Cleveland HeartLab offers inflammatory biomarker testing to help practitioners evaluate cardiovascular risk in patients. This group of tests covers a patient’s biomarker profile which may result from lifestyle concerns (F2-IsoPs) to the development of metabolic or cardiovascular disease (OxLDL, hsCRP, Urinary Microalbumin) and formation of vulnerable plaque and increased risk for an adverse event (Lp-PLA2, MPO).
Our inflammation testing includes the following tests:
MPO is a white blood cell-derived inflammatory enzyme and measures disease activity from the luminal aspect of the arterial wall.
Briefly, when the artery wall is damaged, or inflamed, MPO is released by invading macrophages where it accumulates. MPO mediates the vascular inflammation that propagates plaque formation and activates protease cascades that are linked to plaque vulnerability. White blood cell activation in the bloodstream, in response to luminal injury of the artery wall including fissures, erosions or a degrading collagen cap, leads to MPO release in the bloodstream. This combination of detrimental effects demonstrates that MPO is actively involved in the progression of atherosclerosis. The Cleveland HeartLab MPO test measures free MPO in the bloodstream.
The MPO test may be performed on individuals at intermediate or high risk for developing coronary heart disease who are any age with at least two major risk factors, those ≥65 years of age with one major risk factor, smokers, those with a fasting blood glucose of ≥100 mg/dL, or those who have metabolic syndrome.
Lp-PLA2 (The PLAC® Test)
Lp-PLA2, or lipoprotein-associated phospholipase-A2, measures disease activity within the artery wall below the collagen or calcified cap due to the activation of macrophages. Lp-PLA2 is not an acute phase reactant. When disease is active in the artery, increased levels of Lp-PLA2 are produced by macrophages and foam cells within the intima of the artery. Lp-PLA2 also interacts with oxidized LDL, which increases inflammation and enhances a proatherogenic state, as well as plaque vulnerability. Research suggests that it plays a direct role in the atherosclerotic disease process.
The Lp-PLA2 test may be performed on individuals at intermediate or high risk for developing coronary heart disease who are any age with at least two major risk factors, those ≥65 years of age with one major risk factor, smokers, those with a fasting blood glucose of ≥100 mg/dL, or who those have metabolic syndrome.
High-Sensitivity C-Reactive Protein (hsCRP)
The hsCRP test is a highly sensitive quantification of CRP, an acute-phase protein released into the blood by the liver during inflammation, which has been associated with the presence of heart disease.
The hsCRP test may be performed on individuals at intermediate risk (10-year risk of 10-20%) of developing CHD who are metabolically stable without inflammatory or infectious conditions.
Urinary Microalbumin/Creatinine Ratio (MACR)
Urinary microalbumin is the quantification of small amounts of albumin, a serum protein, in urine that can be used to identify microvascular endothelial dysfunction. The presence of small amounts of albumin in the urine may suggest the presence of systemic endothelial dysfunction – an early indicator of heart disease. This test is more sensitive than a standard dipstick test routinely performed in an office setting.
The urinary microalbumin/creatinine ratio may be performed on individuals with type 1 or type 2 diabetes, hypertension, a family history of chronic kidney disease, those at intermediate (10-20%) risk for cardiovascular disease or those with known vascular disease.
Oxidized LDL (OxLDL)
OxLDL measures protein damage due to the oxidative modification of the ApoB subunit on LDL cholesterol. The oxidation of LDL cholesterol is one of the first steps in the development of atherosclerosis. Briefly, LDL-C enters the artery wall where it becomes oxidized. OxLDL is then recognized by scavenger receptors on macrophages which engulf OxLDL, resulting in foam cell formation, vascular inflammation and the initiation of atherosclerosis.
The OxLDL test may be performed on individuals at risk of metabolic syndrome.
F2-Isoprostanes/Creatinine Ratio (F2-IsoPs)
F2-IsoPs are prostaglandin-like compounds formed from the free radical-mediated oxidation of arachidonic acid, and are the ‘gold standard’ for measuring oxidative stress in the body. F2-IsoPs also have potent biological effects associated with inflammation and therefore may mediate chronic disease initiation and progression. Additionally, F2-IsoPs may also act as potent vasoconstrictors via thromboxane formation in the endothelium, and promote platelet activation resulting in thrombus formation.
The F2-IsoPs test may be performed on individuals at risk of future cardiovascular disease due to lifestyle risks, or those with a family history of cardiovascular disease.