Monitor Your Own Risk – Cardiac & Stroke

We often put the monitoring of our own health in the hands of others.  I am going to show you how you can monitor your own risk and avoid becoming another statistic in the world of cardiovascular disease and stroke.  

According to the latest statistics from the World Health Organisation…. “The world’s biggest killer is ischaemic heart disease, responsible for 16% of the world’s total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by more than 2 million to 8.9 million deaths in 2019. Stroke ……. is the 2nd leading cause of death, responsible for approximately 11% of total deaths”¹.  Maybe it is time to do something different as the first symptom in 50 percent of heart attacks is also the last (ie. sudden death)⁹.  

The knowledge on risk factors related to these diseases has evolved over time.  Like you, I was brought up on the focus that cholesterol was the big villain behind these diseases.  Science has known for some time that it is not that simple.  What you do want to avoid at all costs is the build up of plaque in your arteries as this puts you at risk of heart attack and stroke.  Cholesterol or more specifically, oxidised cholesterol, can be partly to blame for this but it is no longer the headline of this story^10,11.  Metabolic Syndrome takes centre stage as the number one cause of cardiovascular disease².  This is the umbrella term that includes blood pressure, waist circumference, triglycerides, HDL cholesterol, blood sugar balance and inflammation.  If you have at least 3 of these variables outside the optimal range, you have metabolic syndrome.  “The bad news is that metabolic syndrome can kill you before you ever develop diabetes^2,3”.    

Do you have metabolic syndrome^2,3?

Inflammation is a newer addition to the metabolic syndrome table and needs an extra note.  If you were to look up the research database pubmed.gov and typed in “chronic inflammation and cardiovascular disease” you will find about 22,000 publications extending back some 20 years.  Researchers now know atherosclerosis is an inflammatory disease that sets off your body’s immune response⁶.  Inflammation is one of the bodies protection tools but if it becomes chronic, any number of symptoms may present themselves including arthritis, asthma, Alzheimer’s and cardiovascular disease to name a few.  C-Reactive Protein (CRP), made in the liver, gives us a very good clue about how much inflammation is going on in our bodies.  Cardio or High Sensitivity CRP is a more precise indicator of cardiac risk.  Studies show this test as an accurate predictor of heart disease⁶.  It should be no higher than 1.0.  A score of 3.0 poses a high cardiac risk².   

Monitoring for metabolic syndrome gives you the power to get early warning signs before symptoms of plaque build-up in the arteries start to be expressed.  The cost to you can simply be the cost of a visit to your doctor requesting that these tests be completed.  Alternatively, you can take a blood form to your local blood lab and pay for the tests at the counter.  You would request lipids ($43.50), fasting glucose ($13.00), High Sensitivity CRP ($29.00) and pay the blood draw fee ($14.30), a total of $99.80 (costs may vary slightly per lab).  BodyLab can give you a free blood form for this.

Extra advanced tests can be added if you want to explore more.  The following are the ones that specifically relate to the risk of cardiovascular disease.    

GGT

GGT (Gamma Glutamyl Transferase) is a liver enzyme located on the external surface of cell membranes.  Increased GGT activity is a marker of inadequate antioxidant activity and increased oxidative stress.  It reflects insulin resistance, liver inflammation and risk of future diabetes.  There is strong evidence⁵ supporting the association of elevated GGT with increased risk of cardiovascular disease.  In fact, overseas life insurance experts use GGT as a high predictor of mortality⁴.  High GGT indicates your body is not coping with some sort of insult it is receiving.  This puts the spotlight on diet.  A diet that includes excessive carbohydrate (including fruit juices), and high consumption of omega 6 vegetable oils (including margarine) will stress the liver and elevate GGT.  High GGT is associated with 7-9 times the risk of developing coronary artery disease and 1.7 times the risk of cardiovascular death⁴.  It also gives a glimpse of type two diabetes in your future when high BMI is combined with high GGT.  This combination gives you 15 times the risk of future diabetes⁴.  Ideal GGT is <15 U/L and high is >30 U/L⁴.  (Cost $14.50)

Ferritin

This is the amount of iron you have stored in a protein called ferritin.  If your body is not getting enough from the food you eat it will use this stored iron.  Over 80 percent of your iron is contained in haemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of your body, along with other critical processes.  The protein ferritin stores the excess iron until it can’t.  The excess iron builds up and accelerates oxidative stress, damaging the walls of the arteries and causing major inflammation⁶.  This process also oxidises cholesterol which can cling to the artery walls, forming plaques that can block arteries and increase your risk of heart attack and stroke.  It is estimated that every 1 percent increase in ferritin will boost your risk of cardiovascular disease by 4 percent⁶.  The research by Dr Ivor Cummings reports that high serum ferritin is associated with 5 times the risk of developing incident atherosclerosis and 10 times the risk of carotid atherosclerosis⁷.  A Finnish study following 1900 men showed a ferritin level of 200 ug/L more than doubled relative risk for heart attack⁶.  Ideal ferritin is 50-70 ug/L for both men and women⁶.  (Cost $19.50)

