Diagnostic Tests for Heart Disease


Cardiovascular diseases or CVD generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack,  chest  pain  (angina)  or  stroke.  Other  heart  conditions,  such  as  those  that  affect  the  heart's  muscle,  valves  or  rhythm,  also  are considered forms of heart disease. CVD is the cause of mortality in India and worldwide.
Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up
of fatty substances in the coronary arteries.
Over time, the walls of your arteries can become clogged  with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma.
Atherosclerosis can be caused by lifestyle factors and other conditions, such as:
•    Genetics
•    High cholesterol
•    Hypertension
•    Diabetes
•    Smoking
Heart disease is a collective term used for a number of diseases that affect the heart in different ways. Each disease or condition had its
own symptoms and treatment.
Blood test What it is Why is it tested ? What it means Nutritional intervention
Lipid profile It measures cholesterol and triglyceride levels. Dyslipidemia is an important feature of heart disease.
Progression and monitoring is usually done using this basic tests.
•     Cholesterol
•     VLDL
•     HDL
•     Triglycerides
1.    Reducing cholesterol levels :
•     Limit total fat and saturated fat
•     Reduce visceral fat
•     Increase consumption of soluble fibres
•     Decrease alcohol consumption
•     Increase consumption of Omega 3
•     Foods rich in plant sterols and stanols which block cholesterol absorption into the cells eg whole grain, beans, nuts etc
2. Reducing Triglycerides
•     Maintain ideal weight
•     Avoid trans fats
•     Increase consumption of mono and polyunsaturated fats
•     Cut down on smoking
•     Consume soluble fibre
•     Reduce consumption of refined food
Homocystein e Homocystein e is an amino acid present in blood. To  help  determine  if  you  are deficient  in  vitamins  B6,  B9 (folate) or B12; to determine if you  are  at  increased  risk  of heart    attack    or    stroke;    to monitor those who have heart disease It is a sensitive and independent marker for heart disease. High homocysteine levels damage the linings of the arteries.
Faulty MTHF gene causes high homocysteine levels and increases risk of heart disease.
•     Ensure healthy Vitamin B levels.
•     The active form of folate i.e L- methylfolate can achieve higher folate levels quicker than folic acid suppliments and therefore may be more effective in reducing homocysteine levels.
Vitamin B Vitamin Deficiency causes increase in heart disease risk marker- homocysteine.   •     Check for gastritis, pernicious anaemia, GI diseases like Chron’s, celiac or lupus. This effects Vitamin B levels severely.
•     Having a healthy gut with good gut micro biome helps to breakdown Vitamin B from food.
•     Anti biotics and anti seizure drugs
Vitamin D Vitamin Vitamin D deficiency is a risk for CVD People with Vitamin D deficiency are twice as much likely to develop stroke. Low Vitamin D levels also increase blood pressure, inflammation of the blood vessels and also diabetes. •     In most cases Vitamin D supplementation is needed.
•     Ensure that a source of fat is taken with the Vitamin D supplement.
•     Vitamin D in large quantities can be toxic. Monitor blood levels frequently.
CRP/hsCRP CRP or C reactive protein is an acute phase protein. CRP is made by the liver and released into the blood within a few hours after tissue injury or     infection.   It   is   used   to identify     the     presence     of inflammation  and  to  monitor response  to  treatment  for  an inflammatory disorder High CRP levels indicate non specific inflammation. •     Increase consumption of anti inflammatory foods. Foods rich in Vitamin C and E.
•     Reduce refined carbs and processed foods. Aerated drinks should also not be consumed.
•     Ensure adequate hydration.
ESR The          test a c t u a l l y  measures   the rate     of     fall (sedimentatio n   )            o   f erythrocytes (red        blood
cells)     in     a
sample         of blood that has been     placed into     a     tall, thin,    vertical tube
To measure  the degree of inflammation. It is a non specific marker of inflammation. •     Mediterranean diet helps to reduce inflammation.
•     Vitamin E and Vitamin C rich foods decrease inflammation.
