By Cat Troiano
According to the Centers for Disease Control and Prevention (CDC), cardiovascular disease (CVD) is the leading cause of death in the United States, claiming more than 600,000 lives each year. CVD occurs when fatty deposits accumulate within the arteries. These accumulations cause the blood vessels to narrow, restricting the flow of blood that carries oxygen and vital nutrients to organ tissues. CVD can ultimately result in a heart attack or stroke. Approximately 735,000 American men and women suffer heart attacks each year. Cardiac risk assessment screening provides valuable insight for physicians and patients to work together to decrease heart attack risks and increase lifespans.
How Is Cardiac Risk Assessed?
There are various risk factors of CVD. Some of these factors, such as age, genetics and family history, cannot be changed. Risk factors that are within a patient’s control include weight, diabetes, hypertension and lifestyle habits, such as smoking, lack of exercise and a poor diet. In order for a physician to make the most effective health care recommendations for each individual patient, it is helpful to assess each patient’s risk of a CVD event. In addition to checking a patient’s blood pressure and performing a routine EKG, laboratory tests should be ordered. The tests that make up a cardiac risk assessment include:
• Lipid profile
• High-sensitivity C-reactive protein, or hs-CRP
• Lipoprotein (a), or LP(a)
The American Heart Association recommends performing cardiac risk assessment screenings every four to six years on adults aged 20 and older who do not carry additional CVD risks. Those with risk factors will need to be assessed more frequently. The tests are performed on serum from a blood sample, and patients are required to fast overnight prior to the blood draw.
Commonly known as a cholesterol test, the lipid profile analyzes the amounts of different lipids, or fats, in the blood. These lipids are measured in milligrams per deciliter of blood and include:
• Low-density lipoprotein (LDL), which is the damaging lipoprotein
• High-density lipoprotein (HDL), which is the beneficial lipoprotein
• Triglycerides, which is fat
The National Heart, Blood and Lung Institute has published these guidelines for normal reference ranges of a lipid profile:
Ideal – Less than 100 mg/dL
Near or greater than ideal – 100 to 129 mg/dL
Borderline high – 130 to 159 mg/dL
High – 160 to 189 mg/dL
Very high – 190 mg/dL or greater
Ideal – Less than 150 mg/dL
Borderline high – 150 to 199 mg/dL
High – 200 to 499 mg/dL
Very high – 500 mg/dL or greater
Desired range for men – 40 mg/dL or greater
Desired range for women – 50 mg/dL or greater
HDL is responsible for eliminating LDL from the blood. If a patient’s HDL value is less than 40, then he or she has an increased risk of CVD. Conversely, when that value is higher than 60, the risk of CVD is reduced.
Ideal – Less than 200 mg/dL
Borderline high – 200 to 239 mg/dL
High – 240 mg/dL or greater
When total cholesterol exceeds the ideal range, the level of risk for CVD can be fine tuned by calculating the ratio of total cholesterol to HDL. This ratio is calculated and assessed as follows:
Total cholesterol/HDL = ratio
A ratio of 3.5 is ideal. A ratio of 5.0 or greater places the patient at risk of CVD.
High-Sensitivity C-Reactive Protein
The hs-CRP test evaluates the concentration of C-reactive protein in the blood. This particular protein is indicative of the inflammation that is seen with atherosclerosis, the condition in which lipid deposits on the arterial walls narrow the blood vessels and decrease normal blood circulation. The interpretation of an hs-CRP test result is:
• Less than 1.0 mg/L indicates a low risk of CVD.
• mg/L to 3.0 mg/L indicates an average risk of CVD.
• Greater than 3.0 mg/L indicates a high risk of CVD.
The LP(a) test evaluates the level of lipoprotein (a) in the blood, and this test may be ordered for patients who carry genetic risks of CVD. It is via this lipoprotein that cholesterol and fats are carried through the blood. The higher the level of this lipoprotein in the blood is, the higher the risk is for CVD. The interpretation of an LP(a) test result is:
• Less than 30.0 mg/dL indicates a lower CVD risk.
• Greater than 30.0 mg/dL suggests an increased CVD risk.
Once a physician has conducted a physical examination, gathered a patient’s medical history and reviewed these laboratory test results, then a treatment plan can be implemented to reduce the patient’s CVD risk. If the patient’s lipid profile results are within the high range, statins may be prescribed to lower cholesterol production.
February is National Heart Health month. Be proactive and conduct a cardiac risk assessment screening for each of your patients today to help reduce their chances of suffering a heart attack tomorrow.