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A-Z Lab test

A laboratory (lab) test is a procedure in which a health care provider takes a sample of your blood, urine, other bodily fluid, or body tissue to get information about your health. Some lab tests are used to help diagnose, screen, or monitor a specific disease or condition.

Important Blood Tests to Get

Important Blood Tests To Get

Important Blood Tests To Get

Important Blood Tests to Get

Preventive medicine is rapidly advancing towards a more personalized approach. This shift is driven by international medical organizations that prioritize disease prevention and develop clinical recommendations that account for various risk factors. Despite this, many medical centers still offer a standard list of tests to all patients, disregarding individual risk factors and updated recommendations. This approach can lead to delayed diagnosis of many diseases. It is crucial to understand which important blood tests to get based on individual needs and risk factors to avoid missing a potential illness. Additionally, understanding which tests to get can also help avoid unnecessary tests, false diagnoses, and treatments that can lead to excess mortality.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2022. This article was last modified on 3 March 2023.

Screening examinations

Let’s delve into the concepts of diagnostic and screening tests. If you visit a doctor with specific complaints and they prescribe a list of tests, those are diagnostic tests. However, if the doctor also recommends tests unrelated to your complaints, those are screening tests. While diagnostics are relatively straightforward, screenings can be more complicated.

If you’re experiencing symptoms, diagnostic tests can help identify the underlying cause. These tests are tailored to your specific needs and symptoms. On the other hand, screening tests are typically used to detect a particular disease or condition before symptoms develop. These tests are often recommended based on age, sex, family history, or other risk factors, even in the absence of symptoms.


However, screening tests are not always necessary or appropriate for everyone. Some tests may carry risks or lead to unnecessary interventions and treatments. That’s why health screening can be complex. Many articles on screening present a staggering array of medical data, and many reputable organizations offer their own (often differing) recommendations on screening. But where do these differences come from?

One reason for differing screening recommendations is the varying levels of evidence supporting them. Some tests may have a strong evidence base, while others may not. Additionally, different organizations may prioritize different outcomes, such as mortality reduction or cost-effectiveness. For example, a screening test that is highly effective at reducing mortality may also be expensive or carry risks, leading some organizations to recommend against it.

Diseases that are good candidates for screening are those that are widely prevalent and cause significant morbidity and mortality. For example, in the United States, good examples are heart disease and lung cancer. On the other hand, trypanosomiasis may be a good target for screening in Tanzania, but not in the United States. Thus, screenings depend not only on gender and age, but also on the place of permanent residence. But that’s not all.

The Factors for Assessing the Need for Screening

There are several factors that contribute to identifying which blood tests are important to get and will provide benefits. For example, it makes no sense to screen for diseases that have no asymptomatic period. Additionally, even if there is an asymptomatic period, it is necessary to consider whether treatment started before symptoms appear will reduce morbidity or mortality. The effectiveness of treatment should also be considered as a factor in the need for screening. Why screen for a disease that cannot be cured?

When it comes to screening for diseases, the next important factor to consider is selecting the appropriate screening test. Medical researchers aim to find tests with high sensitivity and specificity, but no test is perfect. For instance, the screening approach for diabetes has changed multiple times. Prostate cancer screening using PSA1 is known for having a high rate of false positives, which can lead to additional testing. Conversely, normal levels of biomarkers may be present in someone undergoing cancer treatment that produces those biomarkers2. Thus, it’s crucial to ensure that you have been recommended the best screening test available before getting important blood tests to get. However, this is just one of the many factors that need to be taken into consideration before deciding on a screening test.

The next factor that should be considered is the family history of diseases. Studying the hereditary risk factors allows for not missing potentially dangerous diseases, which are usually not screened for in a wide range of people because they are rare. For example, there are multiple methods for testing mutations in genes such as BRCA1 and BRCA2. The most accessible and affordable method is PCR testing, but it’s also the least accurate, diagnosing only 5% of all mutation cases. Therefore, if you have a family history of breast or ovarian cancer, it’s recommended to use more advanced screening methods like NGS. It’s crucial to take all of these factors into account when determining which important blood tests to get to ensure early detection and prevention of potentially life-threatening illnesses.

Interesting Fact

Do you know that there are several methods for testing mutations in the BRCA1 and BRCA2 genes? The most accessible and inexpensive one is PCR testing for mutations in the BRCA1 and BRCA2 genes. And as you might guess, it is the least accurate. Only 5% of all cases of mutations will be diagnosed by this testing method. Therefore, if you have a family history of breast or ovarian cancer, the NGS method is used as a screening method.

What Important Blood Tests to Get?

Fortunately, medical organizations such as the US Preventive Services Task Force, the American Society of Clinical Oncology (ASCO), the Centers for Disease Control and Prevention, and others, develop and publish their guidelines on screening and prevention of diseases, including important blood tests to get. Typically, these guidelines take into account risk factors, assess the benefits and harms of screening, and recommend the most optimal screening tests. In addition, they are constantly updated, allowing for the latest research on disease prevention to be utilized.

Thus, you can compile a list of tests that are specifically needed for you. This same list can be obtained using platforms such as Healsens. Typically, such a list of screening tests includes:

  • Cancer screenings
  • Screenings for the most common age-related diseases
  • Laboratory tests for general health maintenance

And this is actually a great idea to accumulate all recommendations because the medical field often undergoes changes and updates. Collecting information about which tests to take in one place, as well as monitoring them carefully and linking to sources, can help doctors keep up with the latest developments and improve the quality of their work. In turn, patients can obtain more reliable information about screenings and health recommendations.

Overall, the Healsens checkup plan appears to be a comprehensive and personalized approach to preventive health maintenance, utilizing the latest medical guidelines and research to provide individuals with the most appropriate screening tests for their individual needs.

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mammogram screening guidelines


In one of our previous articles, we wrote that mammography (MMG) is a screening diagnostic method for breast cancer. Today, we would like to expand on this topic and have invited a specialized specialist to share information about MMG and the current mammogram screening guidelines being used.

This article was written by Y. Timovskaya, Ph.D., doctor oncologist of the highest category, Member of ESMO with the help of A Galishyna, head of the diagnostic department of the Specialized Breast Center, a doctor of radiation diagnostics, member of ESR, EUSOBI. This article was last modified on 10 August 2021.

It has been proven that regular examinations increase the rate of early detection of breast cancer.

👉 But are all examination methods (examination, mammography, ultrasound) equally effective for the early detection of breast cancer?
👉 And how often should they be applied: annually, every six months, or are there other options?

Today we will deal with these issues.

Early Diagnosis of Breast Cancer

For early detection of breast cancer, especially preclinical forms, the effectiveness of mammography (MMG) and magnetic resonance imaging (MRI) of the mammary glands with contrast enhancement has been proven. Ultrasound examination of the mammary glands is a useful addition to them. When choosing a diagnostic method, there is no universal approach that would suit everyone.

The results of breast cancer treatment directly depend on the stage at which the treatment of this disease is started. The smaller the stage, the shorter, cheaper, and more effective the treatment. Therefore, the whole world is fighting to identify the early, if possible, preclinical stages of breast cancer (we wrote about what clinical breast cancer is in a separate article).


At the same time, it is necessary to take into account the patient’s age, complaints, anamnesis, clinical examination data, and the results of previous medical tests.

Ultrasound Breast Screening and Mammogram: definition

✔ Mammography (MMG) is an X-ray method for breast examination, which is the gold standard for diagnosing breast cancer. It perfectly detects microcalcifications, one of the early signs of breast cancer. The most important thing when using MMG is the fact that even standard views allow you to visually assess the full volume of an organ.

✔ Ultrasound – ultrasound examination of breast tissue, an additional diagnostic method. Suitable for patients with increased density of breast tissue (women under 35-40 years old). Therefore, it may be more appropriate for patients under 35-40 years of age to have an ultrasound scan rather than mammography (MMG). It is also the best method for fragmentary assessment of breast tissue. It is also used for the differential diagnosis of some formations. These, for example, include formations with a clear outline, identified on mammography.

Each of these methods has advantages and disadvantages. There are no absolute contraindications to their implementation.

How to Choose Diagnostic Methods

As we wrote above, each clinical case requires an individual approach in the selection and examination sequence.

So, for example, if a patient has complaints, her examination is diagnostic in nature. In this case, the doctor’s task is to choose the most appropriate diagnostic method. The aim will be to find out the reason for the complaints, the nature of the process, and the extent to which it has spread.

It’s worth saying that a multimodal approach is often used. In such cases, a combination of several methods is used (MMG + ultrasound, MMG + MRI, using interventional techniques). It is also important to note that doctors sometimes need to apply special techniques within the same research method. For example, in the case of MMG, these are spot view, magnification view(s), Cleopatra’s view, etc1.

But in any case, the doctor is responsible to choose the appropriate diagnostic methods and techniques. Therefore, it is very important to contact specialists who can use the entire arsenal of diagnostic methods.

Is it possible to avoid examinations if there are no complaints from the breast?

The American Society of Breast Surgeons says that all women over the age of 25 must have a formal breast cancer risk assessment. You can do it yourself, or go through the risk assessment according to the NCCN guidelines in Healsens (below there will be links to download the app). After such an assessment is made, categories of patients without complaints should undergo screening. If a woman is not at risk, then such examinations can be started from the age of 40+. But we’ll talk more about mammogram screening guidelines below. If the risk of breast cancer is above average, then annual screening mammograms should be started at an earlier age, and in addition to mammography, additional examinations may be required.

