The Cardiology Blood Tests

As part of a complete physical, physicians will order a full blood count, electrolytes, a chemical profile, and renal tests. The usual cardiac evaluation will also include a lipid panel, total cholesterol, HDL (high density lipoprotein), LDL (low density lipoprotein), triglyerides, and ratios for these lipids.

Going beyond cholesterol we pay special attention to elevations of homocysteine, lipo-protein-a, ferritin, fibrinogen, CPR and (C-reactive protein). Hormone levels are checked including estrogen, testosterone, and thyroid. Even a slight reduction in thyroid hormone increases the risk for CVD (cardiovascular disease). Blood levels of glucose and insulin are measured. A raised level of insulin over time sets the stage for silent arterial inflammation.

Homocysteine

Do you know what your homocysteine level is? The normal range as determined by a blood test is 5-15 micromoles/L. An optimal level would be 9 micromoles/L or less.

Homocysteine is an amino acid produced in the human body by the chemical conversion of methionine, a compound regularly consumed within the diet. When methionine-rich foods such as meat are eaten homocysteine levels increase. Drinking coffee also increases homocysteine levels, caffeine is partly responsible for this effect

Elevated blood levels of homocysteine have been linked to increased risk of premature coronary artery disease, stroke, and thromboembolism (venous blood clots), even among people who have normal cholesterol levels. Abnormal homocysteine levels appear to contribute to atherosclerosis in at least three ways: (1) a direct toxic effect that damages the cells lining the inside of the arteries, (2) interference with clotting factors, and (3) oxidation of low-density lipoproteins (LDL).

Homocysteine and B Vitamins

Elevated homocysteine is widely recognized as a major risk factor for cardiovascular disease. Dr Kilmer McCully a pathologist in America postulated that homocysteine triggers arterial disease causing plague and blood clot formation.

The homocysteine problem stems from a deficiency of three B-complex vitamins----B-6, folic acid, and B-12----that prevent proper processing of dietary protein. B-6 and folic acid have been deficient in the standard American diet filled with nutrient-poor processed foods. More than 50% of adults fail to eat the recommended 3 servings of vegetables, and only 24% eat the recommended two servings of fruit.

Fruits and vegetables are excellent sources of vitamins B-6 and folic acid. In 1998 the Food and Drug Administration mandated supplementation of folic acid to bread and grains to curb the incidence of neural tube defects, a deficiency related condition causing malformations of the spine in newborns.

The famous Framingham Heart study found that older individuals deficient in folic acid, B-6, and B-12 had higher homocysteine levels. The research also showed a narrowing of the carotid arteries. Homocysteine tends to rise slowly with age. The Nurses Health study showed that the lower the intake of folic acid and B-6, the greater the risk of death from CVD. Research has shown that supplementation with folic acid normalizes homocysteine levels and improves endothelial (inner layer of blood vessels) function.

A 2002 study reported in the Journal of the American Medical Association described significant benefits for patients after coronary bypass surgery. In the group of patients who had taken 1 mg of folic acid, 10mg of B-6 and 400mcg of vitamin B-12 there, was a 50% reduction in re-narrowing in the vitamin group compared to the placebo group.

In a 2002 study at King’s College in London researchers showed that in smokers who were given folic supplementation there was a reduction in homocysteine levels, improved arterial dilation, and lower blood pressure. It is known that smoking increases homocysteine levels and this may at least partly account for the vascular abnormalities observed in smokers. Thus a simple and nontoxic vitamin might be useful in primary cardiovascular prevention in this high risk group.

Three recent studies failed to find that the use of B vitamins to lower the homocysteine level has particular effectiveness for high risk patients with advanced CVD or who have already had heart attacks. It is essential to lower homocysteine to prevent the disease once the atherosclerosis process is well advanced, homocysteine may no longer play a critical role.
Recommendations

For general prevention a good multivitamin may contain adequate levels of the B-complex vitamins. If you have elevated homocysteine, take extra folic acid in milligram dosages such as 1mg, 40mg of B-6 and 200mcg of B-12. Repeat your blood test for homocysteine two months after you start on a supplementation program. If still high, add N-acetylcysteine, an excellent antioxidant at 500 mg per day.

The B vitamins are also beneficial in the treatment of nervous problems, fatigue, and stress, and in the prevention of alcohol problems. They also participate in the most important aspects of food metabolism, the production of energy, and immune function.

The only adverse effect from the B-vitamins is constipation in a few patients. The B-vitamins are water soluable and your system excretes the excess. The cause of the fluorescent yellow pigment which turns urine yellow is due to vitamin B-2 called riboflavin. The body absorbs what it needs. The rest passes out through the urine.

Dr Ronald Goedeke
Appearance and Wellness Centre
72 Apollo Drive
Albany, AKL
Ph 09 479 8802