Cardiovascular Disease Markers:
"Normal" levels
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
Triglycerides (mg/dL)
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
C-Reactive Protein(CRP)
Normal range = Below 10 mg/L (1 mg/dL)
Homocysteine
Normal range = Below 17 micromoles/L
Lipoprotein a (Lp a)
Normal range = Below 25 mg/dL
Ferritin
Normal range = Males 20-300, Females 15-120 ng/ml
Iron overload = Above 400 ng/ml
Fibrinogen
Normal range = Males 180-340, Females 190-420 mg/dL
Blood glucose(8hr fast)
Normal = <120 mg/dL Borderline DM = 120-140 mg/dL
Diabetic = Above 140 mg/dL (W.H.O. definition)
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:
"Ideal" levels
Total Cholesterol*
Ideal Range = 180 to 200 mg/dL if less than age 70
Ideal Range = Up to 300 if older than age 70
HDL Cholesterol
Ideal level = Above 50 mg/dL
LDL Cholesterol
Ideal level = Below 100 mg/dL
HDL % or Ratios
Ideal levels = See table below
Triglycerides(TG)
Ideal level = Below 100 mg/dL
C-Reactive Protein(CRP)
Ideal level = Below 1 mg/L (0.1 mg/dL)
Homocysteine
Ideal level = Below 8.0 micromoles/L
Lipoprotein(a)ieLp(a)**
Ideal level = Below 10 mg/dL
Ferritin
Ideal range = 20-50 ng/ml (Above 80 is trouble)
Fibrinogen
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
Smoking: The first evaluation is a simple question. Have you smoked in the past twenty years? The more you have smoked and the more recent the habit, the more detrimental its effect. Chewing tobacco is also injurious but not nearly as much as smoking.
Systolic blood pressure: This is the top number of your blood pressure reading. Above 140 mmHg the risk of cardiovascular disease rises as the blood pressure rises.
Ankle-Arm Index: This is also called Ankle-Brachial Index (ABI) and is the ratio of the ankle systolic blood pressure* divided by the arm systolic blood pressure. A normal index is 1.0 and below 0.9 indicates cardiovascular disease.
I mention this test because you may have heard of it, but be aware that it has limited value. The potential weakness of the test is that it tends to be falsely normal in people with calcifications in their arteries, people with diabetes, pre-diabetes, or those with Vitamin K deficiency. Millions of Americans are pre-diabetic or diabetic and most of them don't even know it. Also, recent studies indicate that significant Vitamin K deficiency is becoming common.
So, if the Ankle-Arm Index is normal you must exclude these causes of arterial calcification before you can assume the test is truly normal. If the test is abnormal, you have some degree of cardiovascular disease.
* Ankle pressure is taken with the cuff just above the ankle and the stethoscope listening just below the cuff on the inner side of the ankle immediately behind the ankle bone.
Resting Heart Rate: An elevated resting heart rate is a powerful indicator of cardiovascular disease in men (however studies have not shown the correlation in women). Healthy = Below 64 beats/min, Mild risk = 64 to 69 beats/min, Moderate risk = 70 to 75 beats/min, High risk = 76 to 80 beats/min, Above 80 beats/min the risk is three times normal.
Heart Rate Recovery: This test assesses how quickly your heart rate returns to normal after exercise and is quite useful in determining cardiovascular health. This requires that you can reach 85% of your maximum predicted heart rate (your maximum predicted heart rate is calculated as 220 minus your age). If you currently aren't accustomed to that degree of exercise, you should get an exercise program from your doctor or a fitness coach and build up to that level slowly. Once you are able to reach that heart rate, you stop the exercise and measure your heart rate 1 minute later. If the rate drops by 12 or less during that minute the test is abnormal and there is significant risk of cardiovascular disease.
Waist size: There are many cardiovascular risk formulas and ratios that use your waist measurement, but one of the simplest is also one of the most accurate:
Your waist size in inches should not be greater than one half your height in inches. The greater your abdominal girth relative to your height, the greater your risk of cardiovascular disease.
Insurance companies are good at making money because their actuaries are very knowledgeable in determining risks. Why do you think they insist on knowing your height and waist measurements as part of your insurance physical? Increased abdominal girth is a strong indicator of hyperinsulinemia, pre-diabetes, and diabetes and consequently a useful indicator of cardiovascular disease.
Summary: 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.
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