Mammogram vs Ultrasound

It is worth pointing out what the limitations are for each diagnostic method. Thus, it will become more obvious what is decisive when choosing a diagnostic method. So, for ultrasound, the following limits are distinguished:

  • the predominance of adipose tissue in the structure of the mammary gland in patients over 40 years of age with symptoms of fibrous-fatty involution of the breast tissue (age-related changes);
  • the presence of large skin lesions. For example, with skin diseases and inflammatory processes.

Since ultrasound assesses the gland tissue fragmentarily, section by section, for patients with large breast sizes, this method is also not very suitable. This is due to the fact that there is a high risk of missing small formations.

Mammography is not recommended without direct indications (suspected cancer) during pregnancy and lactation. In addition, in young patients, the diagnostic value of MMG decreases. This is due to the fact that young women have a higher density of breast tissue. And finally, we add that MMG is also ineffective in the presence of inflammatory diseases of the mammary glands.

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Mammogram screening guidelines

At the moment, medical guidelines aim for an individualized approach, taking into account personal risks. Generally, the higher the risk of breast cancer, the earlier and more often screenings are recommended. So, for example, the American Cancer Society divides women into risk groups.

For Women at Increased Risk of Breast Cancer

✔ It’s recommended annual MMG from age 30 for women at increased risk of breast cancer2. This group includes patients with mutations in the BRCA1 or BRCA2 genes. And also if it is known that mutations in these genes have been identified in first-line relatives.

In addition, other mammogram screening guidelines distinguish the medium-risk group of women who have been treated for ovarian cancer3 or bowel cancer before age 354. Similarly, this risk zone includes women who have close relatives who have had breast cancer and ovarian cancer.

Some sources suggest starting screening MMG for women from this group no later than 10 years before the age at which breast cancer was detected in 1st or 2nd line relatives5. These are sisters, mothers, aunts, grandmothers (both on the mother’s side and on the father’s side). But screening should be started not earlier than 25 years old.

As you can see, everything is very individual.

For example, if the patient’s mother had breast cancer at the age of 36 when her daughter needs to undergo annual examinations, starting at the age of 26. The choice of the method for these annual examinations should be made by the physician, depending on the findings of the clinical examination.

For Women with Low Risk of Breast Cancer

For women with an uncomplicated medical history, it is recommended to carry out screening MMG from 40 years according to the scheme6:

  • once every 2 years from 40 to 50 years old and after 70 years old,
  • once a year at the age of 50-70 years old.

Therefore, all women over 40 should be offered MMG, with possible additional research. In all other cases, the approach to the diagnostic method should be completely individualized.

And in conclusion, adherence to the indicated intervals allows for the most effective detection of breast cancer in the early, often preclinical stages. The main problem remains the low awareness of general practitioners and patients about the problem of breast cancer, as well as the need to perform screening MMGs.

What you need to tell the doctor to determine the research method

Before taking the examination, it is recommended to inform the doctor about the following problems, if any:

  1. A history of oncological diseases (such as breast cancer, ovarian cancer and colon cancer) in the patient or relatives.
  2. Previous breast surgery and past trephine biopsies.
  3. The presence of chronic diseases (especially endocrinological and gynecological) and the constant intake of drugs, especially contraceptives and hormone replacement therapy drugs.
  4. Menstruation (age of onset of menstruation, duration of menopause, regularity of the menstrual cycle), number of pregnancies and childbirth, duration and nature of lactation.
  5. The presence of complaints from the mammary glands (cyclical changes before the onset of menstruation and their severity, pain outside the menstrual cycle, discharge from the nipples, induration).
  6. Results from previous breast studies.

After analyzing the patient’s survey data, the doctor will choose the best diagnostic method. The decisive factors here are the age and timing of previous studies. Because compliance with them allows you to correctly assess dynamic changes.

👉 And finally, the information received on time is the most important!

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Source: ©️2019 Healsens B.V. All right reserve


Соотношение кортизол/ДГЭА-С


A complex interaction between cortisol and dehydroepiandrosterone-sulphate (DHEA-S) is crucial in the stress system balance. In particular, significantly higher or lower cortisol/DHEA(S) ratios have been associated with depression1 and aggression2. In general, DHEA-S levels affect various body systems, as well as prevent aging (Chahal and Drake 2007). That is why the Cortisol DHEA ratio is a very informational indicator, which, along with other indicators calculated in Healsens, provides important information about human health. Thus, using the ratio of cortisol / DHEA-S, you can assess body responses to exercise or evaluate mental health. Another benefit is that you can check your cortisol and DHEA-S levels at home.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 4 March 2021.

How Cortisol and DHEA Sulfate Affect the Body

Let’s start by looking at how cortisol and DHEA-S affect overall health. Dehydroepiandrosterone (DHEA) and cortisol are produced in the adrenal glands and are both derived from pregnenolone. So, DHEA and DHEA-S production reaches its peak at the age of 20–30 and then declines progressively with age. When it comes to cortisol levels, while some studies show that cortisol increases with age3, others do not support this observation4. However, everyone agrees that the reduction in DHEA-S entails disruption of various physiological systems.

Stress Level

As mentioned above, DHEA and DHEA-S play a protective role during acute stress as an antagonist to the action of the stress hormone cortisol56. In turn, cortisol also helps to effectively manage stress. Let’s see how this happens.

About 15 minutes after a stressful situation, cortisol levels rise and remain elevated for several hours. This marks the onset of stage 1. During this stage, there are elevations in cortisol with no corresponding changes in DHEA. Subsequently, glucose is mobilized, non-essential organ systems are suppressed, and inflammation is reduced. All of these physiological responses collectively enable the body to effectively cope with stress.

However, in cases of chronic stress, this adaptive reaction can take a catastrophic turn: cortisol loses its ability to function normally. This transition ushers in stage 2. In this latter stage, the persistence of stress leads to a sustained peak in cortisol levels, matched by a corresponding elevation of DHEA.


It becomes increasingly challenging to maintain appropriate blood sugar levels, to allow for adequate rest, to achieve high-quality sleep, and to achieve a harmonious balance among other hormones. This signals the arrival of stage 3, wherein stress persists and becomes chronic. During this stage, cortisol levels decrease, while DHEA remains elevated. In the absence of timely intervention, prolonged adrenal hyperstimulation can result in adrenal exhaustion. This condition is eventually manifested by a decline in both cortisol and DHEA, a phase often denoted as adrenal exhaustion or stage 4. Ultimately, this process may culminate in adrenal failure.

Thus, the optimal ratio between salivary cortisol and DHEA is approximately 5:1 to 6:1, serving as an indicator of a normal state of adaptation to stress7.

When the body’s ability to maintain its normal stress adaptation is compromised, a process known as stress maladjustment can ensue. This phenomenon is now recognized as a chronic stress response, often identified by terms like pregnenolone steal, cortisol escape, or an elevated cortisol to DHEA ratio. The longer one remains in a state of chronic stress, the more pervasive its negative impact becomes on various aspects of physical well-being.

As a result, individuals grappling with depression or heightened anxiety levels (measured at 0.24 ± 0.03 in the healthy group compared to 0.41 ± 0.12 in the group of individuals with severe anxiety)8, along with those dealing with post-traumatic stress disorder, exhibit disruptions in the cortisol to DHEA ratio9. Nevertheless, it’s worth noting that certain studies have demonstrated the potential of DHEA treatment to mitigate the adverse health effects associated with stress.

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Musculoskeletal disorders

We have already mentioned that cortisol dysfunction entails disorders of the musculoskeletal system10. Thus, the higher the cortisol / DHEA-S ratio, the more serious the risk of this problem.

Moreover, multiple regression analysis showed that the independent risk factor for sarcopenia was a serum cortisol/DHEA-S ratio ≥ 0.211. Sarcopenia is a type of muscle loss that occurs with aging and/or immobility.

Immunity and Cortisol DHEA Ratio

In addition, an increase in the cortisol / DHEA-S ratio with age (Phillips et al. 2007) is associated with immune dysfunction and the risk of infection in the elderly due to the fact that DHEA-S enhances immunity. However, cortisol has an inverse immunosuppressive effect (Buford and Willoughby 2005). It is also worth adding that DHEA-S is known for its antioxidant properties12.

Metabolic Syndrome

Various studies have shown that both cortisol and DHEAS are related to metabolic syndrome13, and type 2 diabetes14. While high cortisol concentrations are associated with an increased risk of metabolic syndrome, high DHEA-S levels appear to be protective. By far, the strongest associations were observed for the cortisol / DHEA-S ratio. According to observations, the higher the coefficient, the greater the risk of metabolic syndrome. This ratio is also strongly associated with four of the five components of metabolic syndrome.

Alzheimer’s Disease

The cortisol / DHEA-S ratio may also be crucial in Alzheimer’s disease. For example, some studies have found a link between the cortisol / DHEA-C ratio and a decrease in hippocampal volume15. It is worth saying that a decrease in the volume of the hippocampus is one of the early diagnostic signs of Alzheimer’s disease.

