Your Comprehensive Guide to 11 Essential Annual Cardiac Markers


Good health is worth just about anything. One of the best things you can do for your health is to invest in an annual check-in with your heart.

The following markers serve to arm you with all the data you need to take care of your heart and health for years to come. Sadly, several of these tests below are never run by standard cardiologists. These are advanced, functional medicine markers. This means that they tell you the most in-depth information you can know about the status of your heart, what your risk of a cardiac event is and how well the heart is working.

This list is our prescription to you. It should also serve as an educational guide to allow you to discern just how important these tests are to both preventing and treating cardiac conditions. A majority of heart attacks and strokes occur due to plaque rupture from small, damaged cholesterol particles and inflammation. Heart failure is rooted in heart stress. These conditions can be identified early with these advanced markers.

A healthy heart is essential to a healthy life. Advanced blood chemistry analysis allows you to forecast years in advance where your health is going.

Below are the top 11 cardiac markers to check each and every year to ensure your heart is strong and healthy:

  1. Apo B: Apo A-1 ratio
    • What is the ApoB: ApoA-1 ratio?This is an advanced ratio looking at the makeup of blood lipids. ApoB and ApoA-1 are the two major apolipoproteins involved in atherosclerosis and heart disease. Ap B reflects the total number of atherogenic particles there are. The higher the ApoB, the greater the cardiovascular risk. Conversely, ApoA-1 is anti-atherogenic and reflects the HDL particle makeup and is considered cardioprotective.
    • Why is this marker important?LDL-C, HDL and TC should no longer be the primary markers used to evaluate cardiovascular risk. ApoB, ApoA-1 and the ApoB: Ap A-1 ratio are needed. Collectively, these markers provide great detail into the balance of atherogenic versus anti-atherogenic particle makeup. Research has shown that the apo ratio is better than conventional cholesterol testing for inferring true cardiovascular risk and addressing lipid treatment.
    • Optimal level of the ApoB: ApoA-1 ratio:An in-control range for the Apo ratio should be less than 0.59 mg/dL.
  2. HS-CRP
    • What is HS-CRP?HS-CRP, which stands for high-sensitivity CRP, looks for low levels of systemic inflammation in the body. It is a protein that is elevated when the blood vessels are inflamed.
    • Why is this marker important?This marker can be used to identify risk of heart disease and stroke in individuals who do not already have heart disease. A high level of HS-CRP, the marker of inflammation, may indicate an increased risk of heart attack, stroke, or sudden cardiac death.
    • Optimal level of HS-CRP:An in-control range for HS-CRP is less than 0.9 mg/L.
  3. MPO
    • What is MPO?MPO, which stands for myeloperoxidase, is an enzyme that is stored in immune cells and released during inflammatory processes. High levels of MPO indicate vascular inflammation, oxidative stress, nitric oxide depletion, increased oxidation of LDL cholesterol, and plaque instability.
    • Why is this marker important?Elevated levels of MPO are associated with the presence of coronary artery disease. High MPO levels also independently predict increased risk for major adverse cardiovascular events including a heart attack. It has also been observed that individuals with elevated MPO levels are 2x more likely to suffer cardiovascular mortality.
    • Optimal level of MPO:An in-control range of MPO is less than 599.9 pmol/L.
  4. PLAC
    • What is PLAC?PLAC measures the amount of lipoprotein-associated phospholipase 2 (Lp-PLA2) enzyme in your blood. This enzyme is made by a type of white blood cell known as macrophages. When “bad” cholesterol gets into your arteries, the body tries to eliminate it by making PLAC.
    • Why this marker is important:High levels of this marker in your blood indicates a high level of inflammation in your arteries. Arterial inflammation is also a signal that an imminent heart attack or stroke are more likely. It is the only test cleared by the FDA to detect heart attack and stroke. PLAC reveals the health of your arteries, if plaque is increasing, and if one is at risk for plaque rupture.
    • Optimal level of PLAC:An in-control range for the PLAC marker should be less than 224 nmol/min/mL. Ideally, the PLAC marker should be less than 200 nmol/min/mL.
  5. OxLDL
    • What is oxLDL?OxLDL, or oxidized LDL, is a type of low-density lipoprotein (known as LDL cholesterol) that has become damaged by a chemical reaction with harmful molecules known as free radicals. LDL oxidation is the first event that occurs in the formation of plaque in the arterial walls and is the basis of atherosclerosis.
    • Why is this marker important?Elevated oxLDL levels indicated an increased risk for cardiac events. This is because high levels of oxidized LDL are associated with depleted nitric oxide, increased calcium deposition in arteries, accelerated atherosclerosis, and increased inflammation.
    • Optimal level of oxLDL:An in-control range of oxLDL is less than 60.0 U/L.
  6. NT-ProBNP
    • What is NT-ProBNP?NT-ProBNP stands for NT-proB-Natriuretic Peptide (BNP). NT-PRoBNP is a non-active pro-hormone produced by your heart.  It is released in response to changes in pressure inside the heart. This marker indicates stress on the heart, and it is increased in heart failure and other cardiac conditions.
    • Why is this marker important?NT-ProBNP is a marker used to monitor heart failure. Levels increase when heart failure develops or worsens. Recent research has also linked elevated levels of NT-ProBNP to be associated with an increased risk for Atrial Fibrillation, cardiac conditions and stroke.
    • Optimal level of NT-ProBNP:
    • An in-control range for NT-ProBNP is less than 184 pg/mL. The lower number, the healthier the heart.

