The heart being such a vital organ is integrated into overall health in so many ways that it both affects and is affected by other systems. As a result, there is a lot that can be done in order to assess and manage heart health. In general, “heart health” goes beyond just the heart itself. This term often refers to the heart, heart vessels, peripheral vascular system, and its integration into respiratory and metabolic systems. While acute cardiac care often requires a visit to the ER with numerous forms of imaging and possibly stress tests down the road, chronic heart illnesses and preventative measures that maintain good heart health are a bit different. At BLI we assess heart health by:
Measuring cholesterol
Cholesterol can be a tricky topic and even somewhat controversial. The conventional medicine approach and functional medicine approach vary in many ways. In traditional medicine, it is common for providers to see elevated cholesterol levels and consequently start patients on statins. While it is indeed necessary in some circumstances, there are many aspects to consider when managing cholesterol. In reality, we need cholesterol. It is pertinent for things like cell membrane structure and sex hormone production. With that in mind, cholesterol is something that actually can be too suppressed by medications such as statins. There is a happy medium and a balance of the various types of cholesterol. In general, the major aspects of a cholesterol panel that need to be taken into consideration when assessing risk for cardiovascular disease include total cholesterol, HDL, LDL, triglycerides, lipoprotein size, apolipoproteins (A, B and B:A ratio), Lp(a), and a few others. When investigating these levels, we have to look at them in relation to one another. The most common example of this is the comparison of “good” vs “bad” cholesterol. High density lipoprotein, HDL, is considered the good cholesterol because of its ability to extract Low density lipoprotein, LDL, from cells and artery walls and bring it back to the liver to be excreted.
A large study recently published in 2021 in Nutrition & Metabolism found a U-curve associated between total cholesterol and mortality suggesting that too high of cholesterol and too low cholesterol both increase risk for mortality. Levels of concern were <120mg/mL (HR 0.60) and >280mg/dL (HR 1.31). Thus, a total cholesterol of 200mg/dL is not enough for us to start a statin in the functional medicine world—in fact, there are even benefits at this level.
Other Heart Health Measures
Measuring inflammation
- Inflammation is one of the most important contributors to heart health risk that needs to be measured and managed appropriately. Cardiovascular disease is often a result of too much inflammation.
Measuring risk for atherosclerosis
- PLAC is a measurement of an enzyme called lipoprotein-associated phospholipase A2. It is released into the bloodstream when there is inflammation of the arteries. If plaque buildup occurs in blood vessels, it causes inflammation. Incorporating heart-healthy nutrients such as vitamin K1 and K2, Omega 3 is critical for helping reduce inflammation and risk.
Measurements that give insight into a poor glycocalyx layer
- Oxidized LDL (oxLDL) and Myeloperoxidase (MPO) are key measurements that assess damage to the blood vessel lining known as the glycocalyx.
Measuring clot risk
- Reduce risk for clotting by incorporating fish oil, emphasizing hydration, staying active, and sometimes using compression stockings and aspirin.
Measuring cardiac stress
- ProBNP (pro hormone B-type natriuretic peptide) is a measure of stress on the heart itself. It is a peptide that is released when the heart is stretched. This occurs in the context of peripheral fluid retention (e.g. Congestive heart failure) or ischemia.
Other measures to consider that are not on a blood-based cardiometabolic panel
- Mitochondrial function of the heart cells
- Blood pressure
He, Guo-dong, et al. “A Nonlinear Association of Total Cholesterol with All-Cause and Cause-Specific Mortality.” Nutrition & Metabolism, vol. 18, no. 1, 2021, https://doi.org/10.1186/s12986-021-00548-1.
