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Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.

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!

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


checking homocysteine serum levels

Checking Homocysteine Serum Levels

Homocysteine is produced in our body (it is not contained in food) through the metabolism of an essential amino acid called methionine. Normally, formed homocysteine quickly turns into other, harmless substances – vitamins B6, B12, and folic acid are needed for these transformations. But in elevated concentrations, homocysteine provides a whole range of adverse effects, which we will discuss in detail below. Also, Also, this article describes who and why may benefit from checking homocysteine serum levels in terms of improving health.

Firstly, it can directly damage vascular walls by making them loose. Thus, the damaged surface is subject to cholesterol and calcium depositing, which form an atherosclerotic plaque. Thus, blood coagulation is activated, and this, in turn, leads to the development of atherosclerosis, arterial and venous thromboses.

Secondly, folic acid deficiency, which almost always accompanies an increase in homocysteine, can lead to gross malformations of the fetal nervous system during pregnancy – anencephaly (lack of the brain), and neural tube failure. It is for the prevention of these defects that all pregnant women are prescribed folic acid preparations.

Thirdly, homocysteine in high concentrations has a direct toxic effect on trophoblast cells, from which the placenta is subsequently formed, causing their death and a decrease in the production of hCG – the pregnancy hormone. This can lead to termination of pregnancy (usually in the first trimester) or to impaired placental development, which further increases the risk of placental insufficiency, fetal growth retardation, preeclampsia, placental abruption, pregnant hypertension, and kidney damage.

Elevated homocysteine levels are also associated with increased thrombus formation, as well as higher risks of heart attacks, cerebral accidents, peripheral arterial diseases, and fractures.

Doctors measure homocysteine levels as a possible cardiovascular risk factor, to diagnose homocystinuria, thrombosis, diabetes mellitus, senile dementia and Alzheimer’s, and obstetric pathology. The testing is necessary in a number of situations since elevated homocysteine levels are cytotoxic.

Which level of Homocysteine passes for normal?

The “ideal” homocysteine level levels of about 5-7 µmol/L1.

Good” levels of less than 10 µmol/L2. So, homocysteine > 10 μmol/L is associated with some risk factors like peripheral microvascular endothelial dysfunction (PMED), higher major cardiovascular events, etc.

The normal range of homocysteine levels are less than 15 micromoles per liter (mcmol/L).

Higher levels are: Moderate (15 to 30 mcmol/L); Intermediate (30 to 100 mcmol/L); Severe (greater than 100 µmol/L).

Any higher than 15 and you will want to work with your Health Coach to further investigate the cause.

The latest studies show that homocysteine is an independent risk factor of cardiovascular diseases3. Clinical research shows that a 5 umol/L elevation in homocysteine concentration in blood plasma increases the vulnerability to cardiovascular disease and total mortality by 1.3 – 1.7 times. Lowering of elevated homocysteine levels in blood plasma can prevent cardiovascular complications.

If levels of homocysteine are found to be elevated, it is advisable to measure the levels of creatinine, thyroid stimulating hormones, folacin, cobalamine to define probable causes of hyperhomocisteinemia and suggest appropriate treatment.

Homocysteine, total

Test Code: 31789
Specimen Type: Blood

Acceptable screening test for disorders of methionine metabolism (congenital hyperhomocysteinemia).

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Causes for High Homocysteine Levels

At first, don’t panic if your homocysteine level is above the norm values.

Just because you have high homocysteine doesn’t mean you will develop heart disease or a neurological condition tomorrow, next week or even next month.

That’s the beauty of functional lab tests; they often allow us to catch patterns of disease and imbalance in the body before they become chronic or diagnosable. And if you’re already dealing with a chronic disease, then by examining your homocysteine levels, you’ve gotten one big step closer to uncovering the root cause and getting your health back on track.

It’s worth mentioning that smokers are more vulnerable to hyperhomocysteinemia. Moreover, high coffee consumption is one of the most powerful factors increasing homocysteine in blood. Those who drink more than six cups of coffee a day have 2-3 umol/L higher homocysteine levels than people who drink no coffee.

Elevated homocysteine levels are often associated with a sedentary lifestyle. So, moderate physical activity lowers homocysteine levels in case of hyperhomocysteinemia. Vegan diet can also decrease its levels by 13% without any supplements.

However, the most frequent cause of high homocysteine levels is folacin deficit4. The deficit of cobalamine (vitamin В12) may also lead to homocysteine accumulation5. However, the effectiveness of using vitamins is a subject of debate among researchers. Several major randomized experiments showed that relatively easy lowering of homocysteine levels through taking supplements did not result in lowering vulnerability to cardiovascular diseases6.


How Often Should You Check?

As with all lab work, how often to re-test is highly individual. Yet, there is a number of indications for investigation, such as:

– cerebral accident, heart attack, thrombosis, atherosclerotic cardiovascular disease in family history;
– blood-clotting disorder;
– neurological disorders in childhood;
– preparation for IVF, pregnancy;
– chromosomal abnormality of the fetus, congenital defects, complications;
– smoking;
– age higher than 75 years old.

Typically, if your levels are on the high-side your Health Coach will recommend re-testing after about 6 months.

In conclusion, some estimates suggest that if homocysteine levels decreased by 40% would lead to an extra 8 years of life per 1000 men, and 4 years of life per 1000 women.

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

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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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