This finding has been confirmed by other studies, observing the relationship between cortisol / DHEA-S and hippocampal atrophy (HA)1617. For example, such a direct relationship was observed in patients with Cushing’s syndrome18. Moreover, HC volume partially recovered following treatment-induced cortisol decrease. However, not all studies support this association within normal cortisol levels in healthy people19.

To sum up, the ratio of cortisol / DHEA sulfate can reflect:

  • psychological health (high level of anxiety, depression, etc.).
  • more favorable hormonal profile which implies higher levels of DHEA sulfate and a lower cortisol / DHEA-S ratio.
  • increased risk of sarcopenia.
  • increased risk of metabolic syndrome and type 2 diabetes.
  • mortality in general, which is strongly associated with the cortisol / DHEA-S ratio

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 4 March 2021.

Assessing Exercises

DHEA (Aldred et al. 2009; Cumming et al. 1986) and DHEA-S (Tremblay et al. 2004) have been shown to increase in response to active exercise. Measuring the ratio of cortisol to DHEA-S can help determine the intensity of physical activity. A higher level of cortisol and/or a lower level of DHEA-S may indicate significant physical stress. This can be valuable information for assessing whether the workout is sufficiently intense or if a lighter approach is needed to prevent overtraining. However, resistance training showed a stronger increase compared to endurance training (Tremblay et al. 2004). It’s also worth noting that trained and untrained people can cause different hormonal responses to exercise. So, untrained people experienced more significant increases in DHEA and cortisol levels2021. Such result was observed in both young people and people over 60 years old22.

How to define intensity of exercise?

For this purpose, the researchers used heart rate (HR) indicators. So the exercise was stopped as soon as the participants had reached 75% of their maximum HR. You can also determine maximum HR by the Tanaka formula:

208 − (age × 0.7)

So, for a 65-year-old person, the maximum heart rate will be 162 beats per minute. Consequently, 75% of this figure will be 121 bpm. Healthwise, muximum loads are not advisable. Therefore, it is recommended to use between 50% and 80% of the maximum.

Research has shown that 16 weeks of regular exercise decreased cortisol/ DHEA ratio by nearly 30%. In addition, athletes with the highest performance levels and the greatest amount of training had the lowest ratio. So,

Healthy Cortisol/DHEA-S Ratio

1 : 5 – 1 : 6

1:6 corresponds to 0.167 & 1:5 corresponds to 0.2

Adrenal/DHEA Restoration

High Adrenal/DHEA-S Ratio

Taking this into account, DHEA supplementation may be considered. Research confirms that it has a significant effect on the concentration of cortisol. For example, even a single morning dose of 200 mg DHEA can lower cortisol concentrations23. Moreover, in women, such a decrease was more pronounced.

An earlier study in healthy people came to the same result24. By the way, researchers also found that taking DHEA (300 mg) did not improve memory. However, supplementation is rational only in cases of decreased DHEA-S levels. In addition, it is important to monitor the sex steroid hormones as well as DHEA-S, because both deficiency and excess of DHEA can lead to negative symptoms.

In addition to DHEA supplements, your doctor may recommend pregnenolone25 and seriphos (phosphatidylserine)26. Seriphos was developed to aid in lowering cortisol. Besides, it contains key nutrients for stress resiliency. As for about pregnenolone, it is a steroid hormone. It plays a key role in the production of other steroid hormones, such as progesterone, DHEA, and estrogen.

Research also shows that fish oil supplements2728 and an Asian herbal medicine called ashwagandha both help to reduce cortisol levels29.

Calculated Cortisol/DHEA-S Ratio in Healsens App

Clinical Note

Improving adrenal function (augmenting DHEA and pregnenolone) can significantly enhance thyroid function, thereby reducing the amount of thyroid medication necessary. If this possibility is taken into account, it is suggested that any patient on thyroid should be closely monitored and lower dosages of pregnenolone and DHEA should be initially considered.

Low Adrenal/DHEA-S Ratio

So, as discussed in previous chapters, exercise has a positive effect on DHEA and cortisol levels. Besides, your doctor may recommend taking licorice extract. This is because licorice helps the adrenal glands prevent the breakdown of cortisol. In some cases, cortisol supplementation may be required.

Either with increased and decreased cortisol / DHEA-S ratio, an adrenal support program is recommended. So, try to balance your intake of protein, healthy fats, and carbohydrates. It will also be very beneficial to increase your vegetable intake to get the required amount of vitamins and minerals. To this end, foods high in vitamin C, B-5, B-6 and magnesium will assist in maintaining adrenal health.

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Source: ©️2019 Healsens B.V. All right reserve


treatment for vitamin d deficiency


Vitamin D deficiency affects people of all ages. Last time we analyzed in detail how a deficiency of this vitamin affects our health. This time we will talk about natural and medical treatment for vitamin D deficiency.

This article was last reviewed by Svetlana Baloban, Healsens, on October 24, 2020. This article was last modified on 29 October 2020.

Let us start with how we define vitamin D deficiency.

In summary, a deficiency occurs when the serum 25-hydroxyvitamin D level is less than 20 ng/ml (50 nmol/L)12.

If your serum 25-hydroxyvitamin D level is between 20 and 30 ng/ml (50 to 75 nmol/liter), then we are talking about vitamin D insufficiency.

Values of less than 10 ng/ml refer to severe vitamin D deficiency. We will analyze the approach to treat this deficiency separately.

Treatment for vitamin D deficiency

Sunbathing, which we wrote about last time, is a great way of treating vitamin D deficiency. Another way to increase vitamin D levels in the body is food. In spite of the fact that food will not give you as much vitamin D as the sunlight, when combined with sun exposure it will work quite well. So make sure that your winter and summer diet includes oily fish (salmon, mackerel, tuna), egg yolks, cheese, liver, as well as enriched dairy and cereal-grain products.


In addition to sunbathing, those who have a lack of vitamin D (especially with critical numbers, when 25 (OH) D is less than 20 ng/ml) are advised to take vitamin D as a supplement. It should be said that an increase of 25(OH)D levels through dietary intake is quite individual.

How much vitamin D should I take if I’m deficient?

So, the amount of vitamin D needed to treat a deficiency depends largely on the degree of the deficiency and the underlying risk factors.

Initial supplementation with Vitamin D3 for 8 weeks, either 6,000 IU daily or 50,000 IU weekly, can be considered34. When the vitamin level exceeds 30 ng/ml, the daily maintenance dose will be 1000 to 2000 IU.

Higher-risk adults may require higher starting doses of vitamin D3. These people include African Americans, Hispanics, people with obesity, chronic illness, and taking certain medications. Typically, your doctor may prescribe 10,000 IU of vitamin per day. For such people, maintenance doses can range from 3000 to 6000 IU / day. So if you are at risk, it is better to discuss the treatment with your doctor. This is due to the fact that for some diseases, an individual approach to the dosage of vitamin D is required.

It is recommended that both D2 and D3 be taken with a diet containing fat to ensure maximum absorption.

Don’t be surprised if it will take you half a year or more to achieve the optimum levels of this vitamin. Furthermore, when the desired level of vitamin D is achieved, to sustain it you will need to take 1000-2000 ME a day and regularly control its level to prevent its overaccumulation in your body. Vitamin D3 (cholecalciferol) is considered to be more effective than vitamin D2 (ergocalciferol), although some recent studies have proven them equally effective.  

The dosage of vitamin D to correct severe vitamin D deficiency (<10 ng/mL)

Although not validated by clinical trials, a commonly applied strategy is to prescribe a “loading dose”. For example, 50,000 IU of vitamin D orally once weekly for 2-3 months, or 3 times weekly for 1 month5.

On the other hand, treatment regimen studies have shown that a minimum total dose of 600,000 IU was most effective in achieving vitamin D sufficiency6.

The study examined the following common treatment regimens, namely:

  • 50,000 IU of D2 once weekly for 4 weeks followed by 50,000 IU once monthly for 5 months;
  • D2 50,000 IU once monthly for 6 months;
  • D2 50,000 IU 3 times weekly for 6 weeks.

Regimens where vitamin D2 intake> 600,000 IU administered over an average of 60 +/- 40 days provided the best option without vitamin D toxicity.

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Maintenance Dose of Vitamin D

The recommended concentrations of 25(OH)D vary from 30 to 60 ng/mL. There is currently no evidence that values of 61-100 ng/mL provide health benefits. Along with taking preventing and maintaining doses, it is advisable to test your 25(OH)D in blood every 6-12 months. First of all, this recommendation is associated with a risk of falling below the levels of vitamin D. For example, some studies suggest that a maintenance dose of 2,000 IU of vitamin D may not be sufficient7.

It’s worth noting that in order to prevent vitamin D deficiency people aged 18-50 should receive 600-800 ME a day, those older than 50 – as much as 800-1000 ME a day. It is not recommended to prescribe more than 10,000 ME a day for a long period (more than 6 months) without medical supervision and control. Due to its lipophilicity, its accumulation in fat tissue may result in vitamin D becoming toxic.

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Source: ©️2019 Healsens B.V. All right reserve


vitamin a immune system


Vitamins are essential constituents of our diet that have been known to influence the immune system. But which vitamins have proven effective to help our immune system? Is a healthy diet enough? All these questions are constantly raised and become especially burning during epidemics. In turn, many studies test hypotheses and publish the results, sometimes breaking quite common myths. This time, to further expand on the topic of immunity health, we will review how vitamin A affects the immune system. We will also answer the question of how to check a deficiency / excess of this vitamin.

