Atherosclerosis: Beyond the Lipid Panel – 3 Advanced Markers to Assess Cardiovascular Risk Early

Despite the advances in cardiovascular medicine and surgery, atherosclerosis is still the leading cause of death globally. Atherosclerosis is a chronic inflammatory disease of the arteries characterized by the build-up of lipids, immune cells, and fibrous tissue in the arterial walls, leading to plaque formation. Arterial plaque begins with endothelial injury or dysfunction to the arterial walls, which facilitates the infiltration of LDL cholesterol particles. Oxidized LDL cholesterol recruits immune cells, leading to hard plaque formation.

Traditional Risk Factors and the Need for Prevention

The traditional risk factors for atherosclerosis include smoking, high blood pressure, obesity, and elevated LDL cholesterol; however, less than one-third of patients with coronary artery disease have two or more of these risk factors. It is therefore prudent to adopt a preventive approach to cardiovascular health by screening for early markers of coronary artery disease.

This enables timely interventions in dietary habits, physical activity, and medication management if necessary. Here are three preventive strategies for screening for cardiovascular disease.

Coronary Calcium Score

A coronary calcium score is a non-invasive CT scan that measures calcified plaque in the arteries of the heart to assess cardiovascular risk. The patient is assigned a score from 0 to 400+, based on the findings. Generally, a higher score is associated with greater plaque accumulation in the arteries and, consequently, a higher risk of cardiovascular events such as a heart attack.

While the coronary calcium score is an important screening tool for cardiovascular disease, the imaging has limitations. For example, this screening can detect only the amount of hard plaque, not soft plaque accumulation. The conventional health community uses the coronary calcium score to determine whether a patient is a candidate for statin therapy, while the holistic community can use a coronary calcium score to determine appropriate lifestyle changes. This can include increasing daily physical activity and/or improving dietary habits.

Using a coronary calcium score with a lipid panel improved the risk reclassification for coronary artery disease by approximately 25%, helping to identify patients at risk of coronary artery disease beyond a lipid panel alone. Coronary calcium scores can also be tracked over time, showing a rate of progression of 2.4% per year, with newly detectable calcified plaque averaging 6.6% per year [1]. Coronary calcium scores typically require a physician referral and are relatively affordable if not covered by health insurance.

Triglycerides

Another important marker of cardiovascular disease risk is blood triglyceride levels. Elevated triglycerides are associated with atherosclerosis and cardiovascular risk in both men and women. Triglycerides have the ability to interact with endothelial cells in the arterial wall, eliciting an inflammatory response. This inflammatory response leads to the formation of foam cells, a hallmark of atherosclerotic plaque formation.

The remnants of triglycerides are small and dense, which permeate the arterial endothelium. Their high lipid content also makes them prone to oxidation. Triglycerides augment the production of LDL cholesterol particles and amplify the atherogenic potential in arterial walls [2]. Triglycerides are a typical lab marker in a lipid panel when screening cholesterol levels. A lipid panel can be ordered by your doctor and covered by health insurance or paid out of pocket at an affordable price.

Apolipoprotein B (ApoB)

As laboratory testing becomes more advanced and precise, we may eventually be able to determine cardiovascular risk with a single laboratory test. As of today, testing for Apolipoprotein B (ApoB) may be the closest blood-based marker for assessing overall cardiovascular risk.

Lipoproteins are responsible for transporting fats and cholesterol through the body. ApoB is a primary protein structure present on the surface of LDL cholesterol. Much like triglycerides, ApoB can become trapped in the arterial wall and contribute to the atherogenic process by inducing inflammation and endothelial dysfunction, leading to the formation of arterial plaque. ApoB can also become oxidized, leading to foam cell formation.

Recommendations on the appropriate reference range of ApoB can vary, so it is important to understand your lab’s reference range measurements. Generally, the higher the ApoB value, the more positive the association with a higher concentration of arterial plaque-building particles. ApoB might prove itself to be a superior marker of cardiovascular health compared to LDL cholesterol as well as non-HDL cholesterol, as ApoB represents total atherogenic particle concentration rather than simply the cholesterol content of particles shown in a traditional lipid panel. While an LDL cholesterol blood marker might read in a normal range, an ApoB blood marker might indicate heightened cardiovascular risk [3].

Take the Next Step in Understanding Your Heart Health

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Author: Dr. Kellyann Tomko, ND

References

1. Wong ND. Evolution of Coronary Calcium Screening for Assessment of Atherosclerotic Cardiovascular Disease Risk and Role in Preventive Cardiology. Curr Atheroscler Rep. 2022 Dec;24(12):949-957. doi: 10.1007/s11883-022-01073-z. Epub 2022 Nov 14. PMID: 36374366; PMCID: PMC9750903.

2. Akivis Y, Alkaissi H, McFarlane SI, Bukharovich I. The Role of Triglycerides in Atherosclerosis: Recent Pathophysiologic Insights and Therapeutic Implications. Curr Cardiol Rev. 2024;20(2):39-49. doi: 10.2174/011573403X272750240109052319. PMID: 38288833; PMCID: PMC11107470.

3. Cole J, Zubirán R, Wolska A, Jialal I, Remaley AT. Use of Apolipoprotein B in the Era of Precision Medicine: Time for a Paradigm Change? J Clin Med. 2023 Sep 3;12(17):5737. doi: 10.3390/jcm12175737. PMID: 37685804; PMCID: PMC10488498.

Disclaimer:

This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.