  7. sdLDL
    • What is sdLDL?SdLDL, otherwise known as small, dense LDL cholesterol, is one of the riskiest types to have. We know that it’s not the quantity of LDL in your blood but the quality that predicts cardiovascular risk. Small, dense LDL is the type of cholesterol that can lodge itself into your arteries, become oxidized and form unstable plaque.
    • Why is this marker important?SdLDL is highly atherogenic. Higher levels of sdDL are linked to an increased risk for atherosclerosis, cardiovascular disease, heart attack and stroke. Research has shown that patients with acute ischemic stroke who had elevated sdLDL levels had a 5.5 fold higher risk of dying during hospitalization than those who had normal sdLDL levels.
    • Optimal level of sdLDL:An in-control range of sdLDL is less than 0.50 mg/dL.
  8. Insulin
    • What is insulin?Insulin is a hormone produced by the pancreas that regulates the amount of glucose in the blood. While insulin is required for normal physiological functioning, too much insulin can harm the heart. There is a link between insulin and the cardiovascular system with effects seen on heart rate, heart contractility and blood vessel health.  High levels of insulin, a condition known as hyperinsulinemia, are most often caused by insulin resistance-  a condition in which your cells don’t respond to insulin. The pancreas compensates by increasing production of insulin, leading to higher than normal insulin levels.
    • Why is this marker important?Recent research has found that insulin can act on heart cells and block signaling that is required for proper contraction and pumping of blood. These same researchers have also linked high insulin levels to an increased risk of heart failure, as a result. This is one of the reasons why diabetics have a 2-5 time higher risk of heart failure than non-diabetics. Overall, high insulin levels inflames and injures heart cells.
    • Optimal level of insulin:An in-control range of insulin is 2.6-24.9 μU/mL.
  9. Ferritin
    • What is ferritin?Ferritin is a protein in the blood that stores iron. While it is the storage form of iron, it can also indicate other aspects of health. High levels of ferritin can occur when the body is inflamed.  Ferritin is an acute phase reactant for inflammation. High ferritin levels are an alarm bell for chronic disease and this condition is known as anemia of chronic disease.
    • Why is this marker important?Higher levels of ferritin are a risk factor for cardiovascular disease and are linked to increased inflammation and an increased risk for cardiac dysfunction. Science has shown that elevated ferritin levels independently increase the risk for new-onset heart failure in women. Research has also shown that high ferritin levels in men were linked to increased risk for cardiovascular mortality.
    • Optimal level of ferritin:The reference range for ferritin is between 13-150 ng/mL.
  10. Homocysteine
    • What is homocysteine?Homocysteine is a chemical released in the blood when methionine (another amino acid) is broken down in the body. Everyone has some homocysteine in the body. The risk arises when homocysteine levels become significantly elevated. Homocysteine is an atherogenic amino acid. Elevated levels of homocysteine in the blood have been implicated as key factors in the development of atherosclerosis and heart disease in the general population.
    • Why is this marker important?Research has shown that elevated levels of homocysteine in the blood are directly linked to increased atherosclerosis and risk of heart attacks and blood clots. Homocysteine acts like a toxin to the inner lining of the blood vessels causing irritation and a cascade of inflammation and oxidative stress.
    • Optimal level of homocysteine:An in-control range for homocysteine is less than 9 μmol/L.
  11. Cortisol
    • What is cortisol?Cortisol (known as the “fight or flight hormone”) is a steroid hormone produced in times of stress by the adrenal glands.  Excess cortisol has direct cardiovascular consequences. The major link between stress and cardiovascular disease is due to cortisol.
    • Why is this marker important?Studies have shown that chronic, high levels of cortisol results in increases in cholesterol, triglycerides, blood pressure and blood sugar. Chronic cortisol production can also accelerate plaque production in arteries. One study found that high levels of cortisol were associated with significant increases in death from cardiovascular disease years later. This association was seen in individuals with and without heart disease at the time of the study and suggested that high cortisol levels were extremely damaging to the cardiovascular system.
    • Optimal level of cortisol:An in-control range for cortisol in the morning is between 6.2-19.4 μg/dL. An in-control range for cortisol in the evening is between 2.3-11.9 μg/dL.

If you have a cardiovascular condition or are interested in preventing cardiovascular disease, it is worth getting these tests done annually. They also give you insight not only into your heart but your entire body and disease state. From these markers, we can also often infer advanced states of inflammation, physiological stress, toxin burden and even micronutrient deficiencies.  If you are interested in this test, consider talking to a health coach today. Or, feel free to purchase our advanced cardiac panel (which includes all these markers and more) here.


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