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:
• High cholesterol
|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.
|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
|• 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
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.