Looking Beyond the Basics: Advanced Blood Markers & Hormonal Insights for Heart Health

Heart disease is the second leading cause of death in Canada. Blood pressure monitoring, standard lipid panels that include triglycerides, HDL (“good”), LDL (“bad”), and non-HDL cholesterol, as well as HbA1c and fasting blood glucose serve as the main markers tracked for cardiovascular health.  

While conventional labs offer important insight, they fall short in providing a comprehensive and more nuanced understanding of an individual’s cardiovascular risk. Cholesterol, for example, has long been vilified as a primary cause of heart disease, but the reality is far more complex. Healthy cholesterol is essential for life as it forms the backbone of hormones like estrogen, progesterone, testosterone, and cortisol, and is a critical component of cell membranes and contributing to brain health. 

By treating the individual and looking beyond standard lipid panels by assessing biomarkers that look at inflammation, oxidative stress, genetic predisposition, and hormones, we can identify risk more accurately and create personalized strategies for cardiovascular prevention and health. 

A Deeper Dive into Advanced Cardiovascular Blood Markers

High Sensitivity C-Reactive Protein (hs-CRP): You have likely seen this marker on your routine bloodwork without giving it much attention. It measures generalized inflammation in the body, a key driver of arterial plaque (atherosclerosis) and heart disease. Chronically elevated CRP levels have been associated with an increased risk of heart attack and stroke, even in those with normal cholesterol levels. 

Lipoprotein (a): An often-overlooked genetic variant of LDL cholesterol that should be screened, especially in those with a family history of early heart disease stroke and high cholesterol. It is a more inflammatory and more likely to cause blood clots than regular LDL cholesterol. Furthermore, it often does not significantly respond to healthy diet and lifestyle changes. 

Lipoprotein-Associated Phospholipase A2 (Lp-PLA2): A newer marker to the table, Lp-PLA2 is an enzyme associated with oxidizing components of LDL cholesterol. It is superior to certain other inflammatory markers due to it specificity to vascular inflammation.  It can help to indicate the presence of rupture-prone plaques in the arteries, which are high risk for leading to heart attacks or strokes.

Apolipoproteins A1 and B: ApoA1 is a “good” protein found on HDL (helpful) cholesterol that helps to remove excess cholesterol from the body. ApoB is considered a “bad” protein found on LDL (lowsy) cholesterol. Higher ApoA1 levels and low ApoB levels are generally better for heart health. Together, these are a better predictor of heart disease risk than traditional cholesterol testing alone. If your LDL is high, but ApoB is low, heart disease risk is lower. Contrary, if LDL is normal or low and ApoB is high, risk of heart disease is high.

Homocysteine: High levels can damage the lining of arteries and make us more prone to blood clotting & blockages, as well as reduce levels of “good” cholesterol. Elevated homocysteine is linked to B6, B12 and folate deficiencies, which may have a genetic methylation component that needs to be investigated. Smoking, lack of exercise, age, and male gender can also increase homocysteine.

Omega-3 Index: We all know that omega 3’s are important to heart health – but did you know there is a way to measure your status? This measures the percentage of healthy omega 3 EPA and DHA in red blood cells. Higher omega 3 levels are associated with reduce cardiovascular risk. 

Lipoprotein Fractionation & LDL Pattern: Provides a detailed analysis of cholesterol size and number, providing further insight into coronary heart disease risk. Smaller, denser cholesterol particles are risk factors for atherosclerosis.

*While the above list is comprehensive, there are additional markers 
not included that may be considered in select cases.*

A Deeper Dive into Hormone Insights: The Less Thought of Influencers of Heart Health

Cortisol - The Stress Hormone: We have all heard how chronic stress is detrimental to our health in a multitude of ways and cortisol often is the hormone to blame for this effect. Though cortisol is not all bad (we need it live), chronically elevated cortisol, and at the wrong times throughout the day, can impact sleep quality, increase blood pressure, blood sugar, triglycerides and LDL cholesterol – all risk factors in heart & metabolic disease. Consider testing urine or salivary cortisol levels over a 12-hour span to assess proper diurnal pattern and abnormally high levels. 

Sex Hormones: Estrogen, Progesterone, and Testosterone: Sex hormones are not always on our radar when thinking about our heart health, but did you know they play a crucial role in cardiovascular function? It is important to note that a balance between these hormones is key, as too high or too low can be problematic.

Estrogen helps to maintain healthy cholesterol levels and improves blood vessel function and blood flow by promoting nitric oxide production and helping to keep arteries flexible. It also plays a role in insulin sensitivity reducing diabetes-related heart risk. It is thought that this is one of the main reasons women have a lower risk of heart disease than men before menopause. Low estrogen in menopause may correlate with rising cholesterol or palpitations.

Progesterone works in tandem with estrogen in counterbalancing clot formation and blood vessel spasms. It also helps to relax blood vessels and reduce blood pressure, in additional to its calming effects on the nervous system. Similar to estrogen, it can help with blood sugar and cholesterol status.

Testosterone also stimulates nitric oxide production, which allows for healthy blood flow, better circulation, and lower blood pressure. It is anti-inflammatory in nature, helps in regulating blood sugar, and supports stronger heart contractions.

Thyroid Hormones - The Metabolic Regulators: Thyroid hormones are key in metabolism, and play a significant part in heart rate, cardiac output, and blood vessel resistance. Both hypo and hyperthyroidism can negatively impact heart health. Slow thyroid function can slow heart rate and increase poor cholesterol, while an overactive thyroid speeds heart rate, increases the risk of atrial fibrillation, and can cause high blood pressure.

In Conclusion

Incorporating advanced cardiovascular and hormonal testing into routine care allows for a more precise and individualized approach to heart health. While conventional markers provide a foundation, exploring deeper insights into inflammation, lipid particle size, genetic risk factors, and hormone balance can reveal hidden risks and offer proactive strategies for prevention. 

By embracing a holistic, functional approach—integrating lifestyle, nutrition, targeted supplementation, and stress management—we empower individuals to take charge of their cardiovascular health and longevity. Heart disease is not just about cholesterol; it’s about the bigger picture. 

References

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6. Traish, A. M. (2020). "Testosterone therapy in men with hypogonadism: A comprehensive review of cardiovascular and metabolic risks." The Aging Male, 23(1), 81-99

7. Sniderman AD, Thanassoulis G, Glavinovic T, et al. Apolipoprotein B Particles and Cardiovascular Disease. JAMA Cardiology. Published online October 23, 2019. doi:10.1001/jamacardio.2019.3780