Every 33 seconds, someone in the United States dies from cardiovascular disease: heart disease is the leading cause of death for men, women, and most racial and ethnic groups across the country.
Identifying and managing heart health risks early can make all the difference in prevention and treatment. In functional medicine, practitioners take a comprehensive approach to cardiovascular testing, using advanced labs to provide a detailed look at heart health.
These labs go beyond the standard lipid panels used in conventional medicine, offering deeper insights into inflammation, metabolic health, and genetic predispositions that can lead to heart disease.
Together we will explore the most commonly ordered cardiovascular labs in functional medicine, explaining when these tests are ordered, what they reveal, and why they are essential for both patients and practitioners.
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1. Advanced Lipid/Cholesterol Panel
A standard cholesterol test measures total cholesterol, LDL (low-density lipoprotein), HDL (high-density lipoprotein), VLDL (very low-density lipoprotein) and triglycerides.
While this provides basic information, an advanced lipid panel goes much deeper. It assesses not only the total amounts of these fats in the blood but also their particle sizes, density, and specific types of lipoproteins.
Key Markers Often Included in an Advanced Lipid Panel
- Apolipoprotein B (ApoB): ApoB is an important marker for heart disease risk because it represents the total number of harmful particles—like LDL, VLDL, and Lp(a)—circulating in the blood. High ApoB levels offer a more accurate assessment of cardiovascular risk than just measuring LDL cholesterol because it helps to identify the likelihood of atherosclerosis and guide more targeted, effective treatment plans to reduce heart disease risk.
- Apolipoprotein A (ApoA): considered a protective factor against heart disease, ApoA measures key proteins involved in cholesterol transport. For example, ApoA1, a major component of HDL particles, supports the removal of excess cholesterol from peripheral tissues and subsequent excretion.
- Lipoprotein(a) [Lp(a)]: Lp(a) is a genetic type of lipoprotein that can greatly increase the risk of heart disease, even if other cholesterol levels are normal. Since it's largely determined by genetics, Lp(a) levels stay mostly the same throughout life, so it usually only needs to be tested once.
- Small Dense LDL (sdLDL): these smaller, denser LDL particles are a risk factor for cardiovascular disease because they are more likely to contribute to plaque buildup in the arteries.
- Oxidized LDL: these LDL particles have been damaged by oxidative stress, making them more likely to cause inflammation and artery damage. Higher oxidized LDL levels are associated with metabolic syndrome.
Why It’s Ordered
An advanced lipid panel is ordered for patients with cardiovascular risk factors including a family history of heart disease or normal cholesterol levels but unexplained symptoms or risk factors.
Advanced lipid panels are also excellent for people interested in health optimization. It provides a more nuanced look at cholesterol and helps identify hidden risks.
What It Reveals
This panel gives a detailed look at how cholesterol behaves in the body. It identifies patterns that increase the risk of heart disease, such as ApoA and ApoB, small dense LDL particles and elevated Lp(a), which are often missed in standard tests.
Practitioners can then create more personalized treatment plans to lower these risks.
2. High-Sensitivity C-Reactive Protein (hs-CRP)
High-sensitivity C-reactive protein (hs-CRP) is a well-established marker of inflammation in the body. Chronic inflammation drives the development of cardiovascular disease, particularly in the formation of atherosclerotic plaques in the arteries.
Why It’s Ordered
Functional medicine practitioners order hs-CRP to assess the level of inflammation in patients at risk for heart disease. It is often used alongside other markers to get a comprehensive picture of cardiovascular risk.
What It Reveals
Elevated hsCRP levels (between 3 to 20 mg/L) indicate systemic inflammation. It is associated with poor cardiovascular outcomes in patients including increased risk of atherosclerotic cardiovascular disease (ASCVD), heart attack, unstable angina and sudden cardiac death in people without diagnosed cardiovascular disease.
This makes hsCRP a useful tool in evaluating cardiovascular risk, especially when other inflammatory conditions are ruled out.
3. Omega-3 Index
The Omega-3 Index measures the amount of omega-3 fatty acids, specifically EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), in red blood cells. Omega-3s are known for their heart-protective benefits, including reducing inflammation and lowering the risk of heart disease.
It reflects long-term intake of omega-3 fatty acids and offers additional predictive value for cardiovascular risk beyond traditional markers.
Why It’s Ordered
This test is often ordered for patients with cardiovascular risk factors, those not responding well to traditional therapies, or anyone who needs to assess their dietary intake of omega-3 fatty acids.
What It Reveals
The omega-3 index informs a person’s overall risk for coronary heart disease, particularly sudden cardiac death. Higher omega-3 index levels are associated with lower cardiovascular risk, with less than 4% considered high risk, 4-8% intermediate, and greater than 8% low risk.
4. Diabetic Risk Labs (HbA1c, Fasting Insulin, and Glucose Tolerance)
Diabetes is a major risk factor for cardiovascular disease.
Hemoglobin A1c (HbA1c), fasting insulin, and glucose tolerance tests assess how well the body regulates blood sugar and insulin levels.
Why They’re Ordered
Patients with metabolic syndrome, prediabetes, or diabetes are at higher risk for cardiovascular complications. These tests help evaluate blood sugar control and insulin sensitivity, which are essential in assessing cardiometabolic health.
What They Reveal
Elevated HbA1c and fasting insulin levels indicate poor blood sugar control and insulin resistance, both of which contribute to the development of heart disease. Early detection of these imbalances allows for interventions that improve both blood sugar and heart health.
