Saturday, June 18, 2011


Metaphorically speaking, cardiovascular disease is comparable to a health terrorist. The factors that promote cardiovascular disease increase slowly and without knowledge, often causing no apparent symptoms until disaster strikes. Cardiovascular disease (CVD), represented by various diseases, including myocardial infarctions (heart attacks), strokes, and various other disorders related to the heart and circulatory system, remain the number one killer worldwide.

This dubious distinction of being the top killer in the world is reflected by the latest statistics released 3 years ago by the American Heart Association. According to those statistics, 61,800,000 Americans have one or more forms of CVD. These include 50,000 with high blood pressure;7,600,000 with heart attacks;and 4,700,000 with strokes. A total of 945,836 people died from the effects of CVD in 2000, or 39.4 of all deaths from any cause. Viewed from another perspective, 1 out of every 2.5 deaths resulted from CVD.

The most tragic aspect of these cold statistics is that although it’s the number one killer, CVD is largely both preventable and treatable. This involves paying attention to various CVD risk factors. Such risk factors include smoking, high blood pressure, obesity, lack of exercise, and a high saturated fat diet. Other risk factors aren’t as controllable, such as genetic predisposition, age, and sex. Males are generally more at risk for CVD compared to younger women.

The bodybuilding lifestyle, with its emphasis on exercise and proper nutrition, offers many protective effects against CVD onset. An example of this is how exercise increases levels of a protective cholesterol-carrier in the blood called high density lipoprotein (HDL). Another cholesterol-carrier, called low density lipoprotein (LDL) is closely linked to CVD onset, particularly when oxidized. But bodybuilders who consume a generous intake of various antioxidant nutrients, such as vitamin E and selenium, confer added CVD protection. Other nutrients likewise play protective roles in CVD, but a discussion of these nutrients is beyond the scope of this article.

You cannot ascertain the degree of your cardiovascular status by outward appearance. Thus, some obese people may have lower total cholesterol levels than their thinner counterparts for various reasons. The only effective way to access your CVD status is through blood testing. Yet, it’s amazing considering the number of people that are stricken with CVD, how few people even bother to have regular blood tests.

   Another factor that makes many avoid CVD blood testing is the notion that only older, out-of-shape people have CVD. But autopsies performed on soldiers as young as 19 killed during the Korean and Vietnam conflicts revealed a surprising level of atherosclerosis, which involves a narrowing of the arteries, and is considered a primary harbinger of impending heart attacks and strokes. A recent study of 141 young men, ages 17 and 18, confirmed that the process of CVD begins early.[i] Age offers no real protection against CVD.

The usual way to ascertain your CVD status is through standard blood tests, collectively known as a lipid panel. Many of these tests are not included in a standard blood panel, and must be specifically ordered. Otherwise, you will likely see only your blood value for total cholesterol. While total cholesterol levels are still important, knowing this value only provides you with a small sample of your total cardiovascular status. The only tests included in a common lipid panel include total cholesterol,  HDL, LDL, and triglycerides. All of these are important, but again, they reveal only a partial picture of your cardiovascular status.

The major breakthrough in cardiovascular lab testing occurred at the Berkeley Lab in California in 1949. That’s when scientists at the lab first isolated and developed tests for lipoprotein and lipoprotein subclasses, allowing doctors to determine the ratio between lipid fractions such as HDL and LDL, and thus get a more accurate idea of patient status in relation to CVD. Since then, several other tests have been developed, and these tests do provide the clearest picture of how you stand in your cardiovascular status.

                                   The cardio blood tests and what they mean

1) Total cholesterol- normal values are below 200 milligrams per deciliter of blood, though optimal protective levels are 140-150 mg/dl. Most people consider cholesterol an evil substance because of its association with cardiovascular disease. But cholesterol, of which about 80 percent% is made in the liver, is an essential element for cell membrane structure, hormones (including testosterone, which is synthesized from cholesterol and carried to the testes in men on LDL in the blood), and bile acids needed for fat digestion. Cholesterol itself cannot freely circulate in the blood, and must be attached to lipoproteins,such as HDL and LDL to circulate in the blood. Other lipoproteins include chylomicrons, which carry mostly triglyceride or fat; very-low density lipoprotein (VLDL), also primary a fat or triglyceride carrier; and intermediate-density lipoprotein (IDL). Although total cholesterol levels have been downplayed in recent years, a recent study found that total cholesterol levels do point to a lifetime risk of coronary heart disease.[ii]

(2) Low density lipoprotein cholesterol (LDL)- as noted, LDL is considered the primary bad guy in CVD onset, especially when oxidized. Ideal levels are below 100 mg/dl. LDL is the primary cholesterol carrier in the blood, where it transports cholesterol made in the liver to body tissues. When circulating LDL gets trapped in lesions in arteries, it tends to get oxidized. When LDL is oxidized, a series of events occurs inside the arterial wall that culminates in atherosclerosis.

