Let's learn more about blood tests for coronary artery disease risk.

Have you ever wondered how healthy your heart is? Sometimes we can develop heart-related diseases without even realizing it. But fortunately, there are blood tests that can help identify these risk factors early. So today, let's talk about what these blood tests are and how they can help you determine your risk of heart disease, especially coronary artery disease (CAD). Let's try to understand this simply, as if you were talking to a friend.

Why do you need these blood tests?

Now you're probably wondering, "Why do I need these blood tests?" Not everyone needs them right away. But there are some situations where a doctor may recommend you have these tests. See if these reasons apply to you:

• Eating habits: You often eat unhealthy foods that are high in oil, sugar, and flour.
• Family history: If anyone in your family, especially your mother, father, or siblings, has had coronary artery disease (CAD) before the age of 50 .
• Obesity or weight gain: If your body weight is much higher than normal.
• Lack of exercise: If the body does not get enough exercise during the day.
• Smoking: If you are a smoker or use other types of tobacco (e.g., betel nut or betel leaf).
• Other medical conditions: If you already have diseases like Diabetes Mellitus, High Blood Pressure, or if you have previously had a heart attack or stroke.

If you have one or more of these issues, it would be wise to talk to a doctor and get a blood test like this.

Who does these blood tests?

Usually, a blood sample is taken from you by someone who is trained for this purpose. We call them a ``Phlebotomist'' or ``Phlebotomy technician''. Then this blood sample is sent to a medical laboratory. There is a ``Medical laboratory technician'' there. He or she uses special machines to measure the different things in your blood and prepares a report.

What do these blood tests measure to detect heart disease risk?

Okay, now let's see what exactly these blood tests look for. These are what doctors use to get an idea of ​​your risk of heart disease.

Cholesterol and Related Factors

• Total Cholesterol (TC): This is the total amount of cholesterol in your blood. It is directly related to your risk of heart disease.
• Triglycerides (TG): This is also a type of fat. These are also linked to heart disease. The simple sugars, simple carbohydrates (like bread, rice), fatty foods, and alcohol we eat can increase these `(TG)` levels. This can be reduced with good exercise.
• High-Density Lipoprotein (HDL): This is what we call "good cholesterol." The more of it there is in the blood, the lower the risk of heart disease.
• Low-Density Lipoprotein (LDL): This is what we call "bad cholesterol." The more of it there is in the blood, the greater the risk of heart disease.
• Lipoprotein (a) (Lp(a)): This is formed when a protein called apo(a) is attached to LDL cholesterol. If its level is high in the blood, there is an increased risk of heart attack, stroke, blood clots, fatty deposits in the arteries after coronary artery bypass surgery, and coronary artery narrowing again after angioplasty. This can also run in families. Therefore, if someone in the family has had heart disease at a young age, the doctor will recommend this test.
• Apolipoprotein B (ApoB): This is a major protein in cholesterol. Some studies suggest that ApoB levels are a better indicator of risk than LDL levels alone. Higher ApoB levels indicate an increased number of small, dense LDL particles.

