Matters of the Heart — Part 2 of 3

A deep dive into cardiovascular health — Evaluating Your Risk

Before we get started today, I’m excited to share that I have a new website! I like to think of it as the hub where you can find everything I’m up to (my writing, radio show, upcoming events, etc.). You can find it at allisonmckeany.com!

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An imperfect plum that I chose to believe looks like a heart ;)

This is the second of three installments in my “Matters of the Heart” series. Part 1 introduced the basics of cardiovascular health. Today’s post is all about evaluating your current and future risk of cardiovascular disease.

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Evaluating Your Risk

Knowing where you stand on each of these objective markers of cardiovascular health can help you prioritize lifestyle changes, monitor if interventions are effective, and help guide discussions with your healthcare team about the need for any medical management of your risk¹.

1. Goal Blood Pressure (BP): <120/80 mmHg — Chronically elevated blood pressure damages blood vessels throughout your body (heart, brain, kidneys, eyes, etc.).

   1. Follow these tips to ensure you are getting an accurate blood pressure reading at home or in the doctor’s office.

2. Goal Resting Heart Rate (RHR): <80 bpm — A higher resting heart rate strains the heart muscle over time, increasing blood pressure and increasing risk of cardiovascular disease.

   1. Here is a step-by-step guide to measuring your resting heart rate.

3. Cholesterol is carried through the blood by lipoproteins (such as LDL and HDL). It is essential for building cell membranes and hormones, but elevated levels of certain types of lipoproteins can contribute to plaque buildup in arteries.

   1. While Total Cholesterol was initially thought to be a good marker for cardiovascular disease risk, we now know that different types of cholesterol provide a more nuanced assessment:

      1. Goal Fasting LDL-Cholesterol: <70 mg/dL²

      2. Goal Fasting Non-HDL-Cholesterol: <100 mg/dL³

      3. Goal Fasting HDL-Cholesterol: >60 mg/dL⁴

4. Goal Fasting Apolipoprotein B (ApoB): <40 mg/dL⁵ — ApoB is a protein found on all plaque-forming lipoproteins, providing a better indicator of cardiovascular disease risk than LDL-C alone.

5. Goal Lipoprotein(a) (Lp(a)): <50 nmol/L⁶ — Lp(a) is a genetically-determined type of LDL with an extra protein attached that is an independent risk factor for cardiovascular disease.

6. Goal Fasting Triglycerides (TG): <100 mg/dL — Elevated triglycerides contribute to plaque formation.

   

   Whiteboard at the end of my most recent Matters of the Heart presentation, trying to make sense of different lipoproteins and cholesterol. The decorations were a pleasant surprise when I arrived, and I thought it fitting to keep them up.

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7. Goal Fasting Blood Glucose (FBG): <90 mg/dL — Chronically high blood glucose (aka “blood sugar”) damages the lining of blood vessels, resulting in inflammation that supports plaque formation and accumulation.

8. Goal Hemoglobin A1c (HgA1c): <5.2 % — A marker of long-term (~3 months) blood sugar levels.

9. Goal Fasting Insulin: <5 µIU/mL — Released by the pancreas in response to rising blood sugar levels, high fasting insulin is an early marker of poor blood sugar management, even if blood sugar levels are at goal.

10. Goal Homocysteine (Hcy): <9-10 µmol/L (age dependent) — Elevated levels damage blood vessels and increase risk for plaque formation and blood clots.

11. Body Composition — Excess body fat, especially in the midsection (visceral fat), increases blood pressure, cholesterol, blood sugar, and inflammation.

    1. Although total body weight and Body Mass Index (BMI) reflect overall body weight, they do not account for the distribution of fat throughout the body.

    2. Assessment of visceral fat provides a more accurate indicator of cardiovascular disease risk:

       1. Goal Waist Circumference: Men <40”, Women <35”

          1. Use this guide to accurately measure your waist circumference at home.

       2. Goal Waist-to-Hip Ratio: Men <0.90, Women <0.85

          1. Here’s a handy ratio calculator.

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Navigating today’s medical system requires self-advocacy. Here are a few resources for you to share with your healthcare team if you encounter resistance to any of the above:

• American Heart Association Publication: Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice

• American Heart Association: Lp(a): A Toolkit for Healthcare Professionals

If that doesn’t do the trick, a second opinion may be called for. This is about your health, and finding a healthcare provider who is aligned with your goals is what matters most.

Thanks for being here,

~Allison

1. This information is meant to educate and inspire, but is not medical advice. Please speak with your healthcare team to determine what is best for you and your health.

2. Some basic biochemistry for those who are interested:

A lipoprotein is a package that carries fatty cholesterol in the blood (since water and fat don’t mix).

The most commonly discussed lipoproteins are Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL).

An important clarification: Even though most medical professionals refer to the numbers on typical lab tests as “LDL” and “HDL,” LDL more accurately measures the number of LDL packages. Standard lab tests report the amount of cholesterol inside the LDL package, which is more accurately referred to as LDL-Cholesterol (LDL-C).

The importance of this difference will become clearer as you read on to footnote #5.

3. LDL-C is not the only type of cholesterol that increases the risk of cardiovascular disease. Non-HDL-C better captures all harmful types of cholesterol and may be a better reflection of cardiovascular disease risk.

4. HDL-C may be associated with a lower risk of cardiovascular disease because it indicates cholesterol being carried away from arteries back to the liver.

5. ApoB is like an AirTag for how many dangerous cholesterol packages are circulating (vs. non-HDL-C, which is how much dangerous cholesterol is being carried). Since the more particles that are present = more chances to accumulate on artery walls, ApoB is a better direct risk marker of cardiovascular disease risk.

6. It is now recommended that every adult have Lp(a) levels checked at least once.