Essential Biomarkers for the Assessment of Heart Health: New Discoveries or Old Friends?

If you are a patient of a BaleDoneen Method provider, you have already participated in a deep dive into your genetics, personal, medical and family history, along with individual biomarkers that influence your risk for heart and brain disease. This has been the foundation of our work since Day One.

Recently, national news outlets have been spotlighting three “new” tests that are crucial for assessing cardiovascular disease (CVD) risk: high-sensitivity C-reactive protein (hsCRP), lipoprotein(a) [Lp(a)], and low-density lipoprotein cholesterol (LDL-C). These biomarkers offer valuable insights into an individual’s cardiovascular health and are instrumental in crafting personalized prevention and treatment strategies. While we have been measuring these and other markers for more than 20 years, this renewed interest in cardiovascular biomarkers offers the opportunity to review the importance of these tests, and to reassure our patients that these markers are not new for BaleDoneen patients.

High-Sensitivity C-Reactive Protein (hsCRP)

hsCRP is a marker of inflammation in the body that is known to fluctuate with the onslaught of illness, dental infection, arthritis and a whole host of other inflammatory conditions. Chronic inflammation plays a significant role in the development of atherosclerosis — the buildup of plaque in the arteries — which can lead to heart attacks and strokes. Elevated levels of hsCRP are linked to an increased risk of cardiovascular events. By monitoring hsCRP levels, your healthcare provider can better gauge your overall inflammatory load that may contribute to heart disease and thus tailor interventions accordingly.

Lipoprotein(a) [Lp(a)]

Lp(a) is a type of lipoprotein (cholesterol particle) that contributes to the development of cardiovascular disease. Unlike LDL cholesterol, which is tested on a conventional lipid panel and can go up and down based on lifestyle and diet choices, Lp(a) levels are largely determined by genetics and do not necessarily respond to lifestyle changes or statin therapy. High levels of Lp(a) are a major risk factor for both heart attacks and strokes, making it a critical component of a comprehensive cardiovascular risk assessment. Identifying elevated Lp(a) levels allows for more targeted treatment options, such as vitamin B3 and newer therapies (currently in the research stage) specifically designed to lower Lp(a). These new pharmaceuticals are likely driving the increased interest in Lp(a), and while we wish this was recognized more widely decades ago, we are pleased to know that more people will be tested for this very strong genetic risk factor and hopefully seek treatment before experiencing an event. Most recently (August 2024), it was published that optimal control of Apo B and LDL-C could eliminate the risk of lipo(a).1

Low-Density Lipoprotein Cholesterol (LDL-C)

Often referred to simply as “bad cholesterol,” LDL-C is a well-established risk factor for cardiovascular disease. Elevated LDL-C levels (in the setting of inflammation and oxidative stress) contribute to plaque formation in the arteries, increasing the likelihood of heart attacks and strokes. Regular monitoring and management of LDL-C are essential in preventing cardiovascular events, a charge we take seriously. While lifestyle changes and medications like statins and PCSK-9 inhibitors are commonly used to lower LDL-C levels (as well as inflammation), understanding its role in the context of these other biomarkers provides a more comprehensive picture of cardiovascular risk. It is our hope that LDL will start to be looked at as a supporting player to the more specific biomarkers such as Lp(a), hsCRP and others.  

The Prevention Center and other BaleDoneen Clinics utilize these biomarkers to offer more precise and personalized care. For instance, if a patient has elevated hsCRP levels, his or her treatment plan might include specific anti-inflammatory dietary strategies in addition to standard cardiovascular therapies. Similarly, if elevated Lp(a) levels are detected, the treatment plan may incorporate Vitamin B3, and hopefully soon, more novel therapies targeting Lp(a) reduction.

Our hope is that widened use of these biomarkers (and others advocated by BaleDoneen) will help practitioners to develop more targeted and effective strategies for managing cardiovascular health, paving the way for improved patient outcomes and more proactive care. This comprehensive strategy not only improves the accuracy of risk assessments but also enhances the effectiveness of preventive measures and treatments, ultimately leading to better outcomes for all individuals at risk for cardiovascular disease.

Reference:

1 Khera A, Valero-Elizondo J, Bittner VA, et al. Lipoprotein(a) and coronary heart disease prediction: A comprehensive analysis of the potential role of apoB vs LDL-C. J Am Coll Cardiol. 2024;83(15):1540-1552. doi:10.1016/j.jacc.2024.04.050