You’ve recently been diagnosed with a heart condition or have a family history of heart disease. Perhaps you’re wondering what you can do about it, and how to track improvements and manage risk. And if you weren’t, hopefully you are now. Cardiovascular illness is the leading cause of death in the United States, with an estimated 1 death every 36 seconds, according to the CDC. 
There are three lab tests I commonly order on patients with a personal or family history of cardiovascular disease. My mindset is prevention, individualized plans, and focused treatment so that we can improve quality of life and maintain good cardiovascular health.
You’ve heard of inflammation from doctors and medical advertisements. But what does it mean? Well, “good inflammation”, is when you cut your finger and see the areas around it become more pink and slightly swollen. Your immune system triggers an inflammatory response due to the cut. A dilation of the blood vessels causes the area to pink up with blood and call out different immune messengers that go into action to clear away debris and fend off bacteria that were outside the skin. Other immune cells lay down new collagen to mend your skin. All of it in a symphonic effort to heal your cut.
Good inflammation is short and efficient. The immune messengers rightfully inflame the area for a short time and then expire. This is an example of very localized inflammation in a controlled area. Body-wide and long-term inflammation are a much graver cause of concern.
This type of inflammation indicates our entire body is under duress. It may be battling stress, overprocessed foods, drugs, or environmental contaminants. That prolonged and widespread battle wears the body out—fatally.
When researchers or doctors want to know if the body is undergoing this kind of chronic inflammation, they test the person’s blood for CRP—C-reactive protein.
CRP is one of the body’s many immune mediators. When cells are damaged, by infection or injury, they release these immune mediators, special biochemical agents that have diverse roles to help deal with the damage. Different tissues have different kinds of immune mediators. Those specific mediators trigger different responses based on factors like the kind of pathogen, or nature of wound.
It just so happens, CRP’s job can give us a wider picture of how the immune system’s inflammatory response is working.
CRP is a special protein inflammation brings in to help heal and protect against infection. This protein works like a smoke signal that attaches itself to dead or dying cells so other biochemical agents can clean up the casualties. The bigger the CRP smoke signal, the more severe the inflammation could be.
Traditionally, physicians would use a test that measures CRP within the range of 10 to 1,000 mg/L. Now it has become more common to use a high-sensitivity CRP test, hs-CRP, that can measure for much smaller amounts, from 0.5 to 10 mg/L.
Because the hsCRP test is able to detect very small amounts of CRP in the body, it can be helpful in predicting cardiovascular disease like heart attack, peripheral artery disease, and stroke which have known associations with chronic inflammation.
Chronic nflammation of the cardiovascular system can result in stress on the vessels, damage to the endothelial cells which line them, decreased blood flow, and even increased risk for clots. This is why monitoring hsCRP can be helpful.
The hsCRP test is not the gold standard for determining cardiovascular risk but research is growing.
But, what do you do if your hsCRP is elevated? One of the best ways to improve your health is maintaining a healthy weight and muscle mass. Weight loss has been shown to effectively decrease hsCRP levels. Excess body fat has been shown to elevate inflammatory markers and trigger increased immune reactivity. In other words, your body seems to treat excess fat tissue as if it were an injury to resolve, and attempts to respond with an inflammation response that appears to make matters worse.
We have different types of amino acids all throughout the body. Amino acids are the building blocks of proteins and proteins are the body’s work force. Amino acids also create enzymes to carry out biological processes, and regulate gene expression, a fundamental aspect of human health. Homocysteine is a type of amino acid commonly found in the body. Vitamins B6, B12, and folic acid are used to convert homocysteine into other metabolites, the substances used or created in the process of the body’s endless biochemical reactions, collectively known as its metabolism. Oftentimes supplementation of these vitamins can lower homocysteine levels, however, it’s prudent to look for other nutrient deficiencies as a whole.
According to Alan Gaby’s book "Nutritional Medicine," high levels of homocysteine have been linked to increased incidence of atherosclerosis (plaque buildup on arterial walls), blood clots, stroke, osteoporosis, recurrent miscarriages, other pregnancy complications, and cognitive decline.
Additionally, genetic mutations in the MTHFR (methylenetetrahydrofolate reductase) gene can impair how the body metabolizes homocysteine and other amino acids in this metabolic pathway. A recent study in Sweden, showed that high homocysteine and low methionine levels were associated with faster comorbidity development in patients that already had cardiovascular disease.
I always remind my patients, however, that homocysteine is merely a piece of the puzzle and should not be used as an isolated evaluation tool. One study by Park et al suggested that asymptomatic individuals are not at increased risk for subclinical coronary artery disease.
You can be mindful of optimizing your own body’s methylation pathway by getting lab work evaluating B vitamin status, homocysteine, and discuss MTHFR genetic testing with your family physician.
A third biologic marker important in assessing cardiovascular health is Vitamin D. Low levels of vitamin D have been linked with increased risk of hypertension and heart failure10. Vitamin D is a hormone that can be produced from exposing our skin to the sun, as well as, through ingestion of foods high in vitamin D like salmon, sardines, egg yolks, and beef liver11.
Studies on hypertensive patients have shown a correlation between low vitamin D levels and increased hormones associated with increasing blood pressure, like renin and angiotensinogen12.
Normal range for vitamin D 25-OH is 30-100 ng/mL, with levels between 20-29 ng/mL being suboptimal and <20 ng/mL as deficient. Vitamin D is also integral in bone health, mental health, immune function, and skin integrity. About 50 percent of the patients I test have suboptimal levels that require regular supplementation to optimize. If you haven’t had your levels tested in the last 6 to 12 months, it’s likely time to get tested again as part of your regular screening.
I encourage all of the people I work with to be proactive about their health. Tracking progress through bloodwork and specific biomarkers like hsCRP, homocysteine, and vitamin D 25-OH are ways you can track positive change in your cardiovascular health and overall risk. Today more than ever we have tools to look at health and improve it on so many levels.
- Bassuk SS, Rifai N, Ridker PM. High-sensitivity C-reactive protein: clinical importance. Curr Probl Cardiol. 2004 Aug;29(8):439-93. PMID: 15258556.
- Kamath DY, Xavier D, Sigamani A, Pais P. High sensitivity C-reactive protein (hsCRP) & cardiovascular disease: An Indian perspective. Indian J Med Res. 2015;142(3):261-268. doi:10.4103/0971-5916.166582.
- Luan YY, Yao YM. The Clinical Significance and Potential Role of C-Reactive Protein in Chronic Inflammatory and Neurodegenerative Diseases. Front Immunol. 2018;9:1302. Published 2018 Jun 7. doi:10.3389/fimmu.2018.01302
- Alan Gaby, Nutritional Medicine
- Park S, Park GM, Ha J, et al. Homocysteine is not a risk factor for subclinical coronary atherosclerosis in asymptomatic individuals. PLoS One. 2020;15(4):e0231428. Published 2020 Apr 8. doi:10.1371/journal.pone.0231428
- Judd SE, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Am J Med Sci. 2009;338(1):40-44. doi:10.1097/MAJ.0b013e3181aaee91
- Schmid A, Walther B. Natural vitamin D content in animal products. Adv Nutr. 2013;4(4):453-462. Published 2013 Jul 1. doi:10.3945/an.113.003780
- Kota SK, Kota SK, Jammula S, et al. Renin-angiotensin system activity in vitamin D deficient, obese individuals with hypertension: An urban Indian study. Indian J Endocrinol Metab. 2011;15 Suppl 4(Suppl4):S395-S401. doi:10.4103/2230-8210.86985