Getting to the heart of CVD prevention

How can you make the most of comprehensive blood testing to support your clients’ cardiovascular health?

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When it comes to transforming the quality of your patients’ or clients’ lives, chronic disease prevention should be somewhere at the top of your list.

Cardiovascular disease (CVD) is the most prevalent chronic disease in the developed world, and yet a heart-skipping 80% of cases are thought to be preventable [1]. With CVD, time is of the essence. For preventative tactics to have the greatest impact, patients must establish their risk as early as possible.

A study published in the BMJ Open found that around four in five people (78.8%) were unaware of their cholesterol levels [6] – and most are likely to have results that put them at increased risk. A cholesterol panel and HbA1c are great starting points, but are you aware of emerging cardiovascular biomarkers to further support your assessment?

This Heart Month, we’re exploring how you can make the most of blood testing to empower your clients and patients towards a long, heart-healthy life.

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It’s never too early to consider CVD risk

A recent study found that non-HDL cholesterol (non-HDL-C) levels during adolescence had the strongest association with atherosclerotic disease in later life [2] – which is thickening or hardening arteries.

They followed three groups over 28 years, measuring non-HDL-C during three life stages:

1.????? Adolescence

2.????? Young adulthood

3.????? Mid-adulthood

Raised non-HDL cholesterol during adolescence was associated with a 16% increased likelihood of developing coronary artery calcifications in mid-adulthood, greater than the association between non-HDL-C levels in young (14%) or mid-adulthood (12%).

What does this mean?

The earlier you can assess and address a person’s risk, the better. This makes sense – the longer artery walls are exposed to atherogenic particles, the more likely they are to form damaging plaques. That’s why a high non-HDL-C result at a younger age more strongly correlates with disease in later life.

To help us decide on when to offer a prevention strategy, we often use measures like a 10-year risk score, but this score is disproportionately influenced by age. So, by the time a score exceeds 10%, most atherosclerotic plaques have already formed. As well as risk prediction algorithms, we should also be considering and managing the cause of cardiovascular disease, namely the number of atherogenic particles. Doing so enables us to give patients the best opportunity to reduce damage in the first place for the greatest impact.

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Enhance your assessment with novel biomarkers

The biomarkers we use to assess cardiovascular risk have transformed over time in response to advancements in research, technology, and our understanding of the disease. We’ve moved from total cholesterol to lipid fractions, to include markers like LDL-C.

In recent decades, newer biomarkers have emerged from the research that offer additional insights into individual risk profiles, especially for people with few traditional risk factors.

1.??? Apolipoprotein B

Apolipoprotein B (ApoB) is often considered to be a better measure of cardiovascular risk than individual markers (such as LDL or non-HDL-C) [3]. There are a few reasons why.

Cholesterol can only enter the arterial wall within apoB particles and all apoB particles are equally atherogenic, even despite how much cholesterol they contain. Hence the number of atherogenic particles (represented by apoB) is a better indicator of risk than the amount of cholesterol they contain (represented by LDL or non-HDL-C) [4]. ApoB also accounts for all atherogenic particles, including IDLs and chylomicrons. So it’s less likely to underestimate someone’s risk than an LDL-C result. ApoB levels can also be measured more accurately than LDL on non-HDL-C, especially at low concentrations [3].

2.??? Lipoprotein (a)

Lipoprotein (a), or Lp(a), stands out as one of the few cardiovascular risk markers that is not significantly impacted by lifestyle changes. It is a sticky molecule, similar to LDL-C, which contributes to atherosclerosis, and likely blood clot formation. Around one in five people have a raised Lp(a) level. Elevated Lp(a) is more likely in people of African descent or people with a strong family history of cardiovascular disease.

It's quite possible to have normal cholesterol results but a significantly raised Lp(a) level, which may come as a surprise for people who consider themselves low risk. Lp(a) levels are largely determined by genetics, but that doesn’t mean there’s nothing that can be done. On the contrary, lifestyle changes become even more important to lower one’s overall cardiovascular risk.

