Cardiac Risk Assessment | Atlanta integrative & Internal Medicine | Roswell, GA


The standard risk evaluation for heart disease includes a lipid panel. This conists of the Total cholesterol, HDL, LDL, Triglycerides and VLDL. However, heart attacks and strokes occur equally commonly regardless of the cholesterol levels. (See my article on the cholesterol myth.) Knowing your LDL level is as accurate a predictor for heart disease as flipping a coin.

What does evaluate my risk for heart disease? Cardiac risk assessment requires a more holistic evaluation to include lifestyle factors such as diet, exercise, stress and smoking, and blood pressure and body composition (percentages of fat vs. muscle). Age, hereditary factors, weight, cigarette smoking, blood pressure, exercise history, and diabetes are all important in determining your risk. The lipid profile is the most important blood test for risk assessment. When cholesterol levels are elevated and there is a question of using drug interventions such as statins, AiiMED can do an advanced lipid panel.

There are other specialty tests available to assess cardiac risk including:

  • High-sensitivity C-reactive Protein (hs-CRP)

    Studies have shown that measuring CRP with a high sensitivity test can help identify risk of cardiovascular disease (CVD). This test is different from the regular CRP test, which detects elevated levels of CRP in people with infections and inflammatory diseases. The hs-CRP test measures CRP that is in the normal range for healthy people. It can be used to distinguish people with low normal levels from people with high normal levels. High normal levels of hs-CRP in otherwise healthy individuals have been found to be predictive of the future risk of heart attack, stroke, sudden cardiac death, and peripheral arterial disease, even when lipid levels are within acceptable ranges.

  • Homocysteine

    This is a marker of inflammation associated with coronary artery disease. Nutrition interventions with specific B vitamins are known to improve this marker.

  • Lipoprotein a (Lp(a))

    Lp(a) 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.

  • ApoB

    This is a measure of all non-HDL particle numbers. This is further confirmation of the number of dangerous lipoproteins.

  • Metabolic Syndrome Traits

    This is an evaluation of patterns of lipid imbalance.

Perhaps the most important indicators for cardiac risk are those of your personal health history. There are imaging tests, non-invasive and invasive, that may be used in cardiac risk assessment. Non-invasive tests may include an electrocardiogram (ECG, EKG), ECG stress test, nuclear stress test, computerized tomography (CT) scan, echocardiogram, and magnetic resonance angiogram (MRA). Invasive tests include an angiography/arteriography and cardiac catheterization.

The advanced lipid panel has all the ingredients of the regular panel but also measures the number and size of particles and markers of inflammation. The level of LDL is not a predictor of risk, but the size and number of the particles is. The large buoyant LDL particles are safe. The small, dense particles are not. Accurate measurement can distinguish high from low risk.

Resources and References