Uric Acid

A missing piece in the cardiovascular disease puzzle is uric acid.  Most people will link this to gout, which is true, but it is also linked to cardiovascular disease.  A paper published by the American College of Rheumatology revealed that elevated uric acid is responsible for 39 percent of total cardiovascular disease⁸.  It often precedes insulin resistance and type 2 diabetes, making it a useful marker to watch for⁸.   The big influencer here is fructose.  Yes, this is in fresh whole fruits but it sneaks its way into many of our food products including sauces, high fructose corn syrup, salad dressings, fruit juice and energy bars to name a few.  By the way, fructose also leads to the formation of triglycerides (think back to your metabolic syndrome markers).  Ideal uric acid is 0.33 mmol/L or below⁸.  (Cost $14.00) 

Homocysteine

It took a number of years for this amino acid to gain traction as a marker for blood vessel damage.  It is produced during the process of breaking down an amino acid (methionine) found in common foods like red meat, poultry, legumes, eggs, avocado and grains.  The process helps prevent oxidised cholesterol clogging your arteries and it also forms homocysteine.  Normally homocysteine is broken down into other chemicals and excreted.  However certain conditions (vitamin B deficiencies, smoking, some medications, kidney failure, low thyroid function) won’t allow this to happen and homocysteine levels rise, damaging blood vessel lining and allowing oxidised cholesterol to form plaques.  Here comes the light bulb moment.  It you combine high blood pressure with high homocysteine levels, you have twenty-five times the risk of having heart attack or stroke.  Ideal homocycsteine is 7 – 10 umol/L⁶.  (Cost $71.00)

Lipoprotein (a)

Heart health is not determined by cholesterol numbers alone.  For example, a US study showed 75 percent of people admitted for heart attack into hospital had normal cholesterol⁶.  The combination of oxidised cholesterol and damaged artery walls (from free radicals) is the bigger concern for plaque formation.  LDL cholesterol has typically been labelled as the bad cholesterol.  However, there is a harmless form of LDL cholesterol (LDL-A) with large fluffy particles, and these contribute to good health.  The harmful form of LDL cholesterol (LDL-B) is made up of small dense particles.  These particles do not contribute to good health.  These particles influence inflammation and plaque formation.  Low levels of physical activity, a diet high in refined carbohydrates, low in foods rich in antioxidants and low in healthy fats, all favour the small dense LDL particles.  The worst of the small dense LDL particles is called Lipoprotein (a).  These particles have a strong influence in plaque growth.  The bad news is that Lipoprotein (a) can’t really change with diet and lifestyle².  But you can reduce risk significantly by addressing all the other variables mentioned on this blog.  Ideal Lp(a) <200mg/L.  (Cost $21.50)  

ApoB : ApoA1 Ratio

LDL particles are wrapped in a unique protein (ApoB) and HDL particles (very important for cholesterol homeostasis) are also wrapped in a unique protein (ApoA1) which makes the ratio a very powerful risk indicator (x3 risk multipler⁷). This differs from just looking at LDL and HDL on your normal lipid panels which looks at the quantity of cholesterol contained within the particles. This ApoB : ApoA1 ratio looks at the actual number of particles themselves. People with insulin resistance tend to have fewer HDL particles and more LDL particles. The ratio reveals this and it trumps just looking at ApoB alone⁷. Ideal Ratio < 7.0 (Cost $25.00 ApoB & $25.00 ApoA1)

Fasting Insulin

You won’t want to skim over this one.  This is one of the big root causes of cardiovascular disease that started happening when fat was promoted as the villain back in the 70’s.  Filling the gap of a low fat diet meant a lot more carbohydrate was consumed which became more and more processed over time.  Overeating carbohydrates has a direct influence on raising insulin.  The flow on affect from constant higher insulin has become a root cause of obesity, high blood pressure, high cholesterol, and heart disease.  Consuming foods high in cholesterol does not increase blood cholesterol⁶.  The higher your insulin, the higher your triglycerides will be (think back to metabolic syndrome).  Higher insulin also promotes arterial stiffness and less nitric oxide (this promotes dilation of blood vessels for the flow of blood, oxygen and nutrients), which triggers oxidative stress and inflammation.  This test is not often done but if you want an earlier warning sign that type 2 diabetes is on the way, this is important to do.  Ideal insulin is <5 uU/mL¹⁴. (Cost $55.00)

