By Brian Vonk, M.D.
You may have gotten to a point in your life where you're asking, "Where is my health going and why am I in this handbasket?" Or you may be saying, "I feel fine and want to make sure I stay that way."
The fact is, the majority of Americans older than 40 years already have a major health problem. Another disconcerting fact is that the majority of illnesses are subclinical, meaning they smolder under the surface for many years before they are recognized. Whatever your condition, sickness or apparent health, accurately assessing your current health is the proper place to start on your journey to vibrant health.
Since cardiovascular health is key to health in general -- and the lack of it is so common -- it is where I'd like to begin a health review. Heart disease is the #1 killer of Americans, followed, in order of prevalence, by cancer, stroke, emphysema, and accidents.
But every 34 seconds an American dies of heart disease!
Consequently, we all know someone with heart disease, or we have it ourselves. If you're interested in avoiding or ending personal experience with this disease, I have good news for you: the majority of the causes of cardiovascular disease are in our control.
The first and foundational step in gaining or maintaining cardiovascular health is accurately measuring your current condition. Once that is clearly understood, an effective treatment or preventative plan can be made. In this article, we'll review the most important factors indicating cardiovascular health or disease. Collect the information and grade yourself.Blood Analysis
Most of us have had our blood drawn to determine our cholesterol level. That number alone, however, is actually quite useless.
There is a huge amount of misinformation about cholesterol, leaving most people thinking it is the grinch who steals youthful vitality. The truth is cholesterol is vital for health and we'd all be dead without it.
We get disease if cholesterol is too high or too low. But in the broad range of cholesterol levels from 180 to 240 there is no correlation with heart disease. Below 180 there is increased risk of hemorrhagic stroke, depression, and suicide. Above 240 there is increased risk of cardiovascular disease and ischemic stroke. Over age 70, elevated cholesterol and cardiovascular events no longer correlate. All told, total serum cholesterol alone is a poor indicator of cardiovascular disease. Half of all heart attack patients have normal total cholesterol levels.
So why are doctors recommending statin drugs for cholesterol levels above 200?
Ask the pharmaceutical companies who sponsor the drug studies and also help determine what normal cholesterol levels are. The upper limit of normal total cholesterol recently went down from 220 to 200, creating "disease" in additional millions of Americans. How convenient that the drug companies just so happen to have the "cure" for that disease!
I want to help you avoid that treatment trap. In fairness, compared to many drugs, most of the statin drugs are some of the safer drugs you might take and actually have the beneficial effects of being powerful antioxidant and anti-inflammatory agents. These beneficial features are likely the reason studies show decreased cardiac deaths when they are used.
Nevertheless, the statin drugs' potential side effects are significant. In some they deplete coenzyme Q 10 within the liver enough to cause liver enzyme elevations and within the muscles to cause myopathy. Also, and this is not published to my knowledge, but in my and several of my physician colleagues' experiences, statins cause depression or loss of motivation in the majority of patients, probably due to alteration of cholesterol metabolism in the brain. As a result, many of these patients are also on SSRI (selective serotonin reuptake inhibitor) drugs (eg Zoloft, Paxil, Prosac).
What is it worth to you to avoid depression and loss of motivation?
There are far safer ways to decrease cardiac deaths and treat abnormal cholesterol levels without risking drug side effects. Depite this, you would be astounded how many patients would rather take a pill with potential severe side effects than consider changing anything else.
As noted above, total serum cholesterol doesn't correlate with cardiovascular disease in the range of 180 to 240 but certain fractions of that total cholesterol do correlate. These fractions are HDL and LDL cholesterol. This is why you need a Lipid Profile (also called a Lipid Panel) and not just a total cholesterol when you get your blood drawn.
I have compiled two tables below listing the components of cholesterol (ie the Lipid Profile) as well as listing several other markers for cardiovascular health and disease. The first table has the usually quoted normal levels and the second table has ideal levels. Normal levels can change depending upon the levels found in the majority of the population as well as upon what health officials decide is normal. Ideal levels are those which reflect health. We want the ideal levels for optimal wellness not just normal.