5. Trimethylamine N-oxide (TMAO)
TMAO is a byproduct of gut bacteria that is formed when certain foods, particularly red meat, are consumed. TMAO increases cardiovascular disease risk via multiple inflammatory and metabolic pathways, as it promotes atherosclerosis and blood clotting.
Why It’s Ordered
TMAO testing is often ordered for patients with unexplained cardiovascular symptoms or those consuming a high-animal-protein diet.
What It Reveals
High TMAO levels suggest an increased risk for atherosclerosis and other cardiovascular diseases. By identifying high TMAO, practitioners can guide dietary changes to reduce heart disease risk.
6. Thyroid Function Tests (Comprehensive Thyroid Panel)
Thyroid hormones direct metabolism, including heart rate and cholesterol levels. A comprehensive thyroid panel assesses thyroid function by measuring TSH, Free T3, Free T4, and thyroid antibodies.
Why It’s Ordered
Thyroid dysfunction, such as hypothyroidism or hyperthyroidism, can increase cardiovascular risk.
This test is ordered for patients with symptoms like fatigue, unexplained weight changes, or abnormal cholesterol levels.
What It Reveals
Hyperthyroidism is linked with an increased risk of atrial fibrillation and heightened cardiovascular risk, even in subclinical cases. On the other hand, hypothyroidism is associated with increased cholesterol levels, hypertension, and impaired heart function, all of which contribute to cardiovascular disease risk.
A thyroid panel helps identify thyroid imbalances that may be impacting heart health.
7. MTHFR Genetic Testing
The MTHFR gene mutation affects how the body processes folate and homocysteine, both of which are important for cardiovascular health. Elevated homocysteine levels are associated with a higher risk of heart disease.
According to one meta-analysis, the MTHFR mutation was found to elevate homocysteine concentrations by about 20%, translating into a 21% higher risk of ischemic heart disease and a 60% increased risk of deep vein thrombosis in individuals with the homozygous TT mutation compared to those with the wild-type genotype (CC).
Why It’s Ordered
This test is ordered when a patient has elevated homocysteine levels, unexplained cardiovascular issues, or a family history of heart disease.
What It Reveals
A mutation in the MTHFR gene can lead to elevated homocysteine, which increases inflammation and the risk of cardiovascular disease. Treatment may involve supplementing with specific B vitamins to help reduce homocysteine levels.
8. High-Sensitivity Cardiac Troponin I and T
Troponin I and T are cardiac-specific proteins found in heart muscle cells (cardiomyocytes). They regulate the interaction of actin and myosin in muscle contraction, making them essential for the contraction of heart muscles.
High-sensitivity troponin tests can detect even small levels of heart muscle damage: while traditionally used to diagnose acute cardiac events, troponin I and T, are now recognized as independent predictors of future cardiovascular events.
Why They’re Ordered
This test is traditionally ordered for patients with chest pain or those at high risk of heart attacks to assess potential heart damage.
High-sensitivity troponin I and T assays are increasingly used in risk assessment to detect subtle heart damage, even in asymptomatic individuals, providing early prediction of future cardiovascular events.
What They Reveal
Elevated troponin levels indicate heart muscle damage, which could suggest a recent heart attack or ongoing heart strain; it can also help monitor response to treatment. It is a key marker for assessing the severity of heart injury.
9. N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and B-type Natriuretic Peptide (BNP)
BNP and NT-proBNP are markers released by the heart in response to increased pressure, which occurs during heart failure or significant heart strain.
BNP is a hormone that helps regulate blood pressure and fluid balance, while NT-proBNP is a precursor to BNP.
Why They’re Ordered
These tests are essential for diagnosing and monitoring heart failure and assessing the severity of heart dysfunction.
NT-proBNP is also used to assess stroke risk.
What They Reveal
Elevated NT-proBNP and BNP levels indicate heart failure or significant stress on the heart.
Although their main clinical use is to help rule out heart failure in patients with shortness of breath, BNP and NT-proBNP also provide important information about the prognosis of heart failure, coronary artery disease, and valve problems. However, they aren't specific to one pathology; instead, they reflect overall stress on the heart.
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Key Takeaways
- Heart Disease Prevalence
- Causes a death every 33 seconds in the U.S.
- Leading cause of death across all genders and most ethnic groups.
- Early Risk Detection
- Crucial for prevention and treatment.
- Functional medicine uses comprehensive, advanced testing.
- Advanced Cardiovascular Testing
- Goes beyond standard lipid panels.
- Assesses inflammation, metabolism, and genetics for personalized care.
- Essential Cardiovascular Labs
- Advanced Lipid Panel
- Detailed cholesterol types and particle sizes (ApoB, ApoA, Lp(a), etc.).
- High-Sensitivity C-Reactive Protein (hs-CRP)
- Measures systemic inflammation.
- Omega-3 Index
- Levels of heart-protective omega-3 fatty acids.
- Diabetic Risk Labs (HbA1c, Insulin, Glucose Tolerance)
- Evaluates blood sugar control and insulin resistance.
- Trimethylamine N-oxide (TMAO)
- Indicates gut-related cardiovascular risks.
- Comprehensive Thyroid Panel
- Detects thyroid issues affecting heart health.
- MTHFR Genetic Testing
- Identifies genetic mutations linked to heart disease.
- High-Sensitivity Cardiac Troponin I and T
- Detects minor heart muscle damage.
- NT-proBNP and BNP
- Indicates heart failure and heart stress.
- Advanced Lipid Panel
- Benefits of Advanced Testing
- Uncovers hidden cardiovascular risks.
- Enables tailored prevention and treatment strategies.
- Enhances overall heart health management
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