Why Testing Cholesterol Levels Isn’t Enough to Detect Cardiac Risk?

Almost every person I know has heard about keeping cholesterol levels under control to decrease the risk of heart attack, though most of them have no clue what exactly cholesterol levels have to do with heart attack. The reality is that cholesterol level is one of the factors indicating possible inflammation inside the artery walls. At some point of the inflammation process the plague raptures & forms a blood clot and this blood clot blocks the coronary artery & causes the heart attack. So the heart attack is not directly caused by the plague formed by cholesterol.

The inflammation disease inside artery walls is called atherosclerosis and this inflammation can be caused not only due to excess cholesterol in blood. For this reason, just because your cholesterol test results may show normal levels, it is no reason to assume that you are safe from the risk of having a heart attack.

During inflammation the levels of some substances rise in your bloodstream, one of which is cholesterol level. Unfortunately, there are substances that indicate the risk of inflammation that almost never get checked. However, some of these are available at affordable prices & are generally covered by most medical insurance plans. If you are concerned about your cardiac risk, request your doctor to have these tests performed; if you don’t request, they most likely won’t have them performed.


Some of the available tests include:

  • C-reactive Protein Test
  • Fibrinogen Test
  • Homocysteine Test
  • Fasting Insulin Test
  • Ferritin Test
  • Lipoprotein(a) Test
  • Calcium Heart Scan


C-reactive Protein Levels

C-reactive protein test one of the better tests available for indication of inflammation. Despite of the fact that high level of high-sensitivity C-reactive protein (hs-CRP) indicates inflammation in the body, it doesn’t necessarily mean that the inflammation is inside artery walls. Therefore other inflammations in the body need to be considered when looking at C-reactive protein levels. That said, many think that C-reactive protein test is the most accurate available indicator of high risk of heart attack today.


Fibrinogen Protein (AKA Factor I) Levels

Fibrinogen is a protein needed for blood to form a clot. When inflammation is present, the liver produces more Fibrinogen. Therefore, high level of Fibrinogen indicates inflammation.


Homocysteine Levels (tHcy)

Though nobody yet explained why, studies show that high level of serum total homocysteine indicated a risk of heart attack.



Fasting Insulin Test

Insulin resistant people are likely to be physically inactive and/or obese; the chances for developing metabolic syndrome are greater for such people. One way to detect whether you have metabolic syndrome or not is to pass fasting insulin test. Those with metabolic syndrome have greater risk of Type 2 Diabetes (AKA Adult-Onset Diabetes), glucose intolerance, coronary artery disease and stroke. Insulin is required for the body to deal with glucose, more precisely to move it from the blood to cells for later use for energy; insulin resistant people need more than normally required insulin to deal with blood glucose.


Ferritin Test

Ferritin is an iron-protein complex, high levels of which indicate inflammation(for women), low HDL cholesterol (in men) & generally a greater risk for heart disease. Increased levels of ferritin may also indicate liver disease & neoplasm. Waist measurement can be a predictor of elevated ferritin.



Lipoprotein(a) (Lp(a)) Levels

Those with high level of Lipoprotein(a) have higher risk of a clot formation on the raptured plague. Lp(a) promotes the blood clot formation & slows the breaking up of it. Checking Lipoprotein(a) level is especially recommended for those with  high or intermediate  cardiovascular disease / coronary heart disease risk.



Calcium Heart Scan

In this test a computer tomography scan is performed on the heart & nearby arteries in order to detect calcium deposits. There should be no calcium deposits in healthy arteries. Knowing the amount & the distribution of calcium will help estimate the stage of development or the chances of development of plague in coronary arteries. This test is expensive & most likely won’t be covered by most medical insurance plans.



This article is largely referenced by Julius Torelli’s (M.D., Board-Certified Cardiologist, Founder of Integrative Cardiology Center) book “Beyond Cholesterol” 2005.