Better Blood Tests to Assess Cardiovascular Risk | Boulder Longevity Institute

Cardiovascular disease has been the leading cause of death for Americans since 1921, with stroke being close behind since 1938. While the overall percentage of age-adjusted deaths has come down since 1950, cardiovascular disease continues to be the number one reason for death in the United States.

There are myriad factors contributing to the fact that heart disease and its associated issues remain so deadly, despite the fact that significant advances have been made in medicine since 1921. One under-the-radar issue is the lack of proactive care, which leads to the first discovery of cardiovascular problems after a cardiovascular emergency occurs.

A common practice for general practitioners is to attempt to assess cardiac risk factors by running a simple lipid profile and having a look at HDL and LDL cholesterol numbers. While there is some valuable information found in cholesterol levels, especially evaluating ratios like triglyceride to HDL or B to A apolipoproteins, it is worth noting that 50% of all heart attacks and strokes occur in individuals with normal cholesterol levels.

There are better ways to seek an advantage by discovering pre-existing risks of heart disease. Looking at novel blood markers could reveal information that can allow a proactive approach to treating cardiovascular disease before an emergency occurs. 

The PLAC test measures blood levels of an enzyme called lipoprotein phospholipase A2 (Lp-PLA2). This enzyme is known to cause a cascade of events leading to endothelial dysfunction, which sets the stage for atherosclerosis, the accumulation of plaque, and plaque rupture. Indeed, plaque rupture represents the primary cause of heart attack or stroke. 

Thus, an elevated level of Lp-PLA2 could be an alert that an arterial plaque is susceptible to rupture, which could cause a clot to break free and lead to heart attack or stroke. Unlike other markers, like C-reactive protein, Lp-PLA2 is a uniquely vascular-specific inflammatory marker. We know that Lp-PLA2 is a critical marker for the rupture-prone plaque. This dangerous plaque is often not associated with elevated cholesterol levels (which your PCP is so interested in) or even a more specific coronary calcium score.

We can see how dangerous this “silent” plaque can be with its ability to evade discovery by, unfortunately common approaches to cardiovascular care. Lp-PLA2 represents an opportunity to ruin the camouflage used by rupture-prone plaque and potentially predict a cardiac issue in people with no other prior cardiovascular events. This is a game changer in bringing down the numbers of cardiovascular deaths and should be combined with a more in-depth look at standard lipid profile tests by all health care professionals.

This simple PLAC test can indicate a high level of Lp-PLA2 activity, which should alert your physician to start preventative care. A PLAC activity number above 225 should be immediately addressed, as those in this group have two to three times the risk of first-time myocardial infarction, stroke, and cardiac death. Knowing and understanding your PLAC score is an example of improving health and longevity by using newer, novel tools to prevent an issue rather than reacting to it. We have known the dangers of cardiovascular disease since 1921 – it is past time to start addressing this danger before an event occurs.

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Published February 1, 2023

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