Advanced Cardiovascular Risk Panel
This test is used to assess the risk of cardiovascular disease.
The following diagnostic tests are included:
- Total Cholesterol - Main contributor to cardiovascular disease.
- HDL and LDL Cholesterol - Differentiation between high-density (HDL) and low-density (LDL) cholesterol, often referred to as 'good' and 'bad' cholesterol, respectively.
- Cholesterol/HDL Ratio
- LDL/HDL Risk Index
- Triglycerides - Measurement of circulating fat content
- Basic Blood Panel
- Hs-CRP (high sensitivity C-Reactive Protein) - Assess underlying inflammation and predicts cardiovascular risk in asymptomatic individuals
- Lipoprotein(a)
- Apolipoprotein A1
- Apolipoprotein A2
- Apolipoprotein B
Cholesterol
Cholesterol plays a vital role in the human body, contributing to the formation of tissues and organs and the synthesis of specific hormones and bile acids. A small proportion of cholesterol circulates in the blood as fat particles called lipoproteins.
The recommended level of total cholesterol is 5.0 mmol/L or lower, indicating no increased risk of cardiovascular disease.
Levels between 5.0 and 6.5 mmol/L suggest a moderately elevated risk, while levels above 6.5 mmol/L are associated with a significantly increased cardiovascular risk.
A detailed lipid profile and supplementary tests may be used to identify the underlying causes of elevated cholesterol.
HDL en LDL Cholesterol
Cholesterol is synthesized in the liver. Approximately 70–80% of LDL cholesterol is absorbed by the liver, adrenal glands, and gonads (testes and ovaries). The remaining LDL in circulation may be absorbed by vascular cells, potentially leading to fatty deposits in the arterial walls.
LDL cholesterol, often referred to as “bad cholesterol,” is associated with an increased risk of myocardial infarction.
HDL cholesterol facilitates the reverse transport of excess cholesterol from tissues back to the liver, where it is processed and excreted via bile. HDL is therefore considered “good cholesterol,” as higher levels are associated with a reduced incidence of cardiovascular disease.
Beyond lipid transport, HDL plays additional roles in inflammation, immune response, and other physiological processes.
Cholesterol Ratio
A commonly used guideline is the 3-4-5 rule:
LDL cholesterol < 3.0 mmol/L
Cholesterol/HDL ratio < 4.0 (calculated by dividing total cholesterol by HDL cholesterol)
Total cholesterol < 5.0 mmol/L
Maintaining these targets is associated with a reduced cardiovascular risk profile.
Triglycerides
This test measures the concentration of triglycerides in the blood. Triglycerides represent the body's primary fat storage and are predominantly found in adipose tissue.
Postprandial (after meal) triglyceride levels are elevated due to fat transport from the gastrointestinal tract to fat storage sites.
For accurate measurement, triglyceride testing should be performed in a fasting state.
Hs-CRP (High-Sensitivity C-Reactive Protein)
The hs-CRP test is used to detect low-grade inflammation and to estimate the risk of cardiovascular events in otherwise healthy individuals.
Unlike standard CRP assays, the high-sensitivity variant can identify subtle inflammatory processes that are believed to play a role in atherosclerosis.
Recent studies have shown that hs-CRP, particularly when combined with total and HDL cholesterol levels, is a strong predictor of future coronary events.
Chronic, low-grade inflammation is increasingly recognized as a contributing factor in cardiovascular disease development.
Lipoprotein(a) [Lp(a)]
Lp(a) has emerged as an important genetically influenced risk factor for myocardial infarction.
Its levels are not affected by diet, lifestyle, or pharmacological interventions, making it a valuable long-term indicator, particularly in younger individuals.
Low levels of Lp(a) are observed in patients with liver disease or chronic alcohol use.
A concentration above 300 mg/L, even in the absence of other lipid abnormalities, doubles the risk of myocardial infarction.
When elevated LDL levels coexist, the risk may increase up to fivefold.
In cardiovascular risk assessment, Lp(a) should be evaluated alongside total cholesterol, LDL, HDL, and triglycerides.
Apolipoprotein A1
Apolipoprotein A1 (apo A1) is the principal protein component of HDL particles and plays a crucial role in lipid metabolism and reverse cholesterol transport.
Its functions include:
Facilitating reverse cholesterol transport (RCT)
Providing atheroprotective effects
Exhibiting anti-inflammatory properties
Elevated apo A1 levels are generally associated with a favorable cardiovascular profile.
Apolipoprotein A2
Apolipoprotein A2 (apo A2) is also primarily associated with HDL particles and contributes to lipid metabolism.
Its functions include:
Supporting cholesterol transport
Modulating lipoprotein lipase (LPL) activity, an enzyme essential for the breakdown of triglycerides and release of free fatty acids used for energy
Though its precise role is less well-defined than that of apo A1, apo A2 is also believed to contribute positively to lipid homeostasis.
Apolipoprotein B
Apolipoprotein B (apo B) is the main protein component of LDL and VLDL particles and plays a central role in the development of atherosclerosis.
Its presence is strongly associated with increased cardiovascular risk.
Key features of apo B:
Crucial for cholesterol and triglyceride transport via LDL and VLDL
Involved in lipoprotein particle recognition and cellular uptake
High apo B levels, especially relative to apo A1 (the apo B/A1 ratio), correlate with an unfavorable lipid profile
Measurement of apo B is a valuable tool in comprehensive cardiovascular risk evaluation.
