In this article we look at some common and some less common cardiovascular risk blood test markers that we use in our functional medicine clinic. We discuss what these markers are and provide typical ranges to aim for to help optimise your health and lower your cardiovascular risk.
Cholesterol markers and ratios for cardiovascular risk
Cholesterol is a word that often comes up in discussions about health, particularly heart health. My experience is that just the mention of cholesterol seems to be elicit fear and anxiety.
What exactly is cholesterol? Cholesterol is a waxy, fat-like substance that’s found naturally in your body and in certain foods. While it’s often vilified, cholesterol is essential for many bodily functions, such as building cell membranes and producing hormones.
In this section we look at HDL, LDL cholesterols as well as the importance of the ratio between total cholesterol and HDL cholesterol. We also discuss other less commonly assessed markers VLDL cholesterol and dip our toe into cholesterol particle sizes by looking at small LDL cholesterol.
It is important to remember that LDL, HDL are transporters for cholesterol, think of them like trucks on the road transporting cholesterol around the body.
High-Density Lipoprotein Cholesterol (HDL-C)
High-Density Lipoprotein Cholesterol, or HDL-C, is often called the “good cholesterol” because it helps remove other forms of cholesterol from your bloodstream, which is good for your heart health. Effectively it can help to shuttle cholesterol from peripheral tissues back to the liver for excretion. Higher levels of HDL-C are usually a sign that you’re at lower risk for heart problems like heart attack or stroke.
- Typical Normal Range >1.0mmol/l
- Target Optimal Range >1.5mmol/l
Low-Density Lipoprotein Cholesterol (LDL-C)
Low-Density Lipoprotein Cholesterol, or LDL-C, is what many people refer to as “bad cholesterol.” This is the cholesterol that can build up in your arteries and form plaques, which could lead to problems like heart attacks or strokes. Lower levels of LDL-C are generally better for your heart health. However, there are some important distinctions to think about when it comes to LDL cholesterol, such as their particle size. As with all things cardiovascular, it is more about the sum of all parts, than one particular marker.
- Typical Normal Range <3.0mmol/l
- Target Optimal Range – This is person dependant based upon gender, genetics, age etc.
Total Cholesterol / HDL Cholesterol Ratio
The Total Cholesterol to HDL Cholesterol Ratio is a way to measure your risk for heart problems by looking at the balance between different types of cholesterol in your blood. This ratio is calculated by dividing your total cholesterol level by your HDL cholesterol. A lower ratio means you’re generally at a lower risk for heart issues like heart attack or stroke.
- Typical Normal Range <5.0
- Target Optimal Range <4.0, perhaps around 3.0
Small LDL Cholesterol (Small LDL-C)
Small LDL cholesterol, also known as small LDL-C, is a specific type of so called “bad cholesterol” that can be particularly risky for your heart. These small particles are better at sticking to the walls of your arteries and are more likely to contribute to plaque build-up, leading to oxidation of the cholesterol, which could eventually lead to a heart attack or stroke. Anyone with high LDL levels and an increase total cholesterol to HDL ratio should run this slightly more advanced assessment, looking at particle sizes.
- Typical Normal Range <60mg/dl
- Target Optimal Range <30mg/dl
VLDL Cholesterol
Very Low-Density Lipoprotein Cholesterol, or VLDL-C, is another lipoprotein like LDL-C. This type of cholesterol mainly carries triglycerides, a kind of fat, from the liver to peripheral tissues and serve as a precursor to LDL-C. When you have high levels of VLDL-C, it can increase your risk of cardiovascular conditions.
- Typical Normal Range <30mg/dL
Apolipoproteins for cardiovascular risk
You’ve probably heard about cholesterol, but have you heard of apolipoproteins? These are special proteins that help move fats and cholesterol around your body in your blood. Think of them as the ‘team captains’ that help make sure cholesterol gets to where it needs to go, safely and efficiently. Just like you have different types of cholesterol—some good and some bad—you also have different types of these proteins.