Food high in saturated fat tend to lower the level of LDL cell receptors, thus increasing the level of LDL in the blood and increasing the risk of CVD. The other reason that saturated fat is considered bad in terms of CVD is that it acts as a precursor or starting substance for cholesterol synthesis in the liver. While having a LDL level of 100 or less is good, it isn’t a guarantee that you won’t suffer the effects of CVD.
(3) High density lipoprotein (HDL)- any level below 40 mg/dl is considered abnormal, and the higher the level,the better. HDL is considered the good cholesterol carrier, since it transports cholesterol out of the blood, back to the liver, where the cholesterol is degraded into bile. This represents the only way the body can rid itself of excess cholesterol, since cholesterol cannot be oxidized or burned like fat.

HDL also carries a unique and potent antioxidant called paroxanase that helps to douse the oxidant effects occurring in arteries that initiate the process of atherosclerosis. This natural antioxidant nullifies much of the effects of oxidized LDL. Exercise is closely linked to HDL levels, effectively increasing HDL levels in the blood. Most studies, however, show that you must exercise frequently and at a higher level of intensity to derive this exercise benefit of increased HDL. Losing bodyfat also increases HDL. Alcohol may increase HDL, too, but not necessarily the most protective subfraction of HDL.

(4) Triglycerides- Anything above 140 mg/dl is abnormal. Again, the lower the value,the better. Triglycerides are fat in the blood, and the dietary aspects that consistently increases blood triglycerides are carbohydrate intake, along with excess alcohol intake. For years, triglycerides weren’t considered particularly important in CVD. But recent studies show that higher triglycerides often leads to higher levels of both total cholesterol and LDL. Again, losing fat helps lower elevated blood triglycerides. Fish oil supplements can lower elevated triglycerides by about 60 percent.

The above listed tests are the standard lipid blood
tests. But these do not provide a complete picture of cardiovascular status. Studies show that as many as 50 to 80 percent of people with normal cholesterol levels still develop CVD. Determining the true status of your cardiovascular system requires several other tests. Many of these tests focus on inflammatory markers, such as C-reactive protein. This is related to the recognition that CVD is a largely inflammatory disease state in the arteries. Finding this out early enough to do something about it can spell the difference between life and death.

                   The additional CVD markers

                      Small LDL

Small, dense LDL is considered the most dangerous LDL of all.   Having much of this small LDL circulating in the blood is known as LDL pattern B. Those with larger LDL particles have pattern A. People with a predominance of pattern B or small LDL have a 3-times increased risk of CVD. Those with a lot of such small LDL show a 6-times increased risk. Small LDL is related to genetic predisposition, but also shows up in those who consume high carb diets, gain a lot of weight (fat), and don’t workout.

Smaller LDL can more easily become oxidized and thus play a greater role in CVD onset. Interestingly, those with Pattern B LDL can lower their risk by reducing fat intake, but in those with pattern A, a low-fat diet can make things worse by promoting the onset of the unhealthy smaller, denser LDL pattern B. This is one example of why a low-fat diet isn’t suitable for everyone, but you wouldn’t be aware of this unless you were tested for your specific LDL pattern. The good news about pattern B is that while such people show the most rapid progression of CVD, it’s also the most treatable pattern.


                         Lipoprotein (a)

Lipoprotein (a) acts in a manner similar to LDL. In fact, it’s just LDL with a small protein fraction added to it. Having elevated lipoprotein (a) increases the chances of CVD three-fold. This blood protein isn’t tested in normal blood tests. One interesting aspect of lipoprotein (a) is that testosterone lowers it, but growth hormone elevates it. Anything above 20 mg/dl is abnormal. Studies show that elevated lipoprotein (a) levels occur in one-third of all coronary patients, and 15 to 30 percent of people who suffer heart attacks or strokes have elevated levels of this blood protein. Even if all your other lipid levels are good, having an elevated lipoprotein (a) level alone increases your risk of coronary artery disease by 300 percent.