Other important blood components and indicators

• Complete Blood Count with Differential (CBC): This test measures the number of red blood cells, white blood cells, and platelets in your blood. It can detect conditions such as anemia, which is a lack of red blood cells.
• Homocysteine ​​(Hcy): This is an amino acid. High levels of this in the blood increase the risk of heart disease.
• Hemoglobin A1c (HbA1c): This blood test helps diagnose diabetes. Diabetes is a condition that increases the risk of coronary artery disease (CAD). This test shows the average blood sugar level over the past two to three months.
• Fasting Blood Glucose / Fasting Blood Sugar: This measures your blood sugar level in the morning after you have fasted overnight. It can detect prediabetes and diabetes, both of which increase your risk of heart disease.
• Creatine Kinase (CK): This is an enzyme found in the muscles. Its levels may increase if you are taking cholesterol-lowering medications (e.g., statins).
• Alanine Aminotransferase (ALT) or SGPT: This is an enzyme found in the liver. Its levels may increase when you take cholesterol-lowering medications.
• Aspartate Transaminase (AST) or SGOT: This is another enzyme in the liver. It can also be elevated when taking cholesterol-lowering medications.
• Fibrinogen: This is a protein in your blood. It helps blood clot. However, if it gets too high, it increases the risk of heart attack.
• Thyroid-Stimulating Hormone (TSH): This measures how well your thyroid gland is working. Thyroid dysfunction has been linked to heart disease and abnormal heartbeats.
• Ultra-sensitive C-reactive Protein (us-CRP) or High-sensitivity CRP: This indicates inflammation in the blood vessels. The higher its level, the higher the risk of heart and blood vessel disease.
• Urine Albumin-Creatinine Ratio (uACR): This measures the amount of protein in the urine. Even a small amount of protein in the urine is a risk factor for heart disease. This test is especially important for people with diabetes.
• MPO (Myeloperoxidase): This is also an indicator of inflammation. High levels of this are associated with an increased risk of heart attack, stroke, and the need for coronary artery bypass surgery. High levels of this can also indicate worsening cardiovascular disease.
• Vitamin D: This is a fat-soluble vitamin. It regulates calcium and phosphate levels in the body. These help keep bones healthy. Vitamin D deficiency is associated with various health risks. Also, if you are having difficulty tolerating statins (cholesterol medications), this vitamin D deficiency may be a reason.
• Trimethylamine N-oxide (TMAO): This is produced by bacteria in your gut. It is found in high amounts in meat, eggs, and dairy products. Supplements like choline, lecithin, and L-carnitine can also increase TMAO levels. High levels of TMAO in the blood can increase the risk of heart disease, stroke, and atherosclerosis.
• Amino-terminal, pro-Brain Natriuretic Peptide (NT-proBNP): This protein is made in your heart. It is released into the blood when your heart is under extra strain. High levels of this protein indicate a higher risk of heart disease and can also indicate a decline in heart function. Other tests may be done to find out more.
• Serum Creatinine (CR): This is related to the functioning of the kidneys. If the kidneys are not working properly, it can put a strain on the heart. Chronic kidney failure is a condition that can increase the risk of heart disease. And the heart can also affect the kidneys.
• Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score: This score predicts your risk of having an ``atherosclerotic'' event (such as heart attack or stroke) within the next 10 years.

Think of it this way, each of these tests is like a detective. It takes each clue to piece together the whole picture. In the same way, doctors look at these test reports and come to a conclusion about your heart's health.

How to prepare before a blood test?

Before having your blood drawn, it's important to ask your doctor if you need to stop taking any medications, vitamins, or supplements you're taking. Some medications can affect the results of blood tests. But never stop taking any medications without your doctor's advice.

Some blood tests require you to fast for several hours (usually 8-12 hours) before the test. So ask your doctor about this before the test.

What happens during the test?

A phlebotomist usually inserts a needle into a vein in your upper arm or the inside of your elbow. You may feel a stinging sensation as the needle is inserted into the vein. The blood draw takes about a minute.

What happens after blood is drawn?

After the blood sample is taken, the phlebotomist removes the needle, holds the site of the blood sample in place, applies a plaster or piece of cotton, and applies a binder.

What are the results I get? What do they tell me?

The results will vary depending on the different things in your blood. Your doctor will talk to you about your results and tell you what to do next.

Here are some typical expected values ​​for several key tests related to heart disease risk:

