Key Blood Tests in Understanding Heart Health

Heart disease and stroke, which you could collectively call atherosclerotic cardiovascular disease, is the biggest and deadliest killer we face. In the United States, it kills an estimated 2,300 people every day. Women are roughly 10 times more likely to die from heart disease than breast cancer. Many people assume it is just a disease of the elderly. However, half of all major adverse cardiovascular events in men (and a third of those in women) occur before age 65. In men, 25% of all events occur before age 54. The nature of this disease is that it is a slow moving process, unfolding over the course of decades. The problem is that too often, by the time something is finally detected over the course of this process, it is too late. This is why prevention is the name of the game, and understanding certain key blood markers can be so important.

You need cholesterol in order to live. Cholesterol is a substance from the lipid (fat) family that is necessary to build cell membranes, hormones, and bile acids to digest food. No cholesterol = dead. This is why every cell in your body can make it’s own cholesterol. However, your liver will store a good chunk of this cholesterol to hold and ship out as needed.

Have you ever noticed that oil won’t dissolve in water? The same is true with cholesterol not being able to travel around your blood. It needs a transporter to carry it around the bloodstream on it’s journey to various parts of the body. The ship it travels on is called a lipoprotein. There are low density lipoproteins (LDL) and high density lipoproteins (HDL). These lipoprotein particles have a wrapping on them. The wrapping is composed of one or more large molecules called apolipoproteins. HDL particles are wrapped in a molecule called apolipoprotein A (apo A), and LDL particles are wrapped in the type of molecule called apolipoprotein B (apo B).

The lipoproteins with an apo B wrapping are the ones that can penetrate into the blood vessel, get stuck, and kick off the whole cascade that leads to an eventual plaque, calcification, and a possible clot. Therefore, knowing your apoB number and understanding that it is this exposure over a lifetime that determines your overall risk. Analysis has shown that each standard-deviation increase in apoB raises the risk of heart attack by 38% in people without a history of cardiac events or a previous cardiovascular disease diagnosis.

On the podcast, we discuss the issue of levels and what is an ideal level to keep your apoB. This is an area where there is probably a lot of debate. It should involve a good discussion with your doctor and take into account a variety of factors that can paint a good overall picture of your risk. For some people, it may be smart to keep these levels very very low, and perhaps for others it may be more appropriate to simply not let them get too elevated.

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Simplified Takeaways…

1. The apoB blood test measures the number of particles that carry the apoB wrapping on it. It is these particles that can penetrate the blood vessels and kick off a bad cascade of events.

2. This is more useful than a standard cholesterol blood test that simply measures the amount of cholesterol contained in these particles.

3. It is the exposure of apoB particles over time that leads to atherosclerotic cardiovascular disease.

4. As apoB goes up, the risk of myocardial infarction goes up.

5. How low you need to keep your apoB is a conversation you should have with your doctor and most likely needs to take many factors into account.

Further Reading…

1.  The book Outlive by Peter Attia. This is where much of the research for this podcast came from. It is a great read.

2.  Study showing as apoB goes up, your risk of myocardial infarction goes up.

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