Magnesium (Red Blood Cell)

Magnesium has been included on this list as it is a big player in the body.  It is known as a co-factor for more than 300 processes connected with the production of energy.  It is also important for our genes, reproduction, protein synthesis, muscular contraction, blood pressure, insulin metabolism, cardiac excitability, nerve transmission, blood vessel tone, and neuromuscular conduction.  Low magnesium may result in unwanted neuromuscular, cardiac or nervous disorders.  Research by Dr Steven Masley² has identified low magnesium as the number one mineral connected with the development of plaque in arteries.  Ideal magnesium (red blood cell test) is 2.14 – 2.67 mmol/L¹³.  (Cost $12.50)

ECG Exercise Tolerance Test

This is often called a stress test and is a good check if you want to see if there are any signs of current cardiovascular disease.  At BodyLab it is a graded exercise test with ECG, blood pressure and gas analysis monitoring.   The test can be done on a treadmill or bike and usually lasts for 8 – 12 minutes.  The workload is easy at first and then gradually becomes harder over the duration of the test.  The ECG can pick up signs of restricted blood flow to the heart and other ECG abnormalities.  Higher than normal blood pressure recordings can indicate arterial stiffness and the gas analysis (ie. mask on your face to measure the air you breath in an out) provides a very accurate assessment of your cardiovascular fitness.  Blood pressure relates to arterial health, and high cardiovascular fitness relates to lower risk of plaque development².  Your one-minute heart rate after stopping exercise is also checked as this is a very good prediction tool for future cardiovascular events in people with or without heart disease between the ages of 30-80².  It would be concerning if your heart rate dropped less than 20 beats at one minute.  More details can be found here.   

Coronary Artery Calcium Score

This test measures the quantity of atherosclerotic plaque lining the arteries of your heart.  It provides a guide of heart attack risk.  A calcium score is also a useful tracking tool as plaque can grow at the rate of 30-35 percent per year⁹, and it can also decrease with the right diet and lifestyle changes.  The higher your calcium score the more likely a severe blockage is present.  The chart below summaries how the scores are broken down⁹. The cost can vary from $600 – $850.

Once you have this number you are given a percentile rank based on age.  The higher your percentile rank, the higher your risk for plaque rupture and heart attack.     

There are few places in NZ that provide this service.  Here is the list. BodyLab can give you a free referral for some of these.

Ascot Radiology – Auckland 

TRG Imaging – Whangarei

Pacific Radiology – Wellington (and other main cities)

The Heart Group – Auckland

Auckland Radiology Group – Auckland

Cardiology Specialists – Christchurch

References

1. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death 
2. Masley, Steven (2021).  The 30-Day Heart Tune-Up: A Breakthrough Medical Plan to Prevent and Reverse Heart Disease.
3. Ovadia, Philip (2021).  Stay Off My Operating Table.
4. Cummings, Ivor (2019). https://thefatemperor.com/wp-content/uploads/2019/03/TRANSCRIPT-6-Fat-Emperor-on-Fatty-Liver-Enzyme-GGT-Dont-Die-from-Ignorance.pdf 
5. https://pubmed.ncbi.nlm.nih.gov/28149843/ 
6. Gittleman, Ann Louise (2021). Radical Longevity: The Powerful Plan to Sharpen your Brain, Strengthen your Body and Reverse the Symptoms of Aging.
7. Cummings, Ivor and Gerber, Jeffry MD (2018). Eat Rich, Live Long: Use the Power of Low-Carb and Keto for Weight Loss and Great Health.
8. Perlmutter, David (2022).  Drop Acid.  The Surprising New Science of Uric Acid.
9. Davis, William (2005).  What Does My Heart Scan Show?
10. Cummings, Ivor (2023) Podcast https://thefatemperor.com/ep127-a-statin-free-life-revealed-with-dr-aseem-malhotra/
11. Malhotra, Aseem (2021). A Statin-Free Life: A Revolutionary Life Plan for Tackling Heart Disease – without the use of Statins.
12. Bowden, Jonny and Sinatra, Setphen T (2020). The Great Cholesterol Myth, Revised and Expanded: Why Lowering Your Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan that Will.
13. Bredesen, Dale (2020). The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline.
14. Winters, Nasha (2017). The Metabolic Approach to Cancer. Intergrating Deep Nutrition, the Ketogenic Diet, and Non-Toxic Bio-individualised Therapies.
15. Mangan, P.D (2016). Dumping Iron: How to Ditch This Secret Killer & Reclaim Your Health.