This article was last reviewed by Svetlana Baloban, Healsens, on February 23, 2020. This article was last modified on 22 February 2020.

To begin with, we note that vitamins cannot be sufficiently synthesized by our body and must come to us with food. So Albert Szent-Gyorgyi, who won Nobel Prize in Physiology or Medicine, said that “Vitamins and their metabolites are essential for a large number of physiological processes”. And that’s true. Vitamins and their metabolites are essential for a large number of physiological processes. They play an important role in the immune system, extending to both innate and adaptive immune responses

Vitamin A Helps Immune System


Many people know that vitamin A is crucial for maintaining vision. And, of course, who has not heard that it is widely used in cosmetics?! Vitamin A turned out to be the first vitamin approved by the Food and Drug Administration as an anti-wrinkle agent.1. Thus, it confirmed its ability to change the appearance of the skin surface and has anti-aging effects.

However, its functions do not end there. So, it is crucial for promoting growth and development and protecting epithelium and mucus. Did you know that it’s also called an anti-inflammation vitamin? It has to do with its critical role in enhancing immune function. For this function, vitamin A should be referred to as the vitamin that helps our immune system.

In turn, vitamin A deficiency impairs innate immunity by impeding the regeneration of mucosal barriers damaged by infection. It’s not just that our innate immunity suffers, but vitamin A is also required for adaptive immunity2. In severe cases, the immune system is so weak that it cannot even cope with a common cold.

There are several reasons why vitamin A deficiency may develop. First of all, nutritional deficiencies can affect the lack of this vitamin. So, we obtain vitamin A through diet in two forms. Retinol and retinyl ester come from animal sources such as meat, dairy products, and fish. Provitamin A (beta-carotenoid) is derived from colorful fruits and vegetables. Insufficient intake of the vitamin with food may result in its deficiency.

Second, vitamin deficiency is associated with certain diseases, such as liver disorder. Moreover, infectious diseases transiently depress serum retinol concentrations. Zinc deficiency can also impair the absorption, transportation and metabolism of vitamin A.

Let’s see how often vitamin A deficiency occurs in people?

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Vitamin A Deficiency and Its Impact on the Immune System

Vitamin A deficiency (VAD) is the single most important cause of childhood blindness in developing countries. Dietary surveys indicate that many US adults are not meeting dietary requirements for vitamin A3. According to their results, 51% of adults fall short of the Estimated Average Requirement.

But what about the situation in other countries? ? In 2018, a paper was published about vitamin A intake in China among 12,246 adults aged 18 to 64 years old. Approximately 87% of adults didn’t consume enough vitamin A4. Remarkably, retinol intake was significantly higher in younger adults compared to older adults, and in males compared to females.

Therefore, understanding the symptoms of vitamin A deficiency can be very helpful. So, classic symptoms include problems such as dry eyes and night blindness. Although eye problems are the most well-known issues related to vitamin A deficiency, this symptom may not be observed. Therefore, we consider other symptoms.

Dry skin also is suggestive of its deficiency but can be due to other causes. Moreover, poor wound healing, as well as acne, may indicate a problem of vitamin A.

To diagnose vitamin A deficiency, a serum vitamin A/retinol analysis is used. This lab test will be useful if levels are under 28 μg/dL. In this case, it will indicate an acute shortage. However, this analysis is not suitable if deficiency is mild. This is due to the fact that serum retinol concentrations don’t begin to decline in healthy individuals until liver reserves of vitamin A are dangerously low.

How is vitamin A deficiency treated and prevented?

In order to prevent vitamin A deficiency, it will be enough to include foods rich in vitamin A into your diet. Concentrations of preformed vitamin A are highest in liver and fish oils. Other sources of preformed vitamin A include such foods as:

  • Spinach, kale, collards, brocolli and other leafy green vegetables
  • Beta-carotene-rich fruits such as apricots, mango, and peaches, and highly-coloured vegetables such as carrots, squash, sweet potato
  • Milk or cereals enriched in vitamin A
  • Liver
  • Egg yolks
  • Fish liver oils

The recommended daily allowance (RDA) is 900 mcg and 700 mcg per day for men and women. So, one medium-sized raw carrot, weighing 61 g, contains 509 mcg RAE of vitamin A.

To talk about vitamin A deficiency, it treated with vitamin A palmitate oil. For such cases, a dosage of 60,000 IU is taken orally for 2 days. Then the dosage reduced to 4500 IU orally per day.

An alternative dosing is:

  • 50,000 IU for infants below 6 months of age
  • 100,000 IU for infants 6–12 months of age
  • 200,000 IU for 12 months through adulthood

Hypervitaminosis A or Vitamin A Toxicity

Vitamin A is fat-soluble. Therefore the body is able to accumulate it, mainly in the liver. Accordingly, its excessive consumption can lead to its excess, which is toxic (hypervitaminosis A). But do not worry that a regular diet can lead to such results. As already mentioned, a study of dietary preferences came to exactly opposite conclusion.

Nevertheless, excessive consumption of foods rich in vitamin A has been observed. For example, the authors of “Carrot man” tell a story of a 48-year-old male. The man complained to his primary care physician of abdominal discomfort and yellow/orange skin discoloration. It turned out that he ate 6-7 lb of carrots per week which lead to health problems. However, once he abandoned carrot diet, everything returned to norm within 1 month5. As for severe poisoning cases, it is known that researchers in the Arctic in the XIX died after they ate a polar bear liver rich in vitamin A.

To summarize, under normal conditions, an excess of vitamin A is not related to nutrition. As a rule, an excess is usually associated with the consumption of excessive amounts of vitamin A from supplements.

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Как снизить гликированный гемоглобин


Diabetes is a major global health concern with a significant rise in prevalence. At the same time, glycated hemoglobin (A1C) helps to know how your body copes with sugar. For us, it’s an opportunity to detect a condition when the body is not functioning normally but it has not yet reached a state of disease. We’re talking about prediabetes. But for people with diabetes, this test is useful as well, mostly because it shows the risks of complications. In this article, we will talk about the situation when the test has already been done, and its results exceed healthy values. So, here you will find all about how to lower your a1c without medication.

This article was last reviewed by Svetlana Baloban, Healsens, on June 11, 2020. This article was last modified on 7 February 2020.

When talking about Normal Levels of Hemoglobin A1c we shall remember the following ranges. For diabetes-free people the normal range is between 4% and 5.6%. If your hemoglobin levels are 5.7% – 6.4%, the odds you will get diabetes are high. Levels of 6.5% or higher mean you have diabetes.

Decreasing Hemoglobin Goals

In the US, 79 million adults have prediabetes, a prevalence approximately 3 times that of diabetes.

Certainly, whether prediabetes progresses into diabetes depends on a number of variable factors. The willingness of a person to change his or her lifestyle determines treatment success. Nevertheless, a person’s genetics and well-chosen drug therapy are important factors as well.


So, the 4 pillars of effective diabetes management are:

How to Lower Your A1C without Medication

In 2002, Knowler hypothesized that lifestyle changes would prevent or delay the development of diabetes. The researchers randomly chose patients with prediabetes. Some patients received a placebo, other joined a special lifestyle changes program. It included increasing activity to at least 150 minutes/week and losing weight by at least 7%. The mean age of the participants was 51 years old. And the BMI was 34.0 kg/m2. The average follow-up was 2.8 years. As a result, the lifestyle intervention reduced the incidence by 58% compared with the placebo1group. Further analysis of this study showed that if people did not change their lifestyle, most would develop type 2 diabetes over the next 10 years.

Since then, many other studies have confirmed these conclusions. In 2013 researchers compared the effectiveness of lifestyle changes to standard care. Seven of the nine studies reported that lifestyle interventions put off the risk of diabetes by up to 10 years after a lifestyle intervention2.

However, for some people with prediabetes, a change in lifestyle is not enough.

Pharmacotherapy in Type 2 Diabetes Prevention

Evidence from pharmacotherapy preventing diabetes in patients with prediabetes was reported in 2002.

Biguanides, such as metformin, were proven by the researchers to decrease the incidence of diabetes. At the same time, this decrease isn’t as considerable as the one caused by lifestyle changes. Metformin has beneficial effects on BMI and lipid concentrations.

In 2010, Lilly and Godwin concluded after a systematic review of the literature and meta-analysis that metformin lowers risk of Type 2 diabetes by 45%3.

Glycated Hemoglobin (A1C) Tracking in Healsens

Metformin is currently the only medication recommended by the ADA for prediabetes treatment. According to the ADA, it is typically prescribed for patients who are at high risk of developing diabetes. So, if people fail in lifestyle modification therapy and their glucose is progressing, metformin is a reasonable second choice.

However, despite metformin’s widespread use, the medication is not for all patients. So, the ACE/AACE recommends a two-pronged approach to treating prediabetes. At first, intensive lifestyle intervention. Namely lifestyle modification training such as 150 minutes per week of physical activity as well as 7% of weight loss if BMI exceeds 25 kg/m24, followed by the prevention of CV complications for abnormal blood pressure and cholesterol.

Fiber in Diet to Lower Your A1C

Increased fiber in diet is associated with a reduction of glycated hemoglobin (HbA1c), improved lipid profile, and loss of body weight in type 2 diabetes patients5. An increased fiber content decreases the glycemic index of foods.

