You don’t need me to tell you the statistics on heart disease. For years we’ve known it’s a leading killer.
But what you do need to know, and the reason for this blog, is that being fit and having decent cholesterol numbers aren’t a guarantee against having heart disease.
I see it in the news or hear about from time to time. But, I hear about it often enough to be wary of myself and the athletes I know and see in clinic.
It’s almost always a very similar story - healthy appearing 40-something competing in endurance event dies suddenly, due to unrealized and prolific heart disease.
He didn’t have symptoms (other than maybe he told his wife he wasn’t ‘feeling well’ the day of the event, if that). He had ‘healthy’ cholesterol levels. He was super fit, competing all the time.
What happened? From my seat I can only speculate. But what I do know is that getting your cholesterol tested once a year and being fit don’t necessarily mean you don’t have heart disease. Why? Because that’s what the guys who died had going for them - decent cholesterol numbers and fitness.
So what can you do? Ask for more. There are much better screening labs and tests available that can take a much deeper look at your disease risk.
A standard lipid panel, comprised of total cholesterol, HDL (“good” cholesterol), LDL (“bad”) cholesterol and triglycerides is what most people end up getting during their annual exam. This has been the standard, entry-level screening exam for heart disease for many years now.
If you’ve gone to the doc, had a basic physical exam with no findings, no physical symptoms and a total cholesterol that’s come back under 200, you’re presumed good to go. We’ve been taught that other than lifestyle, cholesterol levels are the end-all be-all monitor of cardiovascular health.
But, that’s not enough. It’s not nearly enough to determine whether you have heart disease lurking within you. There’s far more going on in your bloodstream that’s indicative of heart disease than basic cholesterol testing will reveal.
We need to look beyond cholesterol and also measure other inflammatory markers in the bloodstream. After all, it’s the oxidized (inflamed) cholesterol molecules that become ‘sticky’ and cause problems. A standard lipid test won’t measure this. Heart disease is a disease of inflammation - inflammation in the blood vessels.
Please, get more testing done if you’re a 40-and-over athlete.
Here are the cardio-specific labs that I run (CardioMetabolic panel) as part of the Endurance Health & Performance Program:
Lipoprotein Fractionation & particle numbers: This test measures the size and density of your cholesterol molecules. Smaller, more dense molecules increase heart disease risk while larger, less dense carry less risk. It also provides a much more accurate count of each cholesterol molecule than standard lipid panels. Homocysteine: An amino acid that’s a natural by-product of metabolism; elevated levels however are a risk factor for heart disease. Apolipoprotein B: Is a protein associated with LDL (bad) and VLDL (very bad) cholesterol molecules. More is a sign that these forms of cholesterol are being distributed around the body. Apoliprotein A1: Is the protein associated with your HDL (good) cholesterol. Higher levels are indicative of greater cardiovascular health. hsCRP: Or, highly sensitive c-reactive protein. It measures general inflammation in great detail. Inflammation in your bloodstream accelerates the cardiovascular disease process. Be sure to get the highly sensitive version of this test, the basic CRP won’t give you the detail you need. Fibrinogen: A protein that tells us how readily your blood will clot. While clotting ability is important, too much isn’t a good thing as this means your blood is “sticky” and more prone to unnecessary clots - think heart attacks and strokes. Hemoglobin A1c: Normally reserved for diabetics, this test tells us how high your blood sugar has been over the last several months. Keeping blood sugar low over time is key to preventing heart and other diseases. Elevated blood sugar is associated with heart disease. Insulin: Insulin is a hormone that pulls sugar into the cells to be used by the body. If it’s too high, this signifies a danger of not only heart disease but also diabetes (which in turn leads to heart disease). Insulin goes up before blood sugar does, and many doctors only look at blood sugar, not insulin. This is backwards because by the time blood sugar goes up; insulin has been high for a while and contributes toward the inflammatory burden.
You can see the entire list of labs that we run as part of the CardioMetabolic panel here.
Once you’ve had the blood testing done, and if it shows cause for concern, the next step is to get imaging done. The technology and accessibility of imaging tests like carotid artery ultrasound and coronary artery CT scans are available in most larger metro areas.
Carotid Ultrasound Measures any plaque accumulation you may have and it can be used as barometer for the overall health of your arteries.
Coronary Calcium Scan Perhaps the most detailed test available, a coronary calcium scan will dive even deeper than a carotid ultrasound, actually looking at the arteries that supply the heart muscle itself with blood. This test measures the amount of calcified plaque in the coronary arteries; this test is a better predictor of coronary events (heart attack) than other tests.
This is a lot of info! But it’s important to get more than a basic lipid panel if you’re an endurance athlete.
Please take the time to digest, and work with a clinician who can help you interpret your findings. And as always, I’m happy to answer questions or help you take the next steps to improving your cardiovascular health!
Feel free to schedule a complimentary 30 minute consultation if you’d like to learn more about these advanced tests for preventing hidden cardiovascular disease.
Or, just reach out to me directly and reply to this email if you have other questions.
In Health, Fitness and Endurance,
Dr. Jason Barker