Cardiovascular diseases (CVDs) remain a leading cause of death and disability worldwide, affecting millions across the world. With the increasing prevalence of heart-related conditions, particularly in developing countries, understanding and monitoring key health parameters has never been more crucial.
This article highlights the essential blood tests you should consider and the healthy ranges to aim for, helping you reduce the risk of CVD and take proactive steps toward better heart health.
The Growing Burden of Cardiovascular Diseases
Cardiovascular diseases contribute significantly to global morbidity and mortality, affecting individuals regardless of age, race, or region. According to the World Heart Federation, one-third of adults over 25 suffer from CVD globally. Annually, over 17.5 million deaths—amounting to 30% of all deaths worldwide—are attributed to heart-related conditions.
While advancements in medical technology have improved CVD prognosis, developing countries continue to see rising morbidity and mortality rates, driven by environmental factors and unhealthy lifestyles. Addressing these risks requires a proactive approach that includes regular health monitoring, maintaining a healthy lifestyle, and creating supportive environments for heart health.
This article will outline the key blood tests that can aid in early detection and risk management, along with the healthy ranges you should aim for.
1. Ldl-C (Low-Density Lipoprotein Cholesterol)
LDL-C, often called “bad” cholesterol, is one of the most commonly discussed markers in cardiovascular health. While this label oversimplifies its role, it’s important to understand that LDL-C is not inherently harmful. It plays a crucial role in transporting cholesterol to cells for vital functions. However, elevated levels of LDL-C are strongly associated with an increased risk of coronary heart disease (CHD).
Epidemiological studies show a log-linear relationship between LDL-C levels and CHD risk. This means that as LDL-C levels increase, so does the risk of heart disease, without any specific threshold where the risk is zero. In fact, hypercholesterolemia—high cholesterol levels—is a significant global health concern:
Global Impact: Approximately 40% of the global population has elevated cholesterol, making hypercholesterolemia a leading risk factor for cardiovascular diseases.
The good news is that LDL-C levels are easy to measure through quick and affordable lipid testing. Regular monitoring and appropriate management of LDL-C, especially in individuals with high cardiovascular risk, can significantly reduce the chances of heart disease.
Normal range of LDL-C: <100mg/dl – 20-40mg/dl, preferably 60-70mg/dL
2. Apob (Apolipoprotein B)
ApoB (apolipoprotein B) is a protein that plays a critical role in cholesterol transport and cardiovascular health. It is primarily found in two forms:
- ApoB-100: Produced in the liver, present in lipoproteins like LDL-C, VLDL-C, IDL-C, Lp(a), and remnant particles.
- ApoB-48: Produced in thme sall intestine, present in chylomicrons, which transport dietary fats.
ApoB is a key player in atherosclerosis, as all non-HDL cholesterol particles, such as LDL-C, VLDL-C, and Lp(a), contain ApoB. This protein helps these particles bind to LDL receptors, enabling cholesterol delivery to tissues.
Traditional markers like LDL-C measure the concentration of cholesterol in the blood but fail to account for the total number or density of particles, factors that significantly influence their ability to cause harm. Since each ApoB-containing particle has exactly one ApoB protein, measuring ApoB provides a more precise assessment of cardiovascular risk. It serves as a valuable marker, especially when LDL-C alone doesn’t offer a complete picture.
Normal range for apoB : <90 mg/dl- 20mg/dl
3. Total Cholesterol
Total cholesterol measures the combined amount of cholesterol in your bloodstream, including both HDL-C (High-Density Lipoprotein Cholesterol) and LDL-C (Low-Density Lipoprotein Cholesterol), along with a smaller portion carried by other lipoproteins such as VLDL (Very Low-Density Lipoprotein).
Normal range of total cholesterol: preferably <200 mg/dL
4. Lp(A): Lipoprotein(A)
Elevated serum lipoprotein(a), or Lp(a), is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. High Lp(a) levels contribute to plaque buildup in arteries, increasing the likelihood of heart attacks and strokes. It has also been linked to the calcification and narrowing of the aortic valve, further highlighting its role in cardiovascular risk.
Unlike other lipoproteins, Lp(a) levels are predominantly genetically determined and are minimally influenced by lifestyle or diet. This unique characteristic makes it a distinct and critical marker for inherited cardiovascular risk. Emerging evidence suggests a likely causal relationship between elevated Lp(a) and the development of ASCVD.
Current guidelines recommend a once-in-a-lifetime measurement of Lp(a) levels, particularly for individuals at increased risk of atherosclerotic CVD. This includes those with a family history of premature heart disease or unexplained cardiovascular events. Testing for Lp(a) helps identify high-risk individuals and enables more personalized approaches to prevention and treatment.
Normal range for lp(a): preferably <30 mg/dL (or <75 nmol/L)
5. Non-HDL Cholesterol
Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol, representing all atherogenic lipoproteins, including LDL, Lp(a), IDL, and VLDL. As a broader measure of cholesterol contributing to atherosclerosis, non-HDL cholesterol is considered a more comprehensive tool for assessing cardiovascular risk than LDL cholesterol alone.
Normal range for non-hdl cholesterol: preferably <103 mg/dL
6. Triglycerides
Fatty acids in your blood are referred to as triglycerides. They can be stored in fat cells (also known as body fat) or used as energy. Cardiovascular disease (CVD) risk is increased by abnormal triglycerides.
Although a causative relationship has not been proven, elevated triglyceride levels are independently linked to an increased risk of cardiovascular disease events. It is recommended that patients with hypertriglyceridemia have their risk for atherosclerotic cardiovascular disease (ASCVD) evaluated.
Normal range for triglycerides: preferably <100mg/dL.
7. Blood Pressure
Blood pressure is a critical metric for cardiovascular health. Elevated blood pressure, or hypertension, is often referred to as the “silent killer” because it can go unnoticed while causing significant damage to arteries, the heart, and other organs.
Normal range for lp(a):
Normal BP – BP <120/80 mmHg.
Elevated BP (previously referred to as prehypertension) – SBP between 120 and 129 mmHg with a DBP <80 mmHg.
- Stage 1 hypertension – BP between 130/80 to 139/89 mmHg.
- Stage 2 hypertension – BP ≥140/90 mmHg
Wrapping up
Why High-Density Lipoprotein Cholesterol (HDL-C) and Ratios Are No Longer Reliable Predictors of Cardiovascular Risk?
Despite being labeled “good cholesterol,” HDL-C is no longer a reliable target for cardiovascular risk reduction. Evidence shows no direct benefit from efforts to increase HDL-C levels, with studies failing to link treatment-induced HDL-C increases to improved outcomes.
Instead, low HDL-C should prompt a stronger focus on lowering LDL-C, which is a proven strategy for reducing cardiovascular events. Lifestyle changes like regular exercise, smoking cessation, and maintaining a healthy weight indirectly support cardiovascular health and may modestly improve HDL-C, but targeting it directly has no firm evidence of benefit.
Relying on cholesterol ratios, such as TG/HDL, can be misleading and, in some cases, dangerous. These ratios often give a false sense of security, especially when HDL-C is high but other key markers like ApoB, LDL-C, Lp(a), or triglycerides are also elevated.
The focus on ratios has become irrelevant since HDL-C has not been proven to be causally protective against cardiovascular disease. Absolute values of these markers provide a clearer and more actionable picture of cardiovascular risk, ensuring that patients at high risk are not overlooked due to seemingly favorable ratios.
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