All of the markers listed in the tables are important. For example, you can have normal HDL/Chol ratio, normal homocysteine, normal fasting glucose, but have ferritin outside the ideal range and have cardiovascular disease as a result. It only takes one rascal to spill the beans.
Cardiovascular Disease Markers:
These are the declared "normal" levels that your doctor will use to tell you whether your various serum/blood levels are "normal" (NOTE: These levels do NOT necessarily mean healthy levels, rather these will include healthy and many very unhealthy patients):
|Total Cholesterol (mg/dL)||Normal range = It changes with age but quite accurate: |
= Upper level is 230 + age, Max 300
= Lower level is 115 + age
Recommended cholesterol level is a moving target. Recently cardiologists are recommending everyones level should be below 200 at all ages.
|HDL Cholesterol (mg/dL)||Normal range = Males 30-70, Females 35-80|
|LDL Cholesterol (mg/dL)||Normal range = 60-150 below age 20 |
= 70-180 age 30-50
= 80-210 above age 50
|Normal range = It changes with age but quite accurate: = Males upper level is 130 + age, Max 200 |
= Females lowerlevel is 80 + age, Max 165
= Males/Females lower level is your age
Normal range = Below 10 mg/L (1 mg/dL)
Normal range = Below 17 micromoles/L
Lipoprotein a (Lp a)
|Normal range = Below 25 mg/dL|
|Normal range = Males 20-300, Females 15-120 ng/ml |
Iron overload = Above 400 ng/ml
|Normal range = Males 180-340, Females 190-420 mg/dL|
Blood glucose(8hr fast)
Normal = <120 mg/dL Borderline DM = 120-140 mg/dL
Insulin (8 hr fasting)
|Normal = Below 20 microUnits/ml |
Borderline DM = 21-25 microUnits/ml
Diabetic = Above 25 microUnits/ml
|Hemoglobin A1C||Normal range = Below 7.5% of total hemoglobin|
The following serum levels are the most IDEAL (ie. beneficial) levels for cardiovascular (CV) health. Having any ONE of these outside the ideal range can cause or indicate CV disease! These ideal or healthy levels are much tighter than the often quoted "normal" levels referred to by your doctor. Remember "normal" does NOT necessarily mean "healthy". We want healthy, not just normal:
|Total Cholesterol* |
|Ideal Range = 180 to 200 mg/dL if less than age 70 |
Ideal Range = Up to 300 if older than age 70
|Ideal level = Above 50 mg/dL|
|Ideal level = Below 100 mg/dL|
HDL % or Ratios
|Ideal levels = See table below|
|Ideal level = Below 100 mg/dL|
|Ideal level = Below 1 mg/L (0.1 mg/dL)|
|Ideal level = Below 8.0 micromoles/L|
|Ideal level = Below 10 mg/dL|
|Ideal range = 20-50 ng/ml (Above 80 is trouble)|
|Ideal range = 150-300 mg/dL|
Blood glucose(8hr fast)
|Ideal range = 60-85 mg/dL |
Pre-diabetic = 95-110 mg/dL
Diabetic = Above 110 mg/dL
Hypoglycemic = Below 60 mg/dL
Critical levels = Below 40 or Above 450 mg/dL
Insulin (8 hr fasting)
|Good level = Below 5 microUnits/ml |
Best level = 2-3 microUnits/ml
High risk Diabetes= Above 10 microUnits/ml
|Hemoglobin A1C***||Ideal range = Below 6% of total hemoglobin|
* Cholesterol: It is not advisable to have total cholesterol below 150 at any age due to increased risk for internal hemorrhage, depression, and suicide.
Note: A mneumonic to help you remember that LDL is the "BAD" cholesterol: LDL = Low Down Loathsome cholesterol.