•     Anti oxidant rich foods such as amla, oranges etc help reduce inflammation.
L-arganine Amino acid L-arginine is the substrate for endothelial       nitric       oxide synthase    (eNOS),    and    the precursor for the synthesis of nitric oxide (NO). This amino acid    exerts    a    number    of actions  in  the  cardiovascular system,   mainly   through   the production of NO. L-arginine  influences  a  number of   atherosclerosis   risk   factors such   as   hypercholesterolemia, hypertension      and      smoking, improving  endothelial  function in these patients •     Multi vitamin supplements contain L arginine. Check the amounts that are given.
•     It does not affect endothelial function in patients with diabetes mellitus
•     L-arginine isn't recommended after a heart attack due to concerns that the supplement might increase the risk of death.
•     If the client is on blood pressure lowering drugs L arginine supplementation must be prescribed with great caution.
•     L-arginine can worsen allergies or asthma. Use the supplement with caution if you have these conditions.
WBC White blood cells An elevated total white blood cell (WBC) count is a risk factor for atherosclerotic vascular disease. High cholesterol, diabetes also increase WBC levels. •     Anti inflammatory diet.
Omega 3 & 6 Essential fatty acids They are important for heart health. Low Omega 3 & 6 levels increase cholesterol levels. •     Omega         3         -inhibit lipopolysaccharide  induced inflammation.     They     also suppress       acute       phase reactants.         They         also improve     endothelial     cell function.  They  are  also  anti thrombatic   at   high   doses. They also reduce heart rates b y           i n  fl u e n c i n g  monocytes.boosting         the degradation   of   fatty   acids and          accelerating triglyceride  clearance  from the plasma.
•     Omega 6 - excess amounts are pro inflammatory
•     . To help prevent cardiovascular diseases, the ratio of Omega 6 to Omega 3 is 4:1.
Vitamin C Vitamins Vitamin C regulates the catabolism of cholesterol. •     There       is       an       inverse relationship         between Vitamin     C     and     cardio vascular mortality. •     Vitamin C is heat sensitive and is best taken in the raw form.
•     Smokers need higher doses of vitamin C.
Fibrinogen Fibrinogen is a protein, a coagulation factor (factor I) that is essential for blood clot formation. •     To evaluate the cause of a thrombosis   or   a   blood clot.    It    also    helps    to evaluate  the  risk  of  heart disease.
•     Two   types   of   tests   are available      to      evaluate fibrinogen:   a   fibrinogen activity     test     evaluates how      well      fibrinogen functions   in   helping   to form a blood clot while a fibrinogen    antigen    test measures  the  amount  of fibrinogen in the blood
Those     patients     deficient     in vitamin K are at risk for clotting disorders   and   decreased   bone mineral density. While vitamin K deficiencies are uncommon, it may be at higher risk if you:
•        Have a disease that affects absorption in the digestive tract, such as Crohn's disease or active celiac disease
•        Take drugs that interfere with vitamin K absorption
•        Are severely malnourished
•        Drink alcohol heavily
      Vitamin K is a fat soluble vitamin, ensure adequate intake of healthy fats.
      High doses of Vitamin K is toxic - monitor carefully if giving suppliments.
      Warfarin is a blood thinner and commonly taken by people with heart diseases. This drug reduces the efficiency of Vitamin K absorption.
Troponin Troponins  are a    family    of p r o t e i n s  found         in
skeletal     and heart (cardiac) muscle   fibers that    produce m u s c u l a r contraction. Troponin tests measure     the l e v e l          o f c a r  d i a c -  s  p  e  c  i  fi  c troponin       in the   blood   to help       detect heart injury.
They   are   measured   in   the blood to differentiate between unstable         angina         and myocardial   infarction   (heart attack)  in  people  with  chest pain     or     acute     coronary syndrome.    A    person    who recently   had   a   myocardial infarction would have an area of damaged heart muscle and elevated     cardiac     troponin levels in the blood. High troponin levels indicates increases risk of mortality in 1-3 years. Scientifically no known nutrition intervention particularly for this blood tests.