3.??? Omega-3 Index

Most of us have heard of the omega-6:3 ratio. This important ratio of essential fatty acids affects levels of inflammation in the body and cardiovascular risk. However, there’s not much advantage to having a good omega-6:3 ratio if both are low.?

The Omega-3 Index is thought to provide a clearer and highly evidence-based actionable insight. This test reflects the amount of eicosapentaenoic acid (EPA) and docosahexaenoic (DHA) in red cell membranes as a proportion of the total fatty acid content. It is relatively stable over time and is less influenced by recent dietary changes than plasma omega-3 levels. Results also strongly correlate with tissue levels.

There is strong evidence to show that maintaining a level greater than 8% is beneficial for cardiovascular health [5]. Increasing dietary intake of fish oil is a straightforward recommendation that can significantly improve an individual’s result.

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Our top 3 blood test recommendations

This Heart Month we’ve handpicked our top three tests that can support your patients and clients towards a healthy heart.

1.??? Optimal Health Blood Test

This 58-biomarker test is packed full of insights into cardiovascular health and risk. As well as biomarkers assessing general health and organ function, it includes hs-CRP, HbA1c, lipoprotein (a), a full cholesterol breakdown, an apolipoprotein panel, hs-CRP, and HbA1c.

2.??? Advanced Heart Disease Blood Test

For a more focussed cardiovascular screen, our Advanced Heart Disease Blood Test is the one. The lipid profile also features lipoprotein-associated phospholipase A2, or LP-PLA2, a vascular-specific marker of inflammation associated with cardiovascular disease.

3.??? Omega-3 and -6 Blood Test

Our Omega-3 and -6 Blood Test is a great choice for clients who are already making the right lifestyle decisions but might not have considered how their fatty acid profile can affect their heart health. This test includes the more novel Omega-3 Index, for an evidence-based target of greater than 8%.

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Get in touch

If you’re looking to provide even more insights into your clients’ and patients’ heart health, get in touch. We’ll show you how easy it is to incorporate blood testing into your offerings.

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References

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1. ?????????? CVD Prevention | What We Do. In: World Heart Federation [Internet]. [cited 5 Feb 2024]. Available: https://world-heart-federation.org/what-we-do/prevention/

2. ?????????? Armstrong MK, Fraser BJ, Hartiala O, Buscot M-J, Juonala M, Wu F, et al. Association of Non–High-Density Lipoprotein Cholesterol Measured in Adolescence, Young Adulthood, and Mid-Adulthood With Coronary Artery Calcification Measured in Mid-Adulthood. JAMA Cardiology. 2021;6: 661–668. doi:10.1001/jamacardio.2020.7238

3. ?????????? Contois JH, Langlois MR, Cobbaert C, Sniderman AD. Standardization of Apolipoprotein B, LDL‐Cholesterol, and Non‐HDL‐Cholesterol. Journal of the American Heart Association. 2023;12: e030405. doi:10.1161/JAHA.123.030405

4. ?????????? Sniderman AD, Thanassoulis G, Glavinovic T, Navar AM, Pencina M, Catapano A, et al. Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiol. 2019;4: 1287–1295. doi:10.1001/jamacardio.2019.3780

5. ?????????? Harris WS. The omega-3 index: From biomarker to risk marker to risk factor. Curr Atheroscler Rep. 2009;11: 411–417. doi:10.1007/s11883-009-0062-2

6. ?????????? Patel RS, Lagord C, Waterall J, Moth M, Knapton M, Deanfield JE. Online self-assessment of cardiovascular risk using the Joint British Societies (JBS3)-derived heart age tool: a descriptive study. BMJ Open. 2016;6: e011511. doi:10.1136/bmjopen-2016-011511

7. ?????????? Adults’ health: Cholesterol. In: NHS Digital [Internet]. [cited 6 Feb 2024]. Available: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021-part-2/adult-health-cholesterol