Posted by - J. Rand Baggesen, M.D.

Heart disease and stroke account for half the deaths in America. While elevated cholesterol is a risk factor for heart disease, 80% of people with heart disease have the same cholesterol as those who don’t. Vascular disease, the underlying cause of heart attack and stroke, is a complicated mix of inherited genetic-environmental interactions. Factors such as diet, exercise and smoking all play a role in combination with inherited risk traits. It is therefore important to understand the latest laboratory analysis which can identify individuals at risk early in life and implement treatment strategies known to reduce the impact of these inherited traits. So, for those of you who at your checkup receive a total cholesterol, LDL, HDL and triglyceride level with your blood work; read on if you would like to understand what else is necessary to identify your risk before it becomes your disease.

Cholesterol is carried in our bloodstream bound to proteins. Understanding these proteins, and their genetic differences, is the first step in understanding your inherited cardiovascular risk. LDL or low density lipoprotein, is the protein particle responsible for cholesterol buildup in the arterial wall. There are seven types of LDL particles. Smaller, denser LDL particles are more likely to cause cholesterol plaques. There are currently three cholesterol blood tests that measure the size and number of LDL particles in your blood. The AtheroTech VAP, LipoScience NMR and Berkeley Heart Lab advanced cholesterol blood tests all provide, in a slightly different way, insight into the lipoprotein particles of your genetic heritage. Small dense LDL is associated with high triglycerides, low HDL levels and high fasting insulin levels; all risk factors for an elevated inflammatory state predisposing an individual to vascular disease.

HDL, or high density lipoprotein is the particle responsible in our bodies for reverse cholesterol transport. Reverse cholesterol transport is the process of removing cholesterol from the vessel wall back to the liver for metabolism. There are five subclasses of HDL some of which are more cardioprotective than others. Pfizer is currently in phase 3 of a clinical trial investigating whether a medicine which raises HDL levels can reverse the process of vascular disease in our bodies. It is important to understand what your personal genetic HDL pattern is and how it impacts your risk of vascular disease.

Lipoprotein (a) or Lp(a) is a lipoprotein that resembles LDL but has an abnormal protein termed (a) attached. Approximately 30% of people with cardiovascular disease have elevated Lp(a). Your concentration of Lp(a) is genetically determined. Lp(a) is one of the best predictors of heart attacks in young men, blockage of vein grafts following bypass surgery and blockages of the carotid arteries of the neck. Lp(a) resembles another natural protein in our bodies called plasminogen. Plasminogen aids the body in the breakdown of blood clots. By virtue of its resemblance, Lp(a) can interfere with the body’s normal blood clot dissolving mechanism.

Apo E is another genetically determined protein that covers LDL particles. There are three common forms of Apo E, E2-E3-E4. E3 is considered the neutral form. There are some studies suggesting E2 may be somewhat cardioprotective. The E4 iso-type is associated with higher rates of vascular and Alzheimer’s disease. In fact it is believed that over 50% of the genetic predisposition to Alzheimer’s disease is related to your Apo E protein subclass.

Heart disease and stroke are the #1 killers in America, heart disease is often linked to disorders not detected by routine blood tests. Family history is important to understand your risk of inheriting these genetic influences of heart disease. Proper treatment must be customized to your genetic risk factors. With proper treatment disease progression can be halted and some regression is possible. Treatment can reduce heart attack, stroke and the decrease in quality-of-life they cause.

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