This article will highlight some of the lab tests and factors we look at that go beyond cholesterol, explain common imbalances, and shed light on the lifestyle factors that play a role in cardiovascular health. It’s time to look at heart disease through a wider lens.
For years, cholesterol has been the main target in discussions about heart disease, leading many to believe it’s the sole driver behind cardiovascular events.
Conventional approaches are often fixated on cholesterol being the primary driver of cardiovascular disease and the way to manage heart disease risk is through statin medications.
However, a deeper look at the data reveals a more complex reality: a significant number of people who suffer cardiac events have normal cholesterol levels.
So, what else contributes to the development of heart and vascular disease?
The answer lies in a combination of factors that extend beyond simple cholesterol numbers. From inflammation and oxidative stress to lifestyle, genetics, toxins, blood pressure and more. Understanding the full picture is crucial for effective prevention and management.
We need to understand cardiovascular disease is a process with multiple contributing factors and therefore multiple solutions and treatment options.
It’s time to move on from the reductionist view of heart disease that focuses on cholesterol as the only cause and pedals statin lowering medications as the sole solution!
The Cholesterol Myth and Reality
For decades, cholesterol has been the main target in the fight against heart disease. Most people have been conditioned to believe that high cholesterol levels are the leading cause of heart attacks and cardiovascular problems.
While cholesterol does play a role in heart health, the story is more nuanced than it appears. Studies show that a significant number of individuals who experience cardiac events have normal cholesterol levels, over 50% in fact and in metabolically healthy individuals, having high cholesterol has not been shown to increase the risk of vascular disease!
This challenges the conventional approach that assumes cholesterol alone is the primary driver of heart disease.
The focus on cholesterol as the main culprit has overshadowed other vital aspects of cardiovascular health. What many people don’t know is that the form cholesterol takes and whether it becomes oxidised plays a much more critical role in plaque formation and heart disease risk than the sheer amount of cholesterol in the bloodstream.
When LDL cholesterol particles become oxidised, they can penetrate the walls of blood vessels and initiate the inflammatory cascade that leads to plaque buildup.
Recognising the limits of the “cholesterol equals heart disease” narrative opens the door to a broader understanding of cardiovascular health, which includes factors like inflammation, oxidative stress, and overall endothelial function (the lining of the blood vessel wall).
The Multi-Factorial Process of Cardiovascular Disease
Heart disease is not caused by a single factor but is the result of a complex interplay of various elements that affect vascular health. At the core of this process is damage to the endothelial lining of blood vessels.
The endothelium is a thin layer of cells that lines the interior surface of blood vessels, playing a crucial role in maintaining vascular health and regulating blood flow. When this layer becomes damaged or dysfunctional, it sets the stage for plaque buildup and, eventually, cardiovascular disease.
One major contributor to this damage is inflammation. Chronic, low-level inflammation can occur due to various factors such as poor diet, chronic stress, lack of sleep, chronic inflammatory conditions, chronic infections, and exposure to toxins.
Inflammation not only weakens the endothelial lining but also promotes the oxidation of cholesterol in the sub-endothelial space, an essential step in plaque formation.
Oxidative stress is another key player. It occurs when there’s an imbalance between free radicals and antioxidants in the body. This imbalance leads to the oxidation of LDL cholesterol, which then becomes more likely to penetrate the endothelial lining and contribute to plaque development. High blood sugar, smoking, chronic stress, toxin exposure, trans fats, nutrient deficiencies, excessive body fat are some common triggers that elevate oxidative stress.
Understanding that cardiovascular disease is multi-factorial underscores the importance of addressing a range of risk factors and not just one!
Lab Tests and Common Imbalances in Heart Disease
To truly understand cardiovascular risk, it’s essential to look beyond cholesterol levels and assess other significant markers and imbalances that contribute to heart disease. Here are key lab tests and measures that can provide a more comprehensive picture of cardiovascular health:
Homocysteine
Elevated homocysteine levels can damage the inner lining of arteries, leading to inflammation and increased risk of atherosclerosis. It’s often linked to poor methylation, a biochemical process crucial for various bodily functions, including cardiovascular health.
Lipoprotein (a) [Lp(a)]
Lp(a) is a type of lipoprotein like LDL but with an added protein called apolipoprotein(a). High levels of Lp(a) are associated with increased clotting risk and accelerated plaque formation. Unlike LDL, Lp(a) levels are largely genetically determined, making it an essential marker for individuals with a family history of heart disease.
Insulin and HbA1c
Insulin resistance is a major contributor to metabolic syndrome and cardiovascular disease. Elevated fasting insulin levels can indicate early stages of insulin resistance. HbA1c, a measure of long-term blood sugar control, reflects average blood glucose levels over the past two to three months. Higher HbA1c levels are linked to an increased risk of endothelial dysfunction and vascular damage.
Triglycerides
High triglyceride levels in the blood are a strong indicator of metabolic issues and cardiovascular risk. Elevated triglycerides often result from excessive intake of refined sugars and unhealthy fats and are frequently associated with low HDL levels.
C-reactive protein (CRP)
High-sensitivity CRP is an indicator of inflammation in the body. Chronic inflammation is a known driver of vascular damage and plaque formation, even in individuals with normal cholesterol levels.