• Total Cholesterol (TC):
• Age 20 or younger: Between 75 - 169 mg/dL.
• Age 21 or older: Between 100 - 199 mg/dL.
• Triglycerides (TG): Less than 150 mg/dL is good. If it is more than 500 - 1000 mg/dL, there is a risk of pancreatitis. This level is usually higher in obese people and people with diabetes.
• High-density lipoprotein (HDL - "good cholesterol"): The higher this is, the better.
• Men: greater than 45 mg/dL.
• Female: greater than 55 mg/dL.
• Low-density lipoprotein (LDL - "bad cholesterol"): The lower the better. The expected level will vary depending on your health status:
• If you have heart disease, blood vessel disease, diabetes, or are at very high risk for heart disease: Less than 70 mg/dL.
• If you have `(Metabolic Syndrome)` or more than one risk factor for heart disease: Less than 100 mg/dL.
• If you have a low risk of coronary artery disease: Less than 130 mg/dL.
• Complete blood count (CBC):
• White blood cell count: 5,000 - 10,000 (per microliter).
• Hematocrit (the amount of blood made up of red blood cells): Males 40% - 55%; Females 36% - 48%.
• Hemoglobin (the part of red blood cells that carries oxygen): Males 14 - 18 gm/dL; Females 12 - 16 gm/dL.
• Lipoprotein (A) (Lp(a)): Less than 30 mg/dL is good.
• Apolipoprotein B (ApoB): Less than 100 mg/dL is good.
• Homocysteine ​​(Hcy): Less than 15 mcmol/L is good.
• Hemoglobin A1c (HbA1c):
• Healthy level: 6% or less.
• Prediabetes: 5.7% - 6.4%.
• Diabetes: 6.5% or higher.
• Target for someone with diabetes: 6.5% - less than 7%.
• Fasting Blood Glucose: Less than 100 mg/dL is good.
• Prediabetes: 100 - 125 mg/dL.
• Diabetes: 126 mg/dL or higher on two separate occasions.
• Creatine Kinase (CK): Normal range 30 - 220 U/L.
• Alanine aminotransferase (ALT/SGPT): Normal range 5 - 45 U/L.
• Aspartate transaminase (AST/SGOT): Normal range 7 - 40 U/L.
• Fibrinogen: Normal range 200 - 400 mg/dL.
• Thyroid Stimulating Hormone (TSH): The ideal range is 0.4 - 5.5 mIU/mL. (This may vary if you have had previous thyroid treatment.)
• Ultra-sensitive C-reactive protein (us-CRP):
• Low risk: less than 2.0 mg/L.
• Moderate risk: 2.0 - 3.0 mg/L.
• High risk: greater than 3.0 mg/L.
• Urine albumin-creatinine ratio (uACR): Less than 30 mg/g is good.
• MPO: Less than 420 pmol/L is good.
• Vitamin D: Optimal range is 31 - 80 ng/ml.
• Trimethylamine N-oxide (TMAO):
• Low risk: less than 6.2 uM.
• Moderate risk: 6.2 - 9.9 uM.
• High risk: 10 uM or more.

(If TMAO levels are high, your doctor may recommend lowering LDL and controlling other risk factors. They may also recommend taking low-dose aspirin twice a day and following a Mediterranean diet.)

• NT-proBNP: Less than 125 pg/mL is good.
• Serum Creatinine (CR):
• Female: 0.58 - 0.96 mg/dL.
• Men: 0.73 - 1.22 mg/dL.
• ASCVD risk score:
• Low risk: <5%
• Borderline risk: 5-7.4%
• Moderate risk: 7.5-<20%
• High risk: >20%

Important: These are just average values. Your results should be compared to many other factors, such as your age, gender, and other medical conditions. Therefore , it is essential to discuss these results with your doctor.

How long does it take to know the results?

Blood test results usually take a few days or longer to come back. Ask your doctor how long it will take to get your results.

Should I see the doctor again?

If you haven't received your test results after about two weeks, call your doctor. Once you get the results, your doctor will discuss them with you and tell you what to do next.

Remember, while blood tests can give you a good idea of ​​your risk for heart disease, they alone cannot tell you for sure that you have the disease. If your blood tests show that your risk is high, your doctor may recommend further testing. Don't be afraid to talk to your doctor about any questions or concerns you have throughout this process.

Take-Home Message

Simply put, these blood tests are a valuable tool for early detection of heart disease. Based on the information they provide, you can make lifestyle changes and, if necessary, begin treatment. Then, you have a greater chance of protecting yourself from serious heart disease.

Remember:

• If you have risk factors for heart disease (the ones we discussed earlier), get these tests done on medical advice.
• Talk openly with the doctor about the results.
• Don't worry if the results show that the risk is high. It just means that you need to take a little more care of your health.
• You can keep your heart healthy by following a healthy diet, exercising regularly , and avoiding smoking .

Just as your heart is valuable to you, it's also very valuable to be aware of your heart health!

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