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.

Lipid Profile
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:

LDL Cholesterol
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

Triglycerides
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

HDL
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.

Cholesterol
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.

Lipoprotein (a)
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.

 

 

 

 

By Cat Troiano

According to the American Thyroid Association, roughly 20 million Americans are affected by thyroid disease. As many as 12 million of those individuals are unaware of their thyroid condition. Performing a TSH test is essential for diagnosing common thyroid conditions and preventing serious consequences that can result from untreated thyroid disease.

What Is TSH?
The thyroid gland, situated in front of the trachea at the lower portion of the neck, is responsible for producing thyroid hormones that aid in regulating metabolism and other bodily functions, such as heart rate, respiration, digestion and temperature. Thyroid-stimulating hormone (TSH) is produced in the pituitary gland, which is located at the base of the brain. TSH stimulates the thyroid gland’s production of thyroid hormones, which include:

• Thyroxine
• Thiiodothyronine
• Calcitonin

The TSH test evaluates the level of TSH in the blood. The result of the TSH test enables physicians to diagnose thyroid disease. The TSH test is also valuable in monitoring the management of thyroid disease.

The TSH test is performed on the serum from a blood sample. No fasting or other special preparation is required for the TSH test. However, certain medications, including prednisone, oral contraception, potassium iodide, dopamine, lithium, biotin supplementation and medications used to treat thyroid disease, can interfere and produce inaccurate results. The normal reference range for TSH levels is 0.4 to 4.0 milli-international units per liter.

What Does a High TSH Test Result Indicate?

When the TSH test result reads higher than the normal reference range, this means that the pituitary gland is producing too much TSH in an effort to stimulate an increase in thyroid hormone production. A high TSH result is indicative of hypothyroidism.

Hypothyroidism, defined as underactive thyroid, is the condition in which the thyroid gland produces insufficient thyroid hormones. Common signs and symptoms of hypothyroidism include weight gain, lethargy, forgetfulness, sensitivity to cold temperatures, dry hair and skin, depression and constipation. Hypothyroidism can be managed with oral synthetic thyroid hormone supplementation.

Hashimoto’s disease is an autoimmune disease in which the body’s immune cells attack the thyroid gland, resulting in hypothyroidism. Iodine deficiency is another potential cause of hypothyroidism since the thyroid gland relies on iodine for hormone production.

What Does a Low TSH Result Indicate?

If the TSH test result reads lower than the normal reference range, the pituitary gland is producing less TSH in response to high levels of thyroid hormones already in circulation. A low TSH result is indicative of hyperthyroidism.

Hyperthyroidism, defined as overactive thyroid, is the condition in which the thyroid gland produces excessive amounts of thyroid hormones. Common signs and symptoms of hyperthyroidism include weight loss, nervousness, irritability, vision problems and rapid heart rate. Hyperthyroidism is typically controlled with antithyroid medications or with radioactive iodine treatment.

Grave’s disease is an autoimmune disorder in which the body’s immune cells attack the thyroid gland, leading to hyperthyroidism. Another cause of hyperthyroidism is the presence of thyroid nodules, which are lumps that form on the thyroid gland. Although roughly 15 percent of all thyroid nodules are cancerous, according to the American Cancer Society, nodules that cause hyperthyroidism are nearly always benign.

Additional Screening Options
Additional thyroid function tests may be ordered to measure levels of free and active thyroid hormones in the blood. Results of these additional tests, combined with that of the TSH test, can provide a more complete picture of how efficiently the pituitary and thyroid glands are working together. These tests include:

• T4 and FT4, which check thyroxine levels
• T3 and FT3, which evaluate triiodothyronine levels

Depending on a patient’s symptoms, medical history, risk factors, laboratory test results and physical examination findings, diagnostic imagery, such as ultrasound or a radioiodine scan, may also be ordered to rule out or confirm the presence of thyroid nodules.

Test Now to Prevent Consequences Later
Individuals who have undetected thyroid disease carry the risks of serious health complications. Some of these complications include:

• Osteoporosis
• Heart disease
• Nerve damage
• Respiratory problems, including sleep apnea
• Reproductive problems, including infertility, miscarriage, preterm delivery and birth defects
• Thyroid storm, a potentially life-threatening event in which a large quantity of thyroid hormone is secreted into the blood within a short time period

Prevent these consequences by ordering TSH tests on all patients who present with potential symptoms of thyroid disease and on those with risk factors for developing these manageable conditions.
Image: WebMD, LLC