In addition, foods containing dietary fibers are also a rich source of magnesium. To underline, that magnesium is a co-factor for enzymes involved in glucose metabolism. In turn, dietary magnesium lower the incidence of type 2 diabetes. Studies also say that dietary fiber is associated with a reduced risk of diabetes which can be explained through markers of inflammation. We are talking about markers like interleukin-6 and tumor necrosis factor α6.

Moreover, some researches showed that when total dietary fiber was separated into cereal, fruit, and vegetable fiber groups, it appeared that cereal fiber reduced the incidence of developing type 2 diabetes the most7.

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недостаток цинка


Immune response is the main mechanism of host defense against infections and pathogenic microbes, it helps to eliminate toxic or allergenic substances that enter our body through mucosal surfaces. So, the importance of immune response can hardly be overestimated. However, a wide range of factors can disrupt it. And by reason of it, it is so important to understand what exactly causes the failure. In this article, we will talk about the role of zinc in the immune system and this will open a series of articles on the topic of maintaining immunity.

This article was last reviewed by Svetlana Baloban, MD on 18 March 2020. This article was last modified on 7 February 2020.

How to boost the immune system

When talking about ways to strengthen our immune system, we cannot help recalling some general recommendations. Usually, general recommendations look exactly the same as those for maintaining a healthy lifestyle, namely:

  • Don’t smoke
  • Eat a diet high in fruits and vegetables.
  • Exercise regularly.
  • Maintain a healthy weight.
  • If you drink alcohol, drink in moderation.
  • Get adequate sleep.
  • Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.
  • Try to minimize stress.

But the most effective means of preventing infection are still vaccines.


Even though this list of general recommendations is non-exhaustive, these recommendations are universal and will work for everyone. And since you probably heard about them, we will talk about other factors that can negatively affect immunity. So, there is evidence that various micronutrient and vitamin deficiencies result in a weak immune system. These, for example, include vitamin A and vitamin D deficiencies, lack of zink, selenium, and others. As we have already said, we will begin our review with the effect of zinc on immunity. We will loop over the role of zinc in the immune system, talk about diagnostics and analyze treatment methods.

About Zinc

Zin is a mineral that’s important to the body in many ways. It is the second most abundant trace metal in the human body after iron. In contrast to the latter, zinc cannot be stored and has to be taken up via food daily to guarantee sufficient supply. So, it plays a role in cell division and growth, wound healing, and the breakdown of carbohydrates. Zinc also provides normal brain functioning, improves memory, and mental performance. In addition, it contributes to maintaining healthy bones, skin, hair, nails.

Moreover, zinc is an antioxidant and has anti-inflammatory effect. This ability plays a role in the prevention of free-radical-induced injuries during inflammatory processes1.

Zinc and Immune System

But the functions of zinc in the body do not end there. Zinc deficiency, as well as zinc excess lead to a weak immune system, which can result in increased susceptibility to infections and the development of inflammatory diseases.

This is primarily due to the fact that zinc is crucial to normal development and functioning of cells which indirectly affect innate immunity, neutrophils and NK cells. Zinc deficiency also affects cells which absorb particles that are foreign or harmful to the body (macrophages). And in addition, zinc deficiency adversely affects the growth and function of major immune cells (T and B cells).

As far back as 1963, Dr. Prasad for the first time proved the existence of zinc deficiency. Since then, knowledge about zinc evolved rapidly. It has been proven that marginal-to-moderate zinc deficiency leads to a weak immune system, delays wound healing, and increases oxidative stress.

When zinc deficiency was first discovered, it was thought to be a rare disease. However, subsequent studies have found that zinc deficiency is very common, with an estimated two billion people worldwide being affected2. As for zinc excess, it needs to be said, that it is quite rare. As a rule, its symptoms are mostly due to copper deficiency.

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Zinc Deficiency Symptoms

As it was already mentioned above, the lack of zinc is a fairly frequent phenomenon. In addition, it especially affects industrial countries and the elderly. Therefore, let’s look at its indirect and direct signs that can be determined.

The first symptom of zinc deficiency is a weak immune system. So, if you often catch a cold or are susceptible to chronic allergies, it may be a sign of zinc deficiency.

Diarrhea and irritable bowel syndrome may also indicate a lack of zinc. And besides, deterioration of the skin, nails, and hair can mean a deficiency of this trace element. Lack of zinc can cause significant hair loss. Worsening night vision, decreased mood, sleep disturbances, and decreased appetite are also noted.

Vegetarians are more likely to have trouble getting enough zinc than others. This is due to the fact that they exclude meat from the diet, while meat is a good source of zinc. For such people, it would be useful to consider foods high in zinc. For example, you can vary your diet with pumpkin seeds, which can be added to any dishes, or almonds (see the full list of high products in zinc below).

Also, alcoholic beverages decrease the amount of zinc that the body absorbs and increase the amount lost in the urine.

In addition, studies reveal that nutritional deficiency of zinc is caused by high consumption of cereals, legumes, and oilseeds. They are all rich in phytate, which makes zinc unavailable for absorption.


To date, no specific and reliable biomarker of zinc status is known. Nonetheless, serum/plasma zinc concentrations can be seen as potentially useful. Unfortunately, this test is far from ideal, as some elderly people were subject to an increase in pro-inflammatory cytokines (zinc depletion factor) at normal plasma levels of zinc. That is why doctors can offer additional tests to show the content of zinc in the hair or its content in the urine. He may also suggest researching your diet to see how much zinc comes with food. But be as it may, a laboratory blood test for zinc is readily available, inexpensive, and good for primary diagnosing.

Lab Test for Zinc Deficiency

Reference Range (mcg/mL) for the age of 11 years old: 0.66 – 1.10 mcg/mL

Foods High in Zinc

A wide variety of foods contain zinc. Oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc. Other good food sources include beans, nuts, certain types of seafood (such as crab and lobster), whole grains, fortified breakfast cereals, and dairy products.

It’s worth remembering that the bioavailability of zinc from grains is low because of phytates—which we already discussed earlier. Thus, animal foods will provide better sources of zinc.

The current recommended dietary requirements for zinc are as follows:

  • 11 mg for men
  • 8 mg for women, and 11 mg for pregnant women. It is recommended to receive as much as 12 mg of zinc during lactation.

An intake below these ranges can only be seen as an indicator of potential zinc deficiency because many other factors also play a role in decreased zinc intake3. Here’s a comparative table of foods with the highest zinc content.

FoodMilligrams (mg)
per serving
Oysters, cooked, breaded and fried, 3 ounces74.0672
Beef chuck roast, braised, 3 ounces7.067
Crab, Alaska king, cooked, 3 ounces6.559
Pine nut, 3 ounces6.4558
Sunflower seeds, 3 ounces545
Eggs, 3 ounces3.128
Almond, 3 ounces2.724
Chicken, dark meat, cooked, 3 ounces2.421
Yogurt, fruit, low fat, 8 ounces1.715
Cheese, Swiss, 1 ounce1.210
Almonds, dry roasted, 1 ounce0.97
Chicken breast, roasted, skin removed, ½ breast0.97
Peas, green, frozen, cooked, ½ cup0.54.5
Flounder or sole, cooked, 3 ounces0.32.7

*11 mg of zinc per day was taken as the calculation of the norm

Zinc Supplements

In dietary supplements, zinc is present in the forms of zinc picolinate, zinc gluconate, zinc sulfate, and zinc acetate. It is noteworthy that several studies indicate that zinc picolinate has the highest bioavailability as opposed to the other form.

And finally, if the supplementation seems to be the most acceptable option, keep in mind that prolonged zink intake in high concentrations may cause copper deficiency.

Be healthy!

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толщина комплекса интима–медиа сонных артерий


Although countries are focusing on fighting cardiovascular disease (CVD), the burden of coronary artery disease continues to rise globally. Atherosclerosis, the precursor of CV events, keeps progressing insidiously without symptoms. Let’s take a look at the reasons why this is happening, as well as at the solutions for the problem. Among other things, we will introduce some proposals from the expert group of Heart Attack Prevention and Education (SHAPE). We will also dwell on a simple non-invasive test, TCIM (Carotid Intima-Media Thickness), which appeared on the list of recommendations.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 7 February 2020.

We will start by looking back in history. So, the thickness of the intima-media of the carotid artery as a marker of atherosclerosis appeared not so long ago. It wasn’t until 1986 that Italian investigators decided to compare the arterial wall thickness aorta to common carotid arteries. They described the results and came to the conclusion that this approach may be useful. Since then, calculation of carotid IMT (CIMT) has been widely used as non-invasive measure of atherosclerosis.

The Essence of Carotid Intima-Media Thickness Test

Carotid intima-media thickness (CIMT) is a screening test for atherosclerosis. In adults, CIMT is predictive of myocardial infarction and stroke. In children and adolescents, CIMT is used to assess vascular changes in the presence of CVD risk factors.


To understand what is measured with this test, let’s look at the structure of the coronary artery wall. It consists of three layers. The inner layer is called intima, the middle layer is called media, and the outer one is known as the adventitia. The layers of intima and media lie the deepest. So an increase in their thickness can be a sign of plaque formation. It is the thickness of the intima-media complex of the carotid neck arteries which feed the brain that is usually measured.

Clinical Note

CIMT screening is easily, safely, reliably, and inexpensively done with ultrasound.

