Three new blood tests can help identify hidden risk for a heart attack or stroke in seemingly healthy patients—before symptoms strike. The new tests, now available through Cleveland HeartLab (CHL), check levels of certain biomarkers that have been linked to cardiovascular danger in peer-reviewed studies.
Cardiovascular disease (CVD) is the leading killer of men and women, accounting for one in three U.S. deaths. In 2016, it claimed the lives of 2,200 Americans a day—one every 40 seconds, according to the American Heart Association (AHA).
“What’s especially tragic about these statistics is that heart attacks and strokes are potentially preventable,” says Amy Doneen, DNP, ARNP, medical director of the Heart Attack & Stroke Prevention Center in Spokane, Washington. “The key to saving lives—and hearts—is to identify which patients are at risk and develop a personalized prevention plan.”
Half of Heart Attacks and Strokes Occur in People with Normal Cholesterol
Traditionally, medical providers have checked patients for certain standard risk factors, such as high blood pressure, high cholesterol, and a family history of CVD. However, many heart attacks and strokes occur in people who lack these factors. For example, the AHA reports that about 50 percent of these events strike people with “normal” cholesterol levels.
For a more comprehensive assessment of cardiovascular health, Dr. Doneen now offers the new tests, which she uses in conjunction with inflammation testing and other CVD screening methods in her practice. “The new tests help us further fine-tune risk assessment and prevention strategies for our patients.”
Here is a closer look at the three blood tests–and why Dr. Doneen recommends them to her patients.
1. ADMA/SDMA biomarker test.
What it checks: Now available through Cleveland HeartLab (CHL) this blood test measures levels of symmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA).
Potential benefits: “As recently reported, elevated levels of ADMA/SDMA can indicate damage to the endothelium (the inner lining of blood vessels) and are also an independent predictor of heart attack risk,” says Dr. Doneen. When the endothelium is damaged, LDL (bad) cholesterol particles can invade the artery wall and clump into plaque, which could lead to a heart attack or stroke. Endothelial damage also raises risk for kidney failure.
The ADMA/SDMA test may reveal the underlying cause of high blood pressure and vascular inflammation. As a groundbreaking 2002 study demonstrated, high levels of ADMA/SMDA can be an early warning sign of insulin resistance, the root cause of both type 2 diabetes and about 70 percent of heart attacks, adds Dr. Doneen. The test may also identify people with pre-diabetes/undiagnosed diabetes, reduced kidney function, and early signs of CVD.
2. TMAO biomarker test.
What it checks: This test measures levels of trimethylamine-N-oxide (TMAO), a gut bacteria byproduct that contributes to heart disease risk. The liver produces TMAO after intestinal microbes digest certain nutrients in animal-derived food, such as L-carnitine (found in red meat) and lecithin (found in egg yolks, meats and full-fat dairy products).
Potential benefits: Elevated levels of TMAO predict future danger for heart attack, stroke, and early death in people not otherwise identified by traditional risk factors, according to Cleveland Clinic research published in the New England Journal of Medicine and Nature Medicine. In the studies, those with the highest TMAO levels had a 2.5 times higher risk for a cardiovascular event (such as a heart attack or stroke) over the next three years, compared to those with the lowest levels.
The researchers demonstrated that TMAO directly contributes to cholesterol buildup in the arteries, a discovery hailed by the American Heart Association as one of the top 10 advances in heart disease and stroke science in 2013. “These findings are exciting because they offer new insight into why eating meat and full-fat dairy foods triggers inflammation and arterial disease in some people,” says Dr. Doneen. An important benefit of the new TMAO test is that it can help medical providers individualize their dietary recommendations for patients.
What it checks: The OmegaCheck™ test measures the balance of omega-3 and omega-6 fatty acids in your blood. Omega-3 fatty acids are primarily obtained from food, such as oily fish, and have antioxidant and anti-inflammatory effects. They can also help reduce triglyceride levels. Omega-6 fatty acids are found mainly in animal-based foods and plant oils, and at high levels, contribute to inflammation and blood clots.
Potential benefits: It’s also important to know your ratio of omega-6 to omega-3, says Dr. Doneen. The typical American diet has a ratio of about 10:1, while a diet with a ratio of 4:1 or less may reduce risk for death from CVD or other causes by up to 70 percent over a two-year period, a study published in Lancet suggests.
Low levels of omega-3 fatty acids in the blood are linked to increased risk for CVD, high blood pressure, and elevated triglycerides, while consuming omega-3 fatty acids in food or supplement form helps reduce risk for major cardiac events (such as a heart attack or stroke) in both healthy people and those with CVD risk factors or the disease itself.
As we recently reported, a 2015 meta-analysis of data from 70 randomized clinical trials found that the omega-3 fatty acids EPA and DHA lower blood pressure as effectively as such lifestyle changes as increasing exercise, cutting down on salt, or limiting alcohol. The research was published in the American Journal of Hypertension.