                                              Apolipoprotein B (ApoB)

Apo B is a protein attached to LDL particles. Apo-B measurements provide a more accurate assessment of LDL status than even LDL itself. This relates to the fact that LDL is an indirect test, measured in relation to total cholesterol levels. But measuring apo-B is like doing a direct head count of LDL levels in the blood, thus providing a more accurate picture. Knowing precisely how much LDL is in the blood allows you to determine whether a person falls into the dangerous small LDL pattern or the safer larger LDL pattern. In addition, when LDL is oxidized, the portion oxidized is apo-B, thus making it in important risk factor for CVD. Desirable levels of apo-B are 40-60 mg/dl.


HDL2B is the type of HDL considered the most protective against CVD onset. This is the type increased by exercise and decreased bodyfat levels. HDL2B is the engine that makes HDL remove excess cholesterol from the arteries, and also carries the potent natural antioxidant, paraoxanase. People of Asian decent, as well as those who are fat and don’t exercise, often are deficient in this subfraction of HDL.

                                               C-reactive protein (CRP)

C-reactive protein is a general marker of inflammation in the body, and as noted, CVD is now considered an inflammatory disease. Since all forms of inflammation in the body can increase CRP levels, scientists developed a test more specific to CVD, known as a high sensitivity CRP test. CRP is also known as an acute phase reactant, because it’s released so rapidly after an inflammatory event in the body. The body releases such substances to help fight inflammation. Higher levels of HS-CRP point to an inflammation indicative of CVD. Those with high levels of HS-CRP have a 4-7 times increased risk of CVD.

Recent studies show that HS-CRP may be the most predictive test of all in relation to CVD. An elevated HS-CRP is twice as likely to predict the onset of a heart attack compared to LDL cholesterol levels. An estimated 20 to 30 million Americans have elevated HS-CRP, despite also having normal total cholesterol levels.

Having a HS-CRP level of greater than 3 mg/dl is considered a high risk for a heart attack. Elevated levels of CRP also show an increased risk of type-2 or adult-onset diabetes mellitus. Those who smoke, have high blood pressure, are fat, and fail to exercise, tend to have elevated CRP levels. People who regularly exercise show lower levels. In fact, a recent study[iii] showed that exercise was effective in lowering CRP levels even in obese people.


Fibrinogen is another acute phase reactant, involved in blood clotting reactions. Having an elevated fibrinogen level points to an increased tendency for internal blood clots. This is significant because most heart attacks and strokes are initiated by such internal clots that block arteries occluded by atherosclerosis. The normal blood range is 200 to 400 mg/dl.


Homocysteine is a metabolite of the amino acid, methionine. Numerous studies show that this amino acid incurs direct toxic effects against arteries. Again, many people with normal blood lipid values may still have higher homocysteine levels. Studies show that having a high blood level of homocysteine puts you at the same risk of having a stroke as smoking a pack of cigarettes each day. Elevated homocysteine levels in the blood promote atherosclerosis by irritating the arteries and promoting a smooth muscle proliferation in the walls of arteries that leads to narrowed arteries.

The good news is that homocysteine levels are easily controlled by ingesting three nutrients: vitamin B6, folic acid, and vitamin B12. These nutrients convert homocysteine into a safe substance excreted from the body. Normal levels of homocysteine are below 14 micromoles per liter of blood. Steroid users should know that using these drugs increase homocysteine levels in the blood.

Other useful tests include those for resting insulin, since excess insulin can damage the internal linings of arteries, leading to atherosclerosis. Another good test is for apolipoprotein E, which exists in normal and abnormal genetic forms. Knowing which form you have can not only be a prognostic indicator of future CVD, but also of Alzheimer’s disease.

While many of these tests may appear exotic, they nonetheless provide the most accurate portrait of your cardiovascular status. They provide you the needed information that allows you to offset the sneaky effects of CVD to help yourself from becoming just another sad victim of the hidden terrorist within: CVD.

[i].Knoflach M, et al. Cardiovascular risk factors and atherosclerosis in young men.Circulation 2003;108:1064.
[ii].Lloyd-Jones D, et al. Lifetime risk of coronary disease by cholesterol levels at selected ages.Arch Internal Med 2003;163:1966-72.
[iii].Tomaszewski M, et al. Strikingly low circulating CRP concentrations in ultramarathon runners independent of markers of adiposity.Arter, Thromb, Vasc Biol 2003;in press.

©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.

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