I’m continuing (if you’re following) my little series here on cardiovascular health. In terms of stressors to the vascular endothelium (the walls of your blood vessels), there are a number of things in the plasma that might be predictive of coronary heart disease (CHD) risk, and/or in assessing best treatment strategies for CHD. And I’m not talking about cholesterol! That’s right, there are other factors at play that may even be more predictive of your cardiovascular health than cholesterol!
In the plasma biomarkers like C reactive protein, homocysteine and lipoprotein(a) are of interest. The interest in these markers as risk factors for CHD are important because many folks that do have CHD do not have overt hyperlipidemia (high levels of blood lipids like LDL, and triglycerides for example) .
C reactive protein (CRP) is a marker of inflammation which is known to be part of the process in the development of atherosclerosis and thrombosis (clot formation). CRP is an independent predictor of risk for heart attack, stroke, peripheral vascular disease and sudden cardiac death even in those that appear to be healthy. Testing for CRP can provide general information that indicates inflammation exists in the body, but it’s not specific so it can’t tell you where that inflammation is. A high sensitivity C reactive protein (hs-CRP) assay is the test used to determine risk for CHD, but it’s not known if CRP is a sign of CHD or if it has a role in causing CHD. Inflammation in the body however can also be due to cancer, infection, IBD, and rheumatoid arthritis for example [1, 2].
Homocysteine is an amino acid and increased levels of it in the plasma is associated with aggregation of platelets, dysfunction of the endothelial cells lining the walls of blood vessels, inflammation and oxidation of LDL cholesterol. All of these factors can increase CHD risk. Measuring levels of homocysteine may be useful in those with known CHD that do not present with traditional risk factors (like smoking, hypertension, low HDL, and family history of CHD). I thought it was worth mentioning here that increased homocysteine levels may be present in those with low intake of folic acid and B12. What are good sources of these B vitamins? Folate can be found in mushrooms, green veggies, legumes, LIVER (yum!), and many grain products are fortified but that’s processed junk so not an ideal nutrient source. Vitamin B12 is found in animal products (sorry vegans and vegetarians) [1, 3, 4].
Lipoprotein(a) is lipoprotein small “a” and it’s also a biomarker of CHD risk in that it appears that those with elevated levels have an increased risk for heart attack and angina pectoris. It is rich in cholesterol and differs from LDL because it contains an additional protein (apolipoprotein (a)) [1, 5].
So there you have it. I will note that studies show that decreasing levels of these biomarkers of cardiovascular disease risk may not [yet] prove to lower such risk, but they do point to increased risk. See, there is way more to the story than just plain old cholesterol!
- Lee, R. D.; Nieman, D. C. (2013). Nutritional assessment. New York, N.Y: McGraw Hill. pp. 260-261