Blood Pressure
Persistent high blood pressure (hypertension) puts strain on the arterial walls, leading to damage over time. This damage facilitates the penetration of oxidised cholesterol and accelerates plaque buildup.
Visceral Fat and Body Fat Levels
High levels of visceral fat, the fat stored around the organs, are associated with increased inflammation and higher cardiovascular risk. Overall body fat percentage can also impact heart health, with higher levels often correlating with metabolic disturbances.
AA:EPA Ratio
The balance between arachidonic acid (AA) and eicosapentaenoic acid (EPA) is a crucial indicator of inflammatory status. An imbalanced ratio with higher AA and lower EPA points to increased inflammation and higher cardiovascular risk.
Trans Fats
Though often overlooked in routine assessments, trans fats are particularly harmful to heart health. They increase LDL cholesterol and lower HDL cholesterol, promoting inflammation and contributing to endothelial dysfunction.
Assessing these markers provides a clearer, more holistic picture of cardiovascular risk and is why we include them as part of our Cardiovascular Risk Assessment Package. This is a one off lab test (provided by one of our lab partners) and consultation (with Steve) available to those living in the UK.
By identifying these imbalances and taking corrective measures, whether through diet, lifestyle changes, or targeted supplementation, individuals can take more effective steps towards heart health.
Lifestyle Factors Contributing to Cardiovascular Disease
While lab tests can provide valuable insights into cardiovascular risk, lifestyle factors often act as the driving forces behind these imbalances. Addressing lifestyle habits is crucial for both prevention and management of heart disease. Here are key lifestyle contributors:
Diet
A diet rich in processed foods, refined sugars, and unhealthy fats promotes inflammation, oxidative stress, and poor metabolic health. Excessive intake of trans fats and an imbalanced omega-6 to omega-3 ratio can worsen cardiovascular outcomes. On the other hand, a diet based on whole, nutrient-dense foods like vegetables, fruits, lean proteins, healthy fats (such as those from olive oil and oily fish), typically helps support vascular health and reduce chronic inflammation. I say typically because there are always individual circumstances that may require more specific personalisation.
Exercise
Regular physical activity is one of the most effective ways to enhance cardiovascular health. Exercise improves circulation, boosts HDL cholesterol, lowers blood pressure, and helps regulate blood sugar, insulin and triglyceride levels by improving insulin sensitivity as well as supporting better body composition. Both aerobic activities, such as walking and cycling, and strength training play critical roles in supporting heart health.
Sleep
Sleep is an often-underestimated pillar of heart health. Poor sleep quality or consistently getting less than 6-7 hours of sleep per night is linked to increased inflammation, elevated cortisol levels, and impaired glucose metabolism, all of which contribute to cardiovascular risk. Prioritising restful sleep and maintaining a consistent sleep schedule can have a significant impact on heart health.
Chronic Stress
Prolonged stress can elevate cortisol levels, and is linked with sustained high blood pressure, increased blood sugar levels, damage to the vascular tissue and inflammation. Chronic stress also encourages poor lifestyle choices as a result of trying to cope with the stress. This might include more alcohol or substance abuse and emotional eating. It has been shown that issues with mental health is one of the leading causes of heart disease. Incorporating stress-reducing practices like mindfulness, deep breathing exercises, better diary management, and time spent in nature can help reduce cardiovascular risk. If there are ongoing mental health concerns, then getting appropriate support in this area is critical.
Smoking and Environmental Pollutants
Smoking is a well-known contributor to heart disease due to its ability to damage the endothelium, promote clot formation, and accelerate plaque buildup. Even exposure to second-hand smoke and environmental pollutants can impact cardiovascular health by triggering oxidative stress and inflammation.
By focusing on these modifiable lifestyle factors, individuals can not only improve their cardiovascular health but also support overall well-being.
This is why a lifestyle first approach has a much more significant impact on extended both health and lifespan of an individual vs simply taking a medication to treat a specific imbalance.
The Importance of Addressing Multiple Factors
The development of cardiovascular disease is a multi-layered process influenced by various interconnected factors. Focusing solely on cholesterol oversimplifies the issue and can lead to missed opportunities for effective prevention and treatment. By taking a more comprehensive approach, individuals can gain a better understanding of their overall cardiovascular health and take targeted actions to improve it.
Addressing multiple risk factors means assessing inflammation, oxidative stress, metabolic health, and lifestyle habits. For instance, someone with normal cholesterol levels but high CRP or elevated homocysteine is still at an increased risk of heart disease. Similarly, individuals with insulin resistance, high visceral fat, or an imbalanced AA:EPA ratio could be on the path to cardiovascular issues, even if their cholesterol appears normal on traditional tests.
A holistic approach that includes regular testing, lifestyle modifications, and preventive strategies is key to effective cardiovascular care.
Small, sustained changes in diet, exercise, stress management, and sleep can collectively make a significant impact.
By shifting the focus from cholesterol alone to a more integrated understanding of cardiovascular health, individuals can take empowered steps to safeguard their heart and overall well-being.
We can transform your cardiovascular health together
Taking a proactive approach to your heart health can make all the difference. We specialise in comprehensive cardiovascular assessments that go beyond the basics to identify and address all contributing factors. Our personalised support helps you implement sustainable changes tailored to your unique needs.
To learn more about how we help clients, please visit our Cardiovascular Health page.
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