In this section, we are going to go through a bunch of apolipoproteins that we often test as part of our health assessments along with their typical normal reference ranges (these may vary slightly from lab-to-lab and country-to-country).
Apolipoprotein A-I (Apo A-I)
Apolipoprotein A-I, or Apo A-I for short, is a key part of what is commonly known as “good cholesterol” (HDL). This protein helps to remove excess cholesterol from your cells and brings it back to your liver, which can then get rid of it. Think of it like a cleaning crew for your bloodstream.
If your Apo A-I levels are low, it could mean that you’re at a greater risk of heart-related issues, as there may not be enough “cleaning crew” to remove the excess cholesterol. On the other hand, higher levels are generally a good sign but are not the only factor to consider.
- Typical Range 120-175mg/dl
Apolipoprotein B (Apo B)
Apolipoprotein B, or Apo B for short, is a part of what people often call “bad cholesterol” (LDL). This protein is essential for carrying cholesterol around your body. Unfortunately, when there’s too much of it, it can lead to cholesterol building up in your arteries, which may increase your risk for heart disease or stroke.
If your test shows high Apo B levels, it suggests you might have a lot of these “bad cholesterol” particles in your bloodstream. This could be a sign that you’re at higher risk of developing heart problems in the future.
- Typical Range 65-115mg/dl
Apolipoprotein B / A-I Ratio (Apo B/Apo A-I)
The Apo B/Apo A-I ratio is a number that healthcare providers use to better understand your risk for heart disease. It compares the level of Apo B, which is part of your “bad cholesterol,” to the level of Apo A-I, which is part of your “good cholesterol.”
A higher ratio means that you have more “bad cholesterol” compared to “good cholesterol.” This could be a sign that you’re at a higher risk for heart issues like clogged arteries or heart attack. A lower ratio is generally considered better for your heart health.
- Typical Range <1.0
Apolipoprotein CII (Apo CII)
Apolipoprotein CII, or Apo CII, is a protein that helps your body break down fats from your diet. It’s an important part of larger particles in your blood called very-low-density lipoproteins (VLDL) and chylomicrons, which carry fats and cholesterol.
If your Apo CII levels are too low, you might find that you have higher levels of triglycerides, a type of fat in your blood. This can increase your risk of heart disease.
- Typical Range 1.5-5mg/dL
Apolipoprotein CIII (Apo CIII)
Apolipoprotein CIII, commonly known as Apo CIII, is a protein that’s part of some of the lipid (fat) particles in your blood. Unlike some other proteins that help break down fats, Apo CIII actually slows down this process, which can lead to higher levels of a type of fat called triglycerides in your blood.
Higher levels of Apo CIII could mean you’re at greater risk for conditions like heart disease or diabetes. This is because having too much Apo CIII can make it harder for your body to clear fats from your blood, potentially leading to blocked arteries.
- Typical Range 5.5-9.5mg/dL
Apolipoprotein E (Apo E)
Apolipoprotein E, or Apo E, is a protein that helps manage fats and cholesterol in your body. It’s found in several types of fat-carrying particles in your blood and is crucial for removing some types of fats. Apo E also has other roles, like helping with immune function and brain health.
- Typical Range 2.5-4.5mg/dL
Homocysteine for cardiovascular risk
Homocysteine is a type of amino acid, a building block of protein, that’s naturally found in your blood. Elevated levels of homocysteine are associated with a range of conditions, most notably cardiovascular disease, including coronary artery disease, stroke, and venous thromboembolism. High homocysteine has been implicated in dysfunction of the blood vessels and oxidative stress.
Besides cardiovascular risk, elevated homocysteine is also associated with neurodegenerative diseases, cognitive decline, and renal dysfunction. Some studies even suggest a role in osteoporosis and age-related macular degeneration.