Calcium Mineral Excess calcium causes plaque. Calcium is needed for healthy functioning     of     the     heart muscles. Calcium  in  these  supplements could  make  its  way  into  fatty plaques   in   your   arteries   —   a condition  called  atherosclerosis
—   causing   those   plaques   to harden and increase your risk of heart disease.
•     Ensure  adequate  levels  of  calcium.  Too  little  may  be detrimental for myocardiocytes and too much may cause plaques.
•     Avoid supplementation and take calcium in the form of food.
Sodium Electrolyte Too         much         sodium consumption     can     increase blood pressure and cause the body to hold onto fluid. High blood pressure (hypertension) is a major risk factor for heart attack,     stroke     and     other cardiovascular problems. •     The         genetic         marker (GNAI2)  that  is  associated with     the     risk     of     salt sensitivity         in         blood pressure.
•     Blood    pressure    reduction with   a   decrease   in   NaCl intake   is   associated   with AGT TT and AGT MT.
•     Association    between    salt sensitivity    and    ACE    I/D and DD
•     Ensure healthy sodium levels.
•     Don't impose sodium restriction on salt insensitive individuals.
Urine albumin Protein A reduction in serum albumin over  time  is  associated  with increased        incidence        of cardiovascular   disease,   even if the change is within normal albumin range. Albumin   levels   are   related   to the acute phase reaction. Lower albumin levels may be a marker of  persistent  injury  to  arteries a n d          p ro g re s s i o n          o f atherosclerosis and thrombosis. •     Inflammation results in a low albumin level. It is difficult to   increase albumin until the infection or inflammation is treated.
•     Ensure  that  there  is  good  quality  protein  consumed  at every meal.
Genetic tests Gene test The         genetic         variants predisposing   to   CVD   span from    rare    and    deleterious mutations     responsible     for Mendelian  diseases,  such  as f      a      m      i      l      i      a      l hypercholesterolemia,         to common polymorphisms that modulate   the   predisposition to   complex   diseases   with   a weak    effect    at    individual level. •     MTHFR
•     APOE
•     Intervention based on nutrigenomics.
Cortisol Hormone which regulates metabolism, immune response, control sugar level etc To rule out Cushing’s syndrome. High cortisol levels can lead to symptoms such as weight gain, hypertension, high blood sugar, osteoporosis and fragile skin while low levels may cause weight loss, weakening of muscles, fatigue, low blood pressure, vomiting and diarrhea and loss of consciousness. To reduce Cortisol levels:
•      Anti inflammatory diet: whole grains, no processed, nuts , fish, turmeric, ginger, cinnamon
•      DHEA promoting foods: wild yams, soya, flax seeds, salmon, olive oil
•      Vitamin B complex
•      Adaptogens
To increase cortisol levels:
•      Dark chocolate, pro & pre bionics, green tea, banana , pears helps increase cortisol levels.
•      Avoid caffeine,  alcohol, processed food, & refined sugar.
Thyroid panel Hormones that are essential  to regulate growth and metabolism Many times women with symptoms of PCOS may have an underactive thyroid. Be sure to test for these markers along with thyroid peroxidase which can help discover an autoimmune condition. Thyroid dysfunction and associated metabolic imbalance & weight gain. •     Avoid goitrogen rich food like raw broccoli, cabbage, soy etc
•     Thiocynates are sulphur containing compounds- which make it harder for thyroid glad to absorb iodine. Foods that form thiocyanates are Corn, flax seeds. sweet potatoes, broccoli, lima beans, radish , turnip
•     Flavanoids ( like apigenin)present in millets reduce the activity thyroid peroxidase, the enzyme that inserts iodine into thyroid hormone. Apigenin is also present in onions, redwine, beer.
•     Consume at least 150mcg of iodine everyday.
HbA1c Glycated hemoglobin To test for diabetes or /& monitor intervention for diabetes. Higher HbA1c leads to increased risk of CVD. •     Small frequent meals
•     Low to medium GI foods
•     High fire and high protein foods.