Cardiovascular disease (CVD) remains the second leading cause of death in North America. Metabolic syndrome (MetS) is a risk factor for CVD and renal damage. Therefor this comprehensive test evaluates risk for CVD plus too often associated MetS. Many of the risk factors and metabolic abnormalities associated with both CVD and MetS are lifestyle related. Objective advanced laboratory assessment of abnormalities in glucose, lipid and lipoprotein metabolism and adipokines facilitate individualized clinical intervention and can improve clinical outcomes.
Cardiovascular Risk
Well beyond the traditional levels of serum total lipids and lipoprotein cholesterol levels, this test assesses the levels of the most highly atherogenic apolipoprotein B containing lipoproteins. Formulas can be used to calculate the levels of low density (LDL) and very low density VLDL) lipoprotein cholesterol, but when plasma triglycerides (TG) are high the calculated LDL and VLDL cholesterol values may be markedly underestimated. Assessment of non-HDL lipoprotein cholesterol levels, irrespective of TG levels provides accurate assessment of cholesterol transported in atherogenic LDL sub-species, VLDL, IDL and remnant particles. The levels of the real LDL culprits such as oxidized LDL, small dense LDL and lipoprotein(a) have much greater predictive power than LDL-cholesterol. The levels of the important protein constituents of anti-atherogenic HDL (apo AI) and atherogenic LDL species (apo B) are also reported. CVD is an inflammatory condition so artery-specific hsCRP levels are reported. The enzymatic activity of lipoprotein-associated phospholipase-A2 (PLAC®) provides an indication of very significant atherogenic disease activity, inflammation and increased risk for rupture of advanced plaque. Elevated PLAC® activity is a very strong predictor of coronary events and CVD-related mortality regardless of cholesterol levels.
Metabolomics
MetS with core features of insulin resistance, central adiposity and mixed dyslipidaemia is associated with risk for CVD and kidney disease. Fasting glucose and insulin levels are augmented with a sensitive biomarker of hyperglycaemic episodes that are missed using HbA1C. Low serum levels of the dietary glucose-like sugar 1,5-anhydroglucitol (1,5-AG, Glycomark®) indicate daily hyperglycaemic episodes over the past two weeks. Postprandial hyperglycaemia is associated with cardiovascular disease and renal damage, and reduction of hyperglycaemic events appears to decrease macro- and microvascular complications in diabetic patients. Cystatin C is an excellent maker of glomerular filtration. As glomerular function declines, the serum levels of cystatin C rise. Cystatin C is an extracellular cysteine protease inhibitor that is produced by almost all cells. As such it is considered to be a better indicator of GFR than serum creatinine or calculated estimated GFR (eGFR).
Adipokines, hormones produced by fat cells, are regulators of insulin sensitivity, inflammation, oxidative stress and hepatic fatty acid oxidation and secretion of plasma triglycerides. With increased adiposity the level of adiponectin declines. Low levels of adiponectin are associated with marked increases in risk for developing metabolic syndrome, type II diabetes and coronary artery disease. In contrast levels of leptin increase due to leptin resistance that is associated with loss of appetite regulation (satiety). A high of leptin to adiponectin ratio (LAR) is associated with diminished anti-inflammatory, anti-atherogenic, anti-diabetic, anti-oxidative properties, and endothelial dysfunction. There is increased concern with respect to CVD when a high LAR is concomitant with elevated hsCRP (3-10 mg/L).
The blood sample for this profile must be centrifuged and the plasma separated and frozen promptly after collection (a kit is provided with full instructions and all necessary materials). Once the sample has been frozen it remains stable at ambient temperature and is suitable for next-day return to Viva Health Laboratories.
Sample report: Cardiometabolic Profile sample report
Test kit instructions: Cardiometabolic Profile instructions