Analytes tested

Lipids

• Total Cholesterol (TC)
  Measures the amount of cholesterol in all cholesterol-containing lipoproteins
• Triglycerides (TG)
  Elevated levels increase CVD risk by altering lipoprotein metabolism
• High Density Lipoprotein Cholesterol (HDL-C)
  Amount of cholesterol in high-density lipoproteins (HDL)
  Higher levels of HDL are associated with reduced CVD risk, but not all HDL is good
• Low Density Lipoprotein Cholesterol (LDL-C)
  Amount of cholesterol in the atherogenic low-density lipoproteins
• Very Low-Density Lipoprotein Cholesterol (VLDL-C)
  Elevated levels of very low-density lipoprotein cholesterol (VLDL-C) have been associated with the atherosclerotic process
  Very low-density lipoproteins (VLDL) are triglyceride-rich particles secreted by the liver.
• Non-HDL Cholesterol
  A high level of non-HDL cholesterol (NHDL-C) is a stronger CVD risk factor than LDL or triglycerides for patients with high triglycerides or diabetes
  NHDL-C has become the new bad cholesterol, as it reflects the sum of serum cholesterol carried by all the potentially atherogenic apo-B containing lipoproteins including LDL, VLDL, IDL, Lp(a) and other remnant lipoproteins
  Calculated LDL-C is less accurate for risk assessment when triglycerides are greater than 200 mg/d
• Oxidized LDL Cholesterol (OxLDL)
  A high level of oxidized LDL (oxLDL) is a strong predictor of risk for coronary artery disease (CAD) and increasing levels of oxLDL are incrementally associated with the severity of CAD
  High levels of oxLDL also markedly increase the risk for developing metabolic syndrome well within a decade
• Small Dense Low-Density Cholesterol (sdLDL-C)
  Small dense LDL (sdLDL) is an extremely atherogenic LDL subtype that is associated with about 3-times greater risk for CVD than normal-size LDL particles
  SdLDL-C levels are also independently associated with increased risk for Type-II diabetes
  SdLDL-C is associated with elevated triglycerides and low HDL-C (mechanistically), obesity, metabolic syndrome, pre-diabetes, insulin resistance, renal dysfunction, hepatic steatosis and dietary trans-fatty acids
• Ratio – TC/HDL-C
  TC/HDL-C is a stronger risk factor than either LDL-C or HDL-C
  The total cholesterol/HDL ratio is a better indicator of plaque impact
• Ratio – HDL-C/TG
  Low HDL-C/TG is associated with insulin resistance
  70% of plaque-forming patients have IR (i.e. 7 out of 10 of patients with arterial plaque have IR)
  The HDL-C/TG ratio predicts this risk sooner than the fasting glucose or HbA1c
• Ratio – LDL-C/HDL-C
• Ratio – OxLDL/LDL-C
  Ratio may be good but also need to look at whether both are too high
• Ratio – sdLDL/LDL-C
• Lipoprotein(a) (Lp(a))
  Genetic, independent risk factor for premature heart disease, thrombosis and stroke
  Elevated levels are present in 20% of the population
  Impedes fibrinolytic activity (so it blocks the body’s ability to degrade clots efficiently therefore increasing clot risk)
• Apolipoprotein B (ApoB)
  A major protein in atherogenic particles
  Stronger predictor of CVD than LDL-C
  Chylomicron remnants, IDL, LDL, OxLDL, sdLDL and Lp(a)
  Some people think we should only look at Apo B as a marker due to how important it is (without considering ApoA-1)
• Apolipoprotein A-1 (ApoA-1)
  Only on HDL species
  Suppresses recruitment of monocytes into plaques
  Increases insulin-dependent and insulin-independent glucose disposal
  Ameliorates inflammation (vascular and gestational)
  If low – consider CoQ10 supplementation.
• Ratio – ApoB/ApoA-1

Metabolics

• Homocysteine
  High levels are associated with vitamin B deficiency and increased risk for CVD and dementia
• Glucose
  Fasting glucose is a strong predictor of diabetes and CVD risk
• Insulin
  Debate over what optimal/healthy insulin level should be
  This marker is possibly quite time sensitive regarding samples sent from NZ (TBC)
• Hemoglobin A1c (HbA1c)
  Assesses the average blood glucose over the last (three to four months or 120 days which is the average life of the red blood cell) two to three months
• Glycomark (1, 5-anhydroglucitol) (1,5-AG)
  HbA1c is an average vs 1,5-AG indicates frequent episodes of elevated blood glucose
  1,5-AG is a normal dietary glucose metabolite that’s relatively stable, except if have high blood glucose the resorption of 1,5-AG reduces so it spills out into urine and then you’ll have a decreased serum level.
  LOW serum 1,5-AG indicates frequent and high hyperglycaemic episodes (>180 mg/dl) over the past one-two weeks
  Detects significant swings in glucose even if HbA1C looks “acceptable”
  Episodes highly correlated with CVD and diabetic complications
• Adipocytokines
  Peptide hormones/cytokines from white adipose tissue – modulate inflammation, insulin release/sensitivity, hepatic fatty acid/TG metabolism, oxidative stress, arterial integrity and satiety
• Leptin
  Inhibits appetite (hypothalamus), stimulates fatty acid oxidation, facilitates homeostasis and modulates body fat (known as satiety hormone)
  Increased abdominal adiposity increases serum leptin —> leads to leptin resistance (selective for various tissues)
  Associated with metabolic syndrome, T2D, CVD, hypertension, MI and stroke
  Don’t want to see high serum leptin
• Adiponectin
  Most abundant adipocytokine in blood; anti-inflammatory, modulates insulin sensitivity, energy balance, hepatic and muscle fatty acid oxidation, hepatic TG secretion, and supports proper function of endothelial cells (eg: increases eNOS)
  BUT, serum adiponectin levels decrease with increasing adiposity (abdominal/visceral)
  Low serum adiponectin is associated with obesity, T2D, hypertension, CAD and left ventricular hypertrophy
  Don’t want low serum adiponectin
• Leptin/Adiponectin Ratio (LAR)
  Even more sensitive than measuring them individually is measuring the ratio
  Opposing effects on the chronic inflammation associated with MetS, obesity, T2D and CVD. Recent evidence indicates that the LAR is more clinically sensitive than either adipocytokine alone with respect to risk of MetS, T2D and CVD
• Cystatin-C
  Cystatin-C is a protein produced by the cells in your body
  When kidneys work well, they keep the level of cystatin-C in your blood just right
  If the level of cystatin C in your blood is too high, it may mean your kidneys are not working well
• Creatinine with eGFR
  Kidney function assessment

Inflammation

• High Sensitivity C-Reactive Protein (hs-CRP)
  Acute phase inflammatory protein
  Associated with atherosclerosis after excluding other causes
• Lipoprotein associated phospholipase A2 (LP-PLA2 activity) = PLAC
  Direct role in the atherosclerotic disease process
  High Lp-PLA2 activity indicates macrophages activation and disease progression in the arterial wall
  When PLAC interacts with Ox-LDL, it leads to increased inflammation and invokes plaque instability
  PLAC indicates oxLDL has been taken up into the arteries