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Posted on / Dr. Laurie Pozun

Advanced Cardiovascular Testing for Risk Factor Identification

Reducing cardiovascular risk is an important piece of overall health. The common ways to reduce this risk is to maintain a normal lipid panel, fasting glucose level, and A1c level. In addition, maintaining a normotensive blood pressure is important for reducing your cardiovascular risk. There are also a number of laboratory tests that can serve as an adjunct to further evaluate individuals for heart disease risk.

Lipid Fractionation

This laboratory test breaks down LDL cholesterol into particle sizes to determine if there is a predominantly healthier type A LDL (larger, lighter, less adherent and artery clogging) vs type B LDL (dense, small, sticky, artery clogging).

Type B LDL increases risks for plaque formation leading to an increased risk for heart disease and stroke. Research has shown evidence of a high dose niacin (An important B Vitamin) can help convert type B to healthier type A LDL, in addition to regular exercise, diets low in saturated fat, and quitting smoking. 

Lipoprotein A (Lp a)

This unique lipoprotein has emerged as an independent risk factor for vascular disease. Lp (a) has a high affinity for the arterial wall. It is strongly genetic and linked with the Apo (a) gene. The critical level for Lp (a) is 300mg/L or greater. It is a moderate risk factor for heart disease, but that risk is increased in people who have other risk factors such as high LDL or low HDL, or in individuals with blood clot forming deficiencies such as Factor V Leiden, Protein C or Antithrombin III. Drugs are currently in development that will lower Lp (a) by interfering with the assembly of Lp (a) in the liver. Another approach to management involves treating these other risk factor aggressively. High dose niacin (vitamin B3) at does up to 3000mg daily can also reduce Lp (a), but may not be well tolerated due to possible side effects of headache, flushing, glucose elevation or liver toxicity. It’s possible that supplements such as L-car Uribe, L-lysine plus as ornate, cholestin (Xuczhikang) extract, low-dose aspirin, and female post menopausal hormone replacement therapy could reduce Lp (a).


An amino acid that is broken down by vitamins B12, B6 and folate to create cysteine and methionine which our bodies need. Normal homocysteine levels are <15 micro moles/L. Elevated homocysteine levels may mean that you have deficiencies in the above vitamins, or could represent a mutation of a gene (MTHFR). Without treatment, hyperhomocysteinemia increases risk for heart disease, stroke, blood clots and dementia. Methylated B-Complex vitamins help to lower elevated homocysteine, and cessation of smoking and alcohol can also reduce homocysteine.

Apolipoprotein A1

This is the primary protein component of HDL and aids in the metabolism of lipids. High Apo A1 is associated with a reduced risk of first myocardial infarction, or heart attack. Apo A1 levels should be >140 in adults. Statin drugs can increase Apo A1 levels, as can regular exercise and reducing saturated fats in the diet.

Apolipoprotein B

Elevated Apo B corresponds to higher levels of “bad” cholesterol. It can be related to a high fat diet or a reduced rate of LDL clearance. It can be lowered by reducing dietary fat and increasing plant based foods, as well as with statin therapy.


This serves as a catalyst in the formation of reactive oxygen intermediates and is associated with an increased risk for future cardiovascular events.


Elevated levels of these bio-markers can denote vascular inflammation and damage to the lining of blood vessels  ADMA and SDMA can be lowered by incorporating "nitric oxide-rush" foods such as beets, leafy greens and garlic.


Carnitine in meat and choline in dairy, chicken and fish interacts with our gut bacteria to form TMAO. TMAO is inflammatory and promotes the development of arterial plaque, reduces our ability to break down and excrete cholesterol and can increase risk of prostate cancer. Reduction of TMAO is achieved by minimizing intake of animal proteins and consuming a plant based diet.

Next Steps

Comprehensive wellness often starts with personalized medical testing. Patients of LifeScape are often encouraged to test for factors like heart disease. If you’re ready to work with a physician who’s proactive about your care, consider enrolling in LifeScape’s Concierge Care program.


Want to learn more about cardiovascular health? Watch Dr. Laurie Pozun discuss here LIVE from our Brilliant Health Community Facebook Group! 

Ready for whole health for a whole life? Our award-winning practice puts patients first. Learn more about LifeScape's Primary Care options.


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