** Lp(a): LDL + APO(a) = Lp(a). Artery blockage (plaque) is composed of 90-100% Lp(a) NOT of ordinary cholesterol. Lp(a) is a substitute for ascorbate (Vitamin C). If you are not getting enough Vitamin C to produce collagen for tissue repair, when your arteries become injured they cannot heal properly. If there is inadequate Vitamin C, the next best way to repair your arterial injuries is make a Lp(a) plaque to cover the injury. Unfortunately the plaques tend to continue to grow. Simply removing plaque without restoring the artery to health is like tearing a scab off a wound. You do not want to remove the scab until after the tissue underneath has started healing. Your body needs sufficient Vitamin C so your arteries can heal. Elevated homocysteine can also play a role here and is detrimental because it causes the binding of Lp(a) to fibrin in very low concentrations thereby encouraging plaque formation in the vessel walls.
*** HbA1C (also called glycosylated hemoglobin) correlates well with your average blood sugar over the last 3 months. Tight blood sugar control makes a HUGE difference in complications in diabetics and prediabetics. When A1C levels are elevated above 6.5, for every 1 percent reduction in A1C levels there is a 14 percent to 40 percent decrease in diabetes-related complications! Diabetics with A1C levels of 6.5 or lower only need to have the test repeated every six months. Those with higher levels should be tested every two to three months until levels drop to 6.5 or lower, while they make corrections with improved diet and additional diabetes medication. Most diabetics have the disease for 10 years before it is diagnosed, but it has silently been doing damage for all those years.
|Cholesterol Cardiac Risk Factors|
|Cholesterol/HDL Ratio (ie Total Cholesterol divided by HDL):|
|Cardiac Risk||Ratio in Males||Ratio in Females|
|High risk (3X):||9.7 to 23.4 ||7.2 to 11.0|
|Above average risk (2X):||5.1 to 9.6||4.5 to 7.1|
|Average risk:||3.5 to 5.0||3.4 to 4.4|
|Below average risk (1/2):||1.0 to 3.4||1.0 to 3.3|
|HDL Percentage: HDL/Cholesterol X 100 (ie HDL divided by Total Chol X 100):|
|Cardiac Risk||HDL in Males||HDL in Females|
|High risk (3X):||Below 10%||Below 14%|
|Above average risk (2X):||10 to 19%||14 to 22%|
|Average risk:||24% (Range 20 to 29)||26% (Range 23 to 30)|
|Below average risk (1/2):||Above 29%||Above 30%|
|LDL/HDL Risk Ratio (ie LDL divided by HDL) Male or Female:|
|Cardiac Risk||Ratio in Males||Ratio in Females|
|High risk (3X):||6.4 to 8.0||5.1 to 6.1|
|Above average risk (2X):||3.7 to 6.3||3.3 to 5.0|
|Average risk:||1.1 to 3.6||1.6 to 3.2|
|Below average risk (1/2):||Below 1.1||Below 1.6|
Besides obtaining blood work, your doctor has other tests he can order to determine your cardiovascular state including resting EKG, treadmill stress test, CT coronary calcium scoring, echocardiogram, nuclear medicine scans, and coronary angiography. These are useful if you have known or suspected disease; however, as you advance from non-invasive to invasive studies there are increased risks for the tests themselves. There is a one in one thousand chance of dying from a coronary angiogram. This is an average. In your doctor's hands you may have a much lower risk but it also could be much higher. These tests must be used wisely.
You obviously need to go to a doctor if you want to get the appropriate blood work and the other procedures listed above. But there are "low tech" and yet very useful evaluations you can do on your own which also help determine your cardiovascular risk.
The "low-tech" cardiovascular evaluations
Summary: We have reviewed several of the most important indicators of cardiovascular health and disease. As Goethe aptly stated, what one knows, one sees. You now have a knowledge of cardiovascular health and disease that few others have. You are equipped to see what most will overlook.
If you passed most or all of these tests in flying colors, congratulations, your risk of cardiovascular disease is very low.
If you underperformed on many of these tests, now is the time to do something about it. As long as there is life, there is hope. You will find instructions on what to do about abnormal cardiovascular tests in past and future articles here on the website, but the most basic intervention always is maximizing our daily nutrition.