Cardiac risk profile is a group of tests and health factors that have been proven to indicate your chance of having a cardiovascular event such as heart attack or stroke.

Historically, the only means of assessing the cholesterol has been the total cholesterol, LDL, HDL and triglyceride level. Now with innovative technology, ultracentrifugation, your cholesterol can be examined to assess additional parameters which have important implications about your risk for heart attack and stroke and the risk of family members. These factors may also assist in guiding our recommendations regarding diet and exercise for you.

Risk Factors Analysis

Our Cardiac risk profile analyzes the following factors:

• Homocysteine,
• Lp(a),
• D-dimer,
• hsCRP,
• LDL direct and
• Apolipoproteins A1/b

Homocysteine

Homocysteine is an amino acid in the blood. Epidemiological studies have shown that too much homocysteine in the blood (plasma) is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease.

Other evidence suggests that homocysteine may have an effect on atherosclerosis by damaging the inner lining of arteries and promoting blood clots. However, a direct causal link hasn’t been established.

Recent findings suggest that laboratory testing for plasma homocysteine levels can improve the assessment of risk. It may be particularly useful in patients with a personal or family history of cardiovascular disease, but in whom the well-established risk factors (smoking, high blood cholesterol, high blood pressure) do not exist.

Lp(a)

It is a lipoprotein consisting of an LDL molecule with another protein (Apolipoprotein (a)) attached to it. Lp(a) is similar to LDL-C but does not respond to typical strategies to lower LDL-C such as diet, exercise, or most lipid-lowering drugs. Since the level of Lp(a) appears to be genetically determined and not easily altered, the presence of a high level of Lp(a) may be used to identify individuals who might benefit from more aggressive treatment of other risk factors.

D-dimer

D-dimer tests are ordered, along with other laboratory tests and imaging scans, to help rule out, diagnose, and monitor diseases and conditions that cause hypercoagulability, a tendency to clot inappropriately. One of the most common of these conditions is DVT (Deep Vein Thrombosis), which involves clot formation in the deep veins of the body, most frequently in the legs. While clots most commonly form in the veins of the legs, they may also form in other areas as well; for example, clots in coronary arteries are the cause of myocardial infarction (heart attacks). Clots may also form on the lining of the heart or its valves, particularly when the heart is beating irregularly (atrial fibrillation) or when the valves are damaged. Clots also may form in large arteries as a result of damage from atherosclerosis (sometimes called hardening of the arteries). Pieces of such clots may also break off and cause an embolus that blocks an artery in another organ, such as the brain (causing a stroke) or the kidneys.

hs-CRP

hs-CRP is promoted by some as a test for determining the potential risk level for cardiovascular disease, heart attacks, and strokes. The current thinking is that hs-CRP can play a role in the evaluation process before one encounters one of these health problems. More clinical trials that involve measuring hs-CRP levels are currently underway in an effort to better understand its role in cardiovascular events and may eventually lead to guidelines on its use in screening and treatment decisions. hs-CRP usually is ordered as one of several tests in a cardiovascular risk profile, often along with tests for cholesterol and triglycerides. Some experts say that the best way to predict risk is to combine a good marker for inflammation, like hs-CRP, along with the lipid profile.

LDL- Direct

The test for LDL cholesterol is used to predict your risk of developing heart disease. Of all the forms of cholesterol in the blood, the LDL cholesterol is considered the most important form in determining risk of heart disease. Since treatment decisions are often based on LDL values, this test may be used to monitor levels after the start of diet or exercise programs or to determine whether or not prescribing one of the lipid-lowering drugs would be useful.

LDL-C levels are ordered as part a lipid profile, along with total cholesterol, HDL, and triglycerides. This profile may be ordered as a screening profile in a healthy person as part of a routine physical exam. It is recommended that all adults be tested at least once every five years. A fasting lipid profile may be ordered more frequently on those who have one or more major risk factors for heart disease (see below). It may be ordered on someone who has had a high screening cholesterol result to see if the total cholesterol is high because of too much LDL-C.

Apolipoprotein A1/b

To determine whether or not you have adequate levels of Apo A-I, , especially if you have decreased levels of HDL-C, and to help determine your risk of developing coronary artery disease (CAD)

Apo B-100 levels are used, along with other lipid tests, to help determine an individual's risk of developing atherosclerotic heart disease and coronary artery disease (CAD). It is not used as a general population screen but may be ordered when a patient has a family history of heart disease and/or hyperlipidemia. It may be performed, along with other tests, to help diagnose the cause of hyperlipidemia, especially when someone has elevated triglyceride levels (preventing accurate LDL cholesterol calculations).

We offer both Apo A-I (associated with high-density lipoprotein (HDL) - the "good" cholesterol) and Apo B-100 levels to get a ratio of A/B to obtain additional risk information.

Management

• Prevention

1. Use of Antiplatelet (e.g. Aspirin) or anticoagulant
2. Blood Pressure control
3. Cholesterol management
4. Diabetes management
5. Regular Exercise (or Cardiac Rehabilitation if indicated)
6. Use of Fish oil
7. Smoking Cessation

• General management

1. Tobacco avoidance
2. BMI <25 kg/m2 (but even <30 kg/m2 reduces risk)
3. Eating 5 or more fruits and vegetables daily
4. Aerobic Exercise >150 minutes per week

• Risk factors modification

1. Weight loss
2. Blood pressure control
3. Tobacco Cessation
4. Diet or pharmacologic treatment to reduce cholesterol
5. Aerobic Exercise (30-45 minutes, 3-6 times per week)
6. Aggressively treat Diabetes Mellitus
7. Treat comorbid Major Depression
8. Influenza Vaccine