The relation between carotid intima-media thickness and diseases

Interestingly, some studies1 have shown that cIMT is strongly and linearly related to age. Up to 25 years, the thickness is not higher than 0.6 mm. But by the age of 45 years, the CMM is on average higher than 0.8 mm. Some other studies2 have also indicated that CAIMT <0.8 mm is associated with normal healthy individuals, and value of CAIMT at or above 1 mm is associated with atherosclerosis and a significantly increased cardiovascular disease risk in any age group.

Meanwhile, in the ESH/ESC hypertension guidelines (2013), carotid IMT > 0.9 mm has been reconfirmed as a marker of asymptomatic organ damage3.

The American Society of Echography (ASE) task force recommends that IMT ≥ 75th percentile is considered a high cardiovascular risk. Values from the 25th to the 75th percentile are an average cardiovascular risk. And values ≤ 25th percentile are considered low risk.

Moreover, the CMM thickness is also associated with insulin resistance4 in healthy individuals, gallstone disease5, the risk of progression of mild cognitive impairment and even Alzheimer’s disease6.

In other words, the larger CIMT the greater the risk of cardiovascular disease. The process is also associated with aging. However, you should not think that since aging is inevitable, then there is no point in measuring CIMT, since the good news is that recent studies suggest this process can be influenced7 and even reversed8 by increasing physical activities and treating it with medications.

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Despite the many benefits and a wealth of information, screening for IMT has not yet been added to the CVD prevention guidelines. In early 2007, Circulation magazine published a report9 with the conclusion that IMT of the carotid arteries is a serious factor in the development of stroke and heart attack. Nevertheless, a few months later, the American Preventive Task Force recommended asymptomatic people not to undergo an IMT test regularly.

Therefore, the traditional approach involves identifying people at risk of CVD. In this case, if you fall into a risk group (it also matters how great this risk is), then you are recommended to take this test. And vice versa, respectively. Moreover, the problem is that there is no uniform risk assessment system. Therefore, different organizations offer their own options. We’ve already reviewed different Cardiovascular Risk Assessment approaches but let’s take a look at some of them once more.

How to calculate cardiovascular risk?

As we mentioned above, there is currently no unified risk assessment system. At the same time, there are various risk calculators such as Framingham scores, Reynolds risk scores, ASCVD, SCORE, etc. So, the European guidelines on cardiovascular disease prevention suggest taking this test to people with moderate cardiovascular risk. Most asymptomatic middle-aged adults fall into this category. You can calculate this risk using the Healsens application, or on your own.

At the same time, the NCEP recommends estimating the risk using the Framingham risk score. You can calculate it as well. On the other hand, the American Society of Echocardiography recommended adding the following extra criteria10:

  • family history of premature CVD in a first-degree relative (men < 55 years old, women < 65 years old);
  • people younger than 60 years old with severe abnormalities in a single risk factor. In the situation where they would not be candidates for pharmacotherapy;
  • women younger than 60 years old with at least two CVD risk factors.

We wrote more about various risk calculators separately. But what is their importance? Why are we looking at these tools in such detail? The answer is simple. Based on the calculated risk, the doctor will decide whether to initiate preventive treatment. Indeed, as we wrote above, atherosclerotic cardiovascular disease can be prevented. However, cardiovascular disease remains the leading cause of death and severe disability worldwide. What’s the matter?

What’s the problem with the traditional approach?

It turned out that traditional methods of preventing A-CVD have proven largely insufficient. Indeed, studies indicate that traditional risk calculations explain only 60-65% of CVD risk11. In addition, it was shown that the calculated risks don’t always lead to disease development. Conversely, many acute clinical events occur in patients with moderate or no risk. The most probable reason for this is that many other factors are not included in the calculations.

The Screening for Heart Attack Prevention and Education (SHAPE) Task Force

To solve this problem, an international group of experts created screening recommendations for Heart Attack Prevention (SHAPE). They have already proposed the First SHAPE Guideline in primary prevention of A-CVD.

So, to identify atherosclerosis, a Flow Chart was created based on 2 non-invasive methods. The first one is coronary artery calcium scoring (CACS) with the use of computed tomography. And the second one is carotid intima-media thickness (CIMT), which we have discussed in this article.

Look at the first Screening for Heart Attack Prevention and Education (SHAPE) Guideline.

SHAPE Guideline

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Cardiovascular disease is the leading cause of death worldwide, coronary artery disease (CAD) accounting for half of all such deaths. And at least 25% of patients experiencing nonfatal acute myocardial infarction or sudden death had no previous symptoms1. Do you know that a 1999 study2 confirmed that coronary artery disease is ubiquitous between the ages of 17 and 34 years? The disease process at this stage is too early to cause coronary events but heralds their onset in the decades to follow. All of these facts make it clear how crucially important is to identify asymptomatic individuals for implementing preventive strategies. This is exactly the main focus of the Healsens platform. In this article, we will talk about another medical test that allows you to determine the presence of cholesterol deposits in the arteries. We’re talking about Coronary Artery Calcium Score Test or CAC test.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 7 February 2020.

Cardiovascular Disease Risk Assessment Models

To assess the risk of heart disease it’s very useful and highly recommended to apply “Total risk scores” as the initial method of stratification. Although it is only able to predict only 65-80% of future cardiovascular events. The Framingham risk score is one of the most widely used methods and is also calculated by Healsens. The Framingham Risk Score was first developed based on data obtained from the Framingham Heart Study, to estimate the 10-year risk of developing coronary heart disease

There are other estimates of risk stratification assessment algorithms such as the PROCAM score or the European SCORE-system for an individual’s global 10-year risk of acute coronary events.

So, pursuing the goal of preventive care and screening, which means finding problems long before they bring about health issues, and continuing the topic cardiovascular diseases, we take into account the assessment and correction of fats (such as cholesterol) in the blood, as well as such critical risk factors as homocysteine levels ​​and CRP, which are often overlooked. Taking into account all these tests let describe when and why Coronary Artery Calcium Score Test will be relevant and more preferred to the personal preventive program.


Despite the fact that the majority of heart attacks are caused by soft, or unstable, plaques, the presence of hard, calcified plaques in your coronary arteries is a very important factor. So, there is a direct correlation between the content of hard and soft plaque in the arteries. This dependence is determined by the fact that the body isolates unstable plaques using calcined deposits, therefore, the rate of formation of hard plaque is also related to the number of soft plaques.

You can find out how much hard plaque and indirectly much more dangerous soft plaque you have by using ultrafast or electron beam computed tomography (CRT). This study is also known as the Сoronary Artery Calcium Index or CAC test. CAC test takes cross-sectional images of the vessels that supply blood to the heart muscle, to check for the buildup of calcified plaque, which is composed of fats, cholesterol, calcium and other substances in the blood. This calcium is different from the calcium in bones and has nothing to to with too much calcium in a diet.

The measurement can help a doctor identify who is at risk of getting a heart disease before that person shows any signs or symptoms. So, this screening test should be assigned in an early detection program. Below we can determine the criteria for adding this test to a personal preventive medicine list.

The CAC score was studied in association with other traditional risk score systems, especially the Framingham risk score, showing the following advantages: independent added value in the prediction of all-cause mortality and mortality due to coronary disease in asymptomatic individuals; and shifting in the category of coronary artery disease risk-60% of atherosclerotic coronary events occur in patients categorized as being at low or intermediate risk according to the Framingham risk score. As an example, among patients at intermediate risk according to the Framingham risk score and with a CAC score > 300, which would place them in a high-risk category, the 10-year event frequency therefore is approximately 28%. And that means, the CAC score adds value to the Framingham risk score and to other methods, providing a substantial increase in the accuracy of the risk stratification.

The CAC score is also an independent predictor of the risk of major cardiovascular events3, with demonstrated superiority over the Framingham risk score, C-reactive protein level, and carotid intima-media thickness.

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Interpretation of the Coronary Artery Calcium test result

The values obtained from the CAC score can be interpreted and classified in two ways:

  • using the absolute values with fixed cut-off points;
  • and adjusting values for patient age, gender, and ethnicity, as well as calculating distribution percentiles in the general population through the use of several population databases, the Multi-Ethnic Study of Atherosclerosis (MESA) being the most widely used.

The result of the test is usually given as a number called an Agatston score. The score reflects the total area of calcium deposits and the density of the calcium.

Normal Coronary Artery Calcium Score

  • A score of zero means no calcium is seen in the heart. It suggests a low chance of developing a heart attack in the future.
  • A score of 1 to 100 means low risk of future coronary events; low probability of myocardial ischemia.
  • A score of 101 to 400 means increased risk of future coronary events (aggravating factor). It’s associated with a relatively high risk of heart attack or other heart diseases over the next three to five years.
  • A score greater than 300 is a sign of very high to severe disease and heart attack risk.

Based on the Agatston method, the percentile can be calculated on the MESA website (http://www.mesa-nhlbi.org/Calcium/input.aspx) by inserting the patient CAC score, age, gender, and ethnicity. Patients diagnosed with a cardiovascular disease (acute myocardial infarction, angina, stroke, or atrial fibrillation), those using nitroglycerin, and those with a pacemaker, as well as those having undergone angioplasty, myocardial revascularization, or any other cardiac/arterial surgery, along with those under treatment for diabetes, should not be included in this analysis, given that they were not included in the MESA population.

