart disease.
Cardiovascular disease is a broad term used to describe a range of diseases that affect your heart or blood vessels. Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.
Source: Rafai N, Ridker PM. Proposed cardiovascular risk assessment algorithm using high-sensitivity C-reactive protein and lipid screening. Clinical Chemistry. 2001
Cholesterol is an essential body fat needed to produce substances such as hormones and bile. High levels of cholesterol are usually associated with a higher risk of heart disease and narrowed blood vessels. Lipids included in total cholesterol are HDL cholesterol, LDL cholesterol, and triglycerides.
HDL cholesterol is commonly called “good” cholesterol because it can aid in the removal of excess cholesterol in body tissues and help prevent the accumulation of LDL cholesterol in the arteries. Higher levels of HDL cholesterol are desirable. This result is associated with a low risk of coronary heart disease.
The total cholesterol to HDL cholesterol ratio is a number that is helpful in predicting an individual’s risk of developing atherosclerosis (hardening of the arteries). It is a better predictor of risk than either tests alone. The ratio is obtained by dividing the total cholesterol value by HDL cholesterol value. A high ratio is a risk for heart disease including heart attacks and sudden death. A low ratio suggests a low risk for developing heart disease.
The total cholesterol to HDL cholesterol ratio is not elevated and the risk for heart disease is not elevated. There are many other risk factors for heart disease including weight, blood pressure, tobacco use, physical inactivity, and other laboratory tests that influence one’s overall risk for heart disease.
LDL cholesterol is considered “bad” cholesterol because it can accumulate in the inner walls of your arteries, narrowing them and reducing blood flow. This result is measured directly, and is not influenced by whether you fasted or not or if the triglycerides level is high (greater than 250 mg/dL). Lower levels of LDL cholesterol are desirable. The National Cholesterol Education Program considers LDL cholesterol the most important lipid for assessment of coronary heart disease risk. An LDL cholesterol of less than 130 mg/dL is considered desirable and a result of less than 100 mg/dL is considered optimal. For individuals with diabetes or other evidence of being at high risk of coronary heart disease, a desirable LDL cholesterol level may be less than 70 mg/dL. You should be aware it is also important to consider other factors including smoking, diabetes, blood pressure, family history and the results of other tests in assessing your risk for coronary heart disease.
Triglycerides are fats composed of fatty acids and glycerol. Triglycerides combine with proteins to form particles called lipoproteins that transport fats through the bloodstream. These lipoproteins carry triglycerides from the liver to other parts of the body that need this energy source. Triglycerides then return to the liver where they are removed from the body. The level of triglycerides in your blood can indicate how efficiently your body processes the fat in your diet. Accurate results require a minimum of a twelve-hour fast (no food or drink except water and medication) prior to testing.
CRP stands for “C-reactive protein” which is made by the liver in response to infection, tissue injury or inflammation. Even low values, previously regarded as normal, have been shown to be a risk factor for atherosclerosis (fatty deposits lining the walls of blood vessels). Results of this test can help predict your risk of developing atherosclerotic heart disease. Build up of these fatty deposits can cause chest pain, called angina, and eventually lead to a heart attack. Your risk increases with increasing levels of CRP. A desirable Cardio CRP is less than 1 ng/mL. Increased heart disease risk is associated with Cardio CRP levels exceeding 3 ng/mL with levels between 1 and 3 ng/mL suggesting borderline increased risk. When Cardio CRP result is greater than 15.0 mg/L, risk analysis may be confused by a recent infection or illness. If this is noted, wait at least two weeks after resolution of any infection or illness and have another test performed.
Apolipoprotein A-1 (Apo A-1) is the major apolipoprotein of high density lipoproteins (HDL or the “good cholesterol”). The protein promotes cholesterol export from tissues to the liver for elimination. Increased levels of ApoA-1 are desirable and low levels undesirable. Studies suggest that Apo A-1 and Apo B may be a better predictor of cardiovascular disease than the traditional lipids HDL cholesterol and LDL cholesterol and the former tests are not dependent upon a having individuals fast in preparation of specimen collection.
Apolipoprotein B (Apo B) is the primary apolipoprotein of low density lipoproteins (LDL or “bad cholesterol”), that is responsible for carrying cholesterol to tissues throughout the body. ApoB is the primary apolipoprotein component of LDL and required for its formation. Though it is not fully understood, high levels of Apo B can lead to plaques that cause heart disease (atherosclerosis). Studies suggest that Apo A-1 and Apo B may be a better predictor of cardiovascular disease than the traditional lipids HDL cholesterol and LDL cholesterol and the former tests are not dependent upon a having individuals fast in preparation of specimen collection.
The ratio of Apo A-1 to Apo B is useful to assess risk of coronary heart disease, a leading cause of death. Studies suggest that Apo A-1 and Apo B may be a better predictor of cardiovascular disease than the traditional lipids HDL cholesterol and LDL cholesterol and the former tests are not dependent upon a having individuals fast in preparation of specimen collection. The higher the ratio of Apo A-1:Apo B, the lower the risk of coronary heart disease. Other risk factors for coronary heart disease should be considered including family history of heart disease, tobacco use, diabetes, overweight/obesity, and other independent laboratory tests such as Cardio CRP.