Cardiac Risk Assessment

Cholesterol is an essential component of all cells and a critical starting point for the production of many hormones.  Elevated levels of blood cholesterol have been associated with atherosclerosis, or “hardening of the arteries.”   This frequently occurs when the proportion of LDL to HDL (“bad” to “good” cholesterol) is HIGH.  The total cholesterol number is not as important as the amount of bad cholesterol, or LDL, or the proportion of total cholesterol to HDL.

HDL, or high-density lipoprotein is considered the “good” type of cholesterol, thought to be involved in “cleaning out” the arteries.   The higher the HDL, the lower risk of heart disease, generally.  HDL levels can be increased through dietary means, as well as with exercise, certain vitamins and medications.

LDL, or low-density lipoprotein is considered the “bad” type of cholesterol, thought to be involved in the “clogging” of arteries.  High levels of LDL are associated with atherosclerosis, especially when levels of HDL are low.

Cholesterol/HDL Risk Factor is the ratio of the total cholesterol number divided by the HDL value. This proportion is an excellent indicator of the risk of atherosclerosis, and generally should be 3.5 or less.  Levels below 3.5 may actually reverse and shrink prior plaque formation in the walls of arteries in the absence of other risk factors.

Triglycerides are another form of circulating fat in the bloodstream.  After a fatty meal, most dietary fats are absorbed from the stomach in the form of triglycerides. These fats are then filtered out of the bloodstream by the liver.   The liver also manufactures triglycerides, however.   Triglyceride levels ideally should be less than 100, and may be elevated as a result of dietary factors, family history factors, metabolic factors, and/or physical activity.

Your doctor may order you to have a blood test called, Lipid Profile

The lipid profile measures cholesterol triglycerides, HDL and LDL. Triglycerides are the major form of fat found in the body and their function is to provide energy for the cells. Below are the desirable ranges for the components of the lipid profile:

  • Cholesterol less than 200 mg/dL
  • HDL-cholesterol more than 40 mg/dL
  • LDL-cholesterol less than 100 mg/dL
  • Triglycerides less than 150 mg/dL

If any or all of your results are significantly outside these ranges, your risk of a cardiac event is increased. If they are only slightly outside the desirable level, diet, exercise, and/or medication may be sufficient to reduce the abnormal levels, thereby reducing your risk.


What other tests are used to assess cardiac risk?

Another test gaining importance is homocysteine. Homocysteine is an amino acid that comes from the normal breakdown of proteins in the body and appears to be a better test than cholesterol for predicting heart disease, stroke, and reduced blood flow to the hands and feet.  Homocysteine is a sulfur-containing amino acid that is normally present in very small amounts in all cells of the body.

Homocysteine is a product of methionine metabolism.  Methionine is one of the eleven “essential” amino acids – amino acids that must be derived from the diet since the body cannot produce them.  In healthy cells, homocysteine is quickly converted to other products. Levels between 5 and 15 micromoles per liter are considered normal.

Vitamins B6, B12, and folate are necessary to metabolize homocysteine.  People who are deficient in these vitamins may have increased levels of homocysteine.


1. Are some people more at risk for a heart attack than others? Yes.  Those who are overweight, smoke, have high blood pressure or diabetes, abnormal risk test results, and those with a family history of heart disease are at greater risk.

2. Are there home test kits for determining if I am at risk for a heart attack? No.  The diagnosis is based on the results of any or all of the tests mentioned.  The overall assessment requires special equipment and interpretation by a trained professional.

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