Measurement of homocysteine is advisable in individuals with unexplained vascular events, a family history of cardiovascular disease, or other risk factors like hypertension and hyperlipidaemia. Elevated levels may warrant treatment with B-vitamins such as folate, vitamin B6, and vitamin B12, which are cofactors in its metabolism.
- Typical Normal Range < 15umol/l
- Optimal Target Range 5-10umol/l
High-Sensitive C-Reactive Protein (hsCRP) for cardiovascular risk
High Sensitivity C-Reactive Protein, often shortened to hsCRP, is a test that measures a type of protein in your blood. This protein goes up when there’s inflammation in your body, which can happen for many reasons, like infections or injury. But it’s especially interesting to doctors because high levels can also signal that you’re at a greater risk for heart issues like strokes or heart attacks.
It is also relevant in conditions like metabolic syndrome, insulin resistance, and chronic infections. Given its nonspecific nature, elevated hsCRP levels warrant further investigation to rule out other causes of inflammation or infection. When utilized in a cardiovascular context, hsCRP is most beneficial when assessed alongside other biomarkers and risk factors to provide a more comprehensive view of an individual’s cardiometabolic profile.
- Typical Normal Range <5.0 mg/L
- Optimal Target Range <1.0 mg/L
Lipoprotein (a) for cardiovascular risk
Lipoprotein (a), often pronounced as “L-p little a,” is a special type of cholesterol particle in your blood. Unlike regular cholesterol, the levels of Lp(a) you have are mostly determined by your genes, and they don’t change much with diet or lifestyle. High levels of Lp(a) can increase your risk of heart disease, heart attacks, and strokes.
The atherogenic potential of Lp(a) is partly due to its LDL-like properties, which promote cholesterol deposition in arterial walls. It also has prothrombotic properties, which can contribute to clot formation.
- Typical Normal Range <75mmol/l or 30mg/dL
Omega 6 to Omega 3 ratio for cardiovascular risk
This is less common for us to look at, however, Omega-3 and omega-6 fatty acids are both essential polyunsaturated fats that have different roles in the body. Omega-6 fatty acids are generally pro-inflammatory, while omega-3 fatty acids have anti-inflammatory properties. The typical Western diet is often skewed towards a high omega-6 to omega-3 ratio, which has been associated with chronic inflammation, a known risk factor for cardiovascular diseases (CVD).
Several studies suggest that a lower omega-6 to omega-3 ratio is associated with a reduced risk of chronic diseases, including CVD. Therefore, assessing this ratio could provide additional information about an individual’s inflammatory status and associated cardiovascular risk.
The O6:O3 ratio is an evolving area of research. While earlier recommendations based on ancestral diets posited that humans evolved on a diet with a 1:1 ratio of omega-6 to omega-3, most Western diets now have ratios that exceed 10:1 or even 20:1 due to increased consumption of omega-6-rich vegetable oils and processed foods.
- Typical Normal Ratio 3:1
Triglycerides for cardiovascular risk
Triglycerides are a form of lipid that serve as an energy reserve and are carried in the blood by lipoproteins such as VLDL and chylomicrons. Elevated serum triglyceride levels are an independent risk factor for cardiovascular disease (CVD), particularly in the context of low HDL levels and elevated LDL levels. High triglycerides can contribute to the formation of atherosclerotic plaques and are often associated with other metabolic disturbances like insulin resistance, obesity, and elevated inflammatory markers.
Typical fasting triglyceride normal range is general considered <1.7mmol/l, however, I strongly recommend and strive for fasting triglycerides of below 1.0mmol/l
Summary
This comprehensive article delves into the vital blood markers that significantly impact cardiovascular risk, including LDL-C, HDL-C, triglycerides, and various apolipoproteins, among others.
Your cardiovascular health is not determined by a single number but a complex interplay of various markers, genetic predisposition, nutrition, lifestyle and more. With a special focus on areas including blood chemistry analysis and functional lab tests, we can offer you a holistic evaluation of your cardiovascular risk and create a tailored strategy for you.