National Cholesterol Education Program guidelines recommend intensification of low-density lipoprotein (ldl) cholesterol reduction in patients with multiple risk factors and a CAC score above the 75th percentile. Other studies have correlated CAC scores with the use of statins and aspirin in primary prevention.

Use of the Coronary Artery Calcium test in people with diabetes

Patients with diabetes present a risk of cardiovascular events similar to that of patients with a clinical history of atherosclerotic disease. The presence of any degree of CAC in patients with diabetes mellitus translates to a higher risk of all-cause mortality than in patients without diabetes. However, the absence of CAC indicates a lower risk of death in the short term, and the annual mortality rate is similar to that of diabetes-free individuals.

Do I Need a Coronary Calcium Score?

As with most technology, the cost of a coronary calcium score test is dropping, and doctors are more inclined to consider this useful diagnostic tool for people who may have a moderate risk of heart disease or whose heart disease risk is unclear. However, doctors are not on the same page about the appropriateness of this method in assessing risks. A 2007 recommendation by the American Association of Cardiologists states that measuring the calcium index “may be acceptable” in patients who do not exhibit symptoms of the disease and have an average risk (two or more main factors) of coronary disease, but not in low-risk patients (one main risk factor or none) or for the general population.

The NCEP/ATP III Guidelines have incorporated CAC test as a complementary test to modify treatment intensity because it’s able to help doctors to make better decisions and target those people who may need medication to reduce risk or identify people with a CAC score of 0 who may be able to avoid medication.

According to the new guidelines, here are some groups where CAC test may be useful:

– People reluctant to begin statin therapy and those who want to understand their risk and potential benefit more precisely.

– People concerned about restarting statin therapy after stopping treatment because of side effects.

– Men ages 55 to 80 or women 60 to 80 with few risk factors who question whether they would benefit from statin therapy.

– People ages 40 to 55 with an estimated 10-year risk of developing heart disease between 5 percent and 7.5 percent, and risk factors that increase their chances of heart disease.

At the same time Heart Attack Prevention and Education (SHAPE) Guideline recommended taking this test for heathy men by the age of 45, and for healthy women by the age of >55.

Generally, a heart scan is not recommended for the following people:

  • People who already are known to be at high risk, because the heart scan is not likely to provide any additional information to guide treatment decisions
  • People who already have symptoms of or diagnosed with heart disease, because the heart scan will not help doctors better understand the disease’s progression or associated risks

A significant drawback of this test is that the person is exposed to heavy radiation. A coronary artery calcium scan provides about 1 mSv, which is similar to the radiation from a mammogram4.

How to reverse the growth of the calcium index

As we have already said, a zero calcium index is considered optimal, which means the absence of plaques that can be detected. With a non-zero value of the calcium index, the situation is this: the larger it is, the higher the risk of developing a heart attack. You need to compare your calcium index with the range of values ​​observed in people of your age and gender and determined in percentiles. If your index is greater than or equal to the 75th percentile (that is, 75% of people of your age and gender have a calcium index lower than yours), we recommend that you begin to reduce the number of plaques in the coronary arteries as quickly as possible. This growth rate of calcined plaque indicates the presence of unstable plaques. If untreated, the calcium index may increase by 40 percent or more annually. With the help of active actions, you can reduce the growth rate of the calcium index to 10% or less, which was first demonstrated by Dr. Dean Ornish – he even managed to reverse this process due to a radical review of the diet5.

For example, one of the trials determined whether comprehensive lifestyle changes affect coronary atherosclerosis. During 1 year, 28 patients followed a low-fat vegetarian diet, stopped smoking, did stress management training, and moderate exercise. Moreover, their results were compared with 20 people in the control group. 195 coronary artery lesions were analyzed by quantitative coronary angiography. As a result, the researchers concluded that сomprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis without using lipid-lowering drugs6.

Enhanced external counterpulsation (EECP)

In addition to non-surgical methods of treatment, such as following the diet and taking the food supplements described above, patients with heart failure have an original technique for reducing chest pain and improving heart function called enhanced external counterpulsation (EECP)78. This completely bloodless procedure involves the placement of air cuffs on the patient’s legs, hips and buttocks. While he is lying on the couch, the cuffs are filled with air in a certain rhythm, which is set by the computer. In turn, the operation of the computer is regulated by the patient’s electrocardiogram data received in real time. Cuffs are inflated only during periods when the heart muscle relaxes. Such periods are called diastoles. When the computer-controlled cuffs inflate, blood from the lower body moves to the heart. This FDA-approved procedure of treating certain cases of angina pectoris and heart failure contributes to the rapid development of collateral coronary vessels (minor coronary arteries that take over the functions of the main coronary arteries). In other words, EECP causes the heart to grow its own natural shunts.

This procedure seriously accelerates the natural process of creating a bypass (collateral) blood supply paths. As a result, during EECP, the heart receives full physical activity. Older patients with heart disease who had more time to create collateral circulation are known to have a reduced risk of death from a heart attack. Be as it may, thanks to EECP, patients have the opportunity to grow workable collateral circulation at any age. This procedure dramatically improves blood circulation. In the standard course of EECP, procedures are carried out for an hour, five days a week, for seven weeks. Both the FDA and Medicare, the U.S. federal program for insuring people over 65, have approved EECs in certain cases, such as some forms of congestive heart failure. EECP is the main treatment for heart disease in China9.

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Detecting any kind of blood vessel problems before they lead to a catastrophe is life-saving. This is what we call early detection – the primary purpose of creating our platform. It was estimated by WHO that 17,9 million people died from cardio-vascular cases in 2016, which accounts for 32% of all global deaths1. Of these deaths, 85% resulted from either a heart attack or a stroke. In more than half of these cases, diseases were clinically silent. Till the very day when heart attacks took away their lives they didn’t feel any pain in their chest, nor any heartbeat disorder, which could point to any heart problems. That is why today we will talk about monitoring and sustaining healthy lipid levels and the importance of doing so for healthy living. So, a lipid panel blood test helps to assess the four major risk factors for cardiovascular diseases: total cholesterol levels, LDL cholesterol, HDL cholesterol and triglycerides.

This article was last reviewed by Svetlana Baloban, Healsens, on January 4, 2022. This article was last modified on 9 May 2023.

Many tragedies can be avoided due to the existence of a few simple, safe and inexpensive lab tests. These tests are able to detect a cardiovascular disease long before it results in a heart attack or a blood stroke. Detect it when it is possible to prevent almost any disorders. Luckily, for taking the recommended medical tests neither big money nor doctors’ prescriptions or permissions are needed.

So, an effective program of early diagnosing is based on a combination of several blood tests, namely homocysteine levels and CRP lab tests, and radiological methods, including calcium score and coronary ultrasonography, which might be added into your Preventive Medicine health checklist.

The American Heart Association recommends that everyone over age 20 get a lipid panel blood test so you know what your levels are and can do something about them if you need to. The National Cholesterol Education Program (NCEP) recommends that adults have their cholesterol checked every 4-6 years2.

Cholesterol Definition

Cholesterol is the form of fat we need to make outer membranes of our body cells stable. However, doctors have noticed for many years that people with high cholesterol levels suffer from cardiovascular diseases more often.


In fact, they have discovered recently that different forms of cholesterol (“good” and “bad” cholesterol) also play a role. High levels of total cholesterol, high levels of bad cholesterol or low levels of good cholesterol adversely affect the cardiovascular system. For example, LDL or “bad” cholesterol can stick to blood vessel walls. For many years it can be a major factor in artery obstruction and more specifically in hardening of arteries, the process known as atherosclerosis.

Narrow arteries of your heart can get spontaneous blood clots, causing heart attacks and strokes. And high levels of triglycerides in the blood are associated with higher risks of cardiovascular diseases (CVD), even though the exact reason for this is not clear.

Preventive guidelines for a lipid panel blood test among young adults differ, but experts agree on the need to screen young adults who have other risk factors for coronary heart disease: obesity, smoking, high blood pressure, diabetes, and family history.

Less than half of young adults who have these risk factors don’t get cholesterol screening even though up to a quarter of them have elevated cholesterol3.

Lipid Panel Results

Total Cholesterol Levels

Following the recommendations by the US National Cholesterol Education Program (NCEP) total cholesterol concentration should fall below 200 mg/dL (5.17 mmol/L). 200 – 239 range will be the upper limit, any numbers higher than 240 indicate a risk of cardio-vascular diseases twice as high as that indicated by numbers lower than 200. As a general rule, the higher the cholesterol levels, the higher the risk of cardiovascular disease, although cholesterol is not the only risk factor. However, some new scientific evidence suggests that the optimum total cholesterol should lie within the range of 160 to 180 mg/dL (4.6 mmol/L). This data is supported by some investigation, showing that lowering total cholesterol to these indexes may decrease the risk of cardiovascular cases. If your cardiac computed tomography (CT) or carotid artery ultrasound detected problems, you need to bring your total cholesterol down to these optimum levels.


More than 102 million American Adults (20 years or older) have total cholesterol levels at or above 200 mg/dL, which is above healthy levels. More than 35 million of these people have levels of 240 mg/dL or higher, which puts them at high risk for heart disease.

Low-density lipoprotein cholesterol or LDL Lab Test Results

LDL stands for lowdensity lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries. An extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

To define your own optimum LDL cholesterol you have to consider all risk factors from those listed below:

Serious risk factors:

If you found to have one or more serious risk factors, you are in the group of high risk and it’s time to come to grips with the fact that you have to lower your LDL-C levels.

NCEP recommends the maximum level of LDL cholesterol for this high-risk group is 100 mg/dL (2.58 mmol/L).

Key risk factors:

  • Age: older than 45 for men, and older than 55 for women
  • Cigarette smoking
  • Cases of premature heart disease or cardiovascular disease cases among close relatives (parents, siblings, or children) (older than 55 for men or older than 65 for women)
  • High arterial blood pressure (140/90 or higher, or if drugs are taken to normalize blood pressure)
  • HDL levels below 40
  • Calcium score higher than 25 procentile (this is an extra recommendation – it is not listed in NCEP).

If you have one or less key risk factors, then according to NCEP, your LDL levels must be lower than 160 mg/dL (4.14 mmol/L). At the same time if you have 2 or more risk factors, then you should keep your LDL levels below 130, and below 100 would be even better. People who belong to the high-risk group of getting a heart attack or a stroke recommended keeping LDL levels below 100. Some recent studies show (indicate) positive results when the numbers are kept under 70.

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High-density lipoprotein cholesterol or HDL Lab Test results

HDL (high-density lipoprotein), or “good” cholesterol, absorbs cholesterol and carries it back to the liver. The liver then flushes it from the body. But the antiatherogenic properties of HDL cholesterol do not end there. Thus, HDL cholesterol has antioxidant properties and shows an anti-inflammatory effect4. In addition, HDL has the ability to increase glucose uptake by skeletal muscle and stimulate insulin secretion by pancreatic beta cells5.

So, high levels of HDL cholesterol can lower your risk for heart disease and stroke. HDL level below 40 mg/dL (or 1.03 mmol/L) is the main risk factor of cardiovascular disease. If HDL level is higher than 60 mg/dL, cholesterol of this type performs barrier function.

HDL Results Tracking in Healsens App

At the same time, HDL levels below 40mg /dL among men and below 50 mg/dL among women are the symptom of (indicate, point to) metabolic syndrome, which in its turn, is also a major risk factor for cardiovascular disease.

Note that there are several reasons for low HDL cholesterol. Thus, type 2 diabetes is commonly accompanied by a low level of high-density lipoprotein cholesterol. This contributes to the increased cardiovascular risk associated with this condition. In addition, overweight, obesity, smoking, elevated triglycerides (TG), and physical deficiency are among the main factors of low HDL.

As for physical activity, then a recent meta-analysis has provided some insights into how much exercise is required6. So, an increase in HDL concentration was apparent only in people who exercised for at least 120 minutes each week.

Triglycerides Lab Test results

Triglycerides are the main criteria indicating levels of fat in the blood. The high content of triglycerides combined with low HDL levels is considered a characteristic of metabolic syndrome. Often high levels of triglycerides result from high consumption of sugar-containing products and high glycemic index. The general population’s ideal triglyceride level is less than 150 mg/dL or less than 1.7 mmol/L7 by FDA. Anything over 500 mg/dL is considered very high. At this level, there is a high risk of developing pancreatitis (inflammation of the pancreas). This condition can lead to permanent tissue damage. It is usually accompanied by abdominal pain, which can be very severe.

Guidelines for triglyceride levels in healthy adults are:

  • Normal: under 150 mg/dL
  • Borderline high: 150-199 mg/dL
  • High: 200-499 mg/dL
  • Very high: 500 mg/dL or higher

HDL and triglycerides are metabolically connected and are often inversely related: As triglycerides go up, HDL goes down — and vice versa. But that isn’t always so. People can have “isolated” high triglycerides without low HDL levels, and research is now showing that high triglycerides are an independent risk factor for cardiovascular disease, no matter what the HDL is8.

Lipid Panel Blood Test With Additional  Additional Classes

Some labs provide advanced cardiovascular and lipid panel blood test that go beyond typical cholesterol testing to uncover risk factors for early heart disease.

As you can see there are two new components are added to this test: Lp(a) and ApoB. Lp(a) (also called Lipoprotein(a) is a lipoprotein subclass. Genetic studies and numerous epidemiologic studies have identified Lp(a) as a risk factor for atherosclerotic diseases such as coronary heart disease and stroke. It is similar to low – density lipoprotein (LDL, the “bad” cholesterol) in that it contains a single apolipoprotein B protein along with cholesterol and other lipids. This test measures the amount of Lp(a) in the blood to help evaluate a person’s risk of developing cardiovascular disease (CVD).

ApoB and ApoA-I are the two major apolipoproteins involved in lipid transport and in the processes causing atherosclerosis and its complications. ApoB is the main protein found in the low-density lipoproteins (LDL). Apo B increases this clogging, so your Apo B level may be a better indicator of cardiovascular risk than even LDL cholesterol.

Using the VAP Test tas Lipid Panel Blood Test

So, VAP test or Vertical Auto Profile provides even more detailed information about lipid levels as opposed to conventional examination, since this lab test directly assesses LDL levels. Traditional tests on the other hand measure only total cholesterol, HDL and triglyceride levels, and then use them to calculate LDL levels using these numbers. However, this is not the only advantage of VAP test, as this test gives additional information about the size and a current number of LDL particles, as well as tells about the number of less dangerous, large and spongy A-particles, and more dangerous small and dense LDL B-particles present in your body. Light and spongy A-particles easily push off the artery walls. On the other hand, small and dense B-particles are destructive and easily penetrate artery walls. An elevated number of small B-particles is often found among patients suffering from diabetes or metabolic syndrome.    

Components of Lipid Panel Blood Test

  • HDL2 and HDL3  subfractions
  • Pattern A or B LDL
  • VLDL cholesterol
  • Non-HDL
  • apoB100-calc
  • LDL-R (real)
  • Lp (a)
  • IDL
  • Remnant lipoprotein

Cholesterol VLDL

Very low-density lipoprotein (VLDL) cholesterol is a type of fat in the blood. It is considered one of the “bad” forms of cholesterol, along with LDL cholesterol and triglycerides. This is because high levels of cholesterol can clog arteries and lead to a heart attack.

Normal VLDL cholesterol levels range from 2 to 30 mg/dL (0.1 to 1.7 mmol/L).

Because VAP measures additional lipoprotein classes, such as Lp(a), IDL, and subclasses of HDL, LDL, and VLDL, it can identify patients at high risk for coronary heart disease who cannot be identified using the standard lipid panel blood test. In addition, the VAP method is compliant with the National Cholesterol Education Program’s Adult Treatment Panel III guidelines.

Thus, if your lipid levels don’t meet the norms, you should take this test more often, say every four or six months, until you achieve the results you wish.

What to do if your lipid profile is outside the healthy range?

Self-treatment with a balanced diet and regular physical activity can help lower the levels of lipoproteins. If your lipid profile needs correction, consider the following recommendations to reduce the risk of cardiovascular diseases:

  • Quit smoking if you smoke. Smoking is a major risk factor for cardiovascular diseases. The risk of coronary heart disease, stroke, heart failure, or peripheral vascular disease is two to six times higher in smokers compared to non-smokers.
  • Follow dietary recommendations to reduce the risk of cardiovascular diseases, such as the “five-wheel” approach. The most important nutrients influencing this risk are saturated fatty acids (which increase LDL cholesterol levels compared to unsaturated fatty acids), salt (which raises blood pressure), and fiber (which reduces the risk of cardiovascular diseases). Vegetables, fruits, fish, and unsalted nuts also lower the risk of cardiovascular diseases.
  • Allocate at least 150 minutes per week to moderate-intensity exercises such as walking or cycling. Integrate physical activity into your daily life. Increasing the duration, frequency, and/or intensity of exercises will provide additional health benefits.
  • Include strength and bone-strengthening workouts at least twice a week, especially for older adults.
  • Avoid excessive sitting (more than eight hours a day).
  • Maintain a harmonious psycho-emotional state.

Regarding medications, your doctor may prescribe statins such as simvastatin, lovastatin, atorvastatin, and rosuvastatin. These are well-studied drugs that not only lower LDL cholesterol levels but also have a positive impact on blood vessels.

Your doctor will strive to achieve specific cholesterol levels, typically LDL cholesterol levels below 2.6 mmol/L. Additionally, any side effects will be carefully evaluated. If side effects occur, an alternative medication or a reduction in statin dosage may be offered.

People who couldn’t reach their goals for cholesterol levels taking statins may need high doses or additional medications. Other non-statin drugs include ezetimibe and, less commonly, fibrates or niacin.

Additionally, you can consider some beneficial food supplements. They can also dramatically lower your cholesterol and triglyceride levels. Looking ahead we can say that nutritional supplements work independently and can be used with statins. But we’ll expand on that that in the following articles.

And finally, if you are not ready to start statin therapy or want to understand your risks and potential benefits, there are additional tests. We are talking about such medical research as the calcium index of the coronary arteries or computed tomography of the heart. It is worth clarifying that intimal thickness assessment is no longer recommended for CVD risk assessment. So, for example, atherosclerotic plaques can occur in the absence of thickening of the intima-media9.

Unlock your health insights with our smart data analysis – the Free Health Tracker app, your reliable medical record!

Drastically reduce the time to detect chronic diseases & inspire healthy habits


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Source: ©️2019 Healsens B.V. All right reserve


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