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Check your Risk Score for
Coronary Artery Disease
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Do
you know your number?
For
a random total cholesterol screen level you do not need to be fasting.
Cholesterol is a
necessary substance in your body from your first day of life. Experts
recommend a cholesterol level below 200 for good health. Between 200 and 239
is borderline and above 240 is dangerous. When associated with at least two
risk factors such as high blood pressure, diabetes, previous heart disease
or stroke, excess weight and being a smoker, it increases the incidence of
having coronary artery disease and heart attacks.
In the United States and Canada, the average adult's cholesterol level is
210-220. Elsewhere around the world it's about 150 and people get much less
coronary artery disease. It has become more of a threat to North Americans
than to most other populations because a major cause of increased
cholesterol is saturated fat, and other populations don't eat the amount of
saturated fat that we do.
Changing your diet is only one way of reducing your cholesterol level, but
it is an important one. Awareness of what your levels are is the first step
you must take.
According to the National Institute of Health, more than half of the people
in this country have cholesterol levels that put them into a moderate to
high risk of developing heart attacks. However, for each percentage drop in
cholesterol, the risk of having a heart attack drops by 2-3%.
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Lipid Profile
$ 68.00 |
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This
profile requires you to be fasting 12-14 hours. No appointment necessary.
Components of a Lipid Profile
Total Cholesterol
Cholesterol is a necessary
substance in your body from your first day of life. Experts recommend a
cholesterol level below 200 for good health. Between 200 and 239 is
borderline and above 240 is dangerous. When associated with at least two risk
factors such as high blood pressure, diabetes, previous heart disease or stroke,
excess weight and being a smoker, t increases the incidence of having coronary
artery disease and heart attacks.
HDL (Good
Cholesterol)
High density lipoproteins
(HDL) are proteins coated "packages" that carry fat and cholesterol through the
body. The function of HDL is to remove cholesterol from the blood by
transporting it to the liver where it will be prepared for excretion through the
bile. HDL has a protective effect on the deposit of fat in the wall of blood
vessels. Increasing its level in the blood will reduce the risk of
cardiovascular disease. The use of polyunsaturated, monounsaturated fats (Olive
Oil), and physical exercise may increase the level of HDL.
Triglycerides
Triglycerides are a type
of fatty substance which must be measured together with your cholesterol for a
complete picture of your circulating blood fats. Blood triglycerides tend
to be elevated in people who have high cholesterol levels, in people with
diabetes or chronic kidney disease, and in those who are obese. The
relationship between triglycerides and coronary artery disease is still
controversial. Some studies suggest that high blood triglycerides might increase
the risk of coronary artery disease. If your blood level of triglycerides is
elevated you should consult your doctor for dietary changes and weight loss and
exercise program or for the use of medication which may be necessary in
some cases.
LDL
(Bad Cholesterol)
Low density lipoproteins (LDL)
transport one half to two thirds of all blood cholesterol to various body
tissues. A certain amount of LDL cholesterol (up to 130) is normal. But when the
level increases, LDL promotes plaque development on the walls of the coronary
arteries, slowing the flow of blood and sometimes blocking the artery entirely.
Levels of 130-160 are considered borderline high and levels of 160 or higher are
definitely abnormal and should be reduced with rigorous diet, other lifestyle
changes, and/or with drug therapy.
Controversies are now surfacing on the danger of having LDL blood
levels which are too low. The relation to some type of cancers and other
diseases have been noticed with LDL levels reduced below 90 and closer to 50.
Therefore is unclear today how safe is to lower your LDL blood level. A safer
level seems to be between 90-130 and should be associated with an increase in
the HDL levels.
VLDL
(Very Low Density Lipoprotein)
VLDL (Very Low
Density Lipoprotein) is a fraction of Triglycerides circulating in your blood
stream. Not as important as the LDL, this blood fats follows the levels of your
Triglycerides.
Tryglycerides levels may be elevated either for the presence of high fats in
your food which when absorbed in your intestine is transformed as Chylomicrons
and give a milky appearance to the liquid part of your blood ( serum ) or for
the presence of Very Low Density Lipoproteins (VLDL) which is the part of
Triglycerides produced by your body and not ingested with food.
Cholesterol/HDL Ratio
The HDL in the blood is
believed to serve two functions: 1) it coats the inside
of the artery wall and provide a kind of protective layer of grease
to prevent fat deposits from building up and 2) it serves as scavenger by
actually helping dissolve fatty deposits when they occur. The basic rule of
balance for your blood is to have a relatively high amount of HDL in your body
in relation to your total amount of cholesterol. This is called the Cholesterol/HDL
Ratio.
The ratio in men should always be less than 5.0, and preferably less than
4.5. For women, the ratio should be lower and always under 4.0 and preferably
under 3.5. In other words the man's HDL should always represent at least 20% of
the total cholesterol count (and preferably should be 25% or
greater). For a woman the HDL cholesterol should make up at least
25% (or preferably 30%) of the total cholesterol. The Cholesterol/HDL
Ratio is probably the best predictor of future coronary disease. Active people
with low levels of body fat tend to show the best cholesterol balance (ratio) in
their blood.
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Cardiac
C-Reactive Protein
$65.00 |
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The High Sensitivity Cardiac C-Reactive Protein (CRP) test is an inflammatory
marker - a substance that the body releases in response to inflammation
and which has been found to be an indicator of heart health. High Sensitive
Cardiac C-reactive protein may also be used as a potential marker for
predicting coronary artery disease and stroke, which are closely associated
with inflammation of the blood vessels. A High Sensitivity CRP test is often
done along with a Lipid Profile (Blood Fats) to help predict a patient’s
risk of a hear attack. C-Reactive Protein (CRP) has been demonstrated also
to be a general indicator of major tissue damage. Hence, it can be used to
indicate a stroke or heart attack because major blood vessels leading to the
heart or brain are damaged and release large quantities of High Sensitivity
CRP during these disease states. CRP is a particularly useful indicator of
Coronary Artery Disease in women and in patients that demonstrate no other
plasma circulating biochemical indicators. CRP is not normally present in
the blood of a healthy patient. However, there are some conditions that can
cause small amounts of CRP to be found in the blood. These conditions
include diabetes, glucose intolerance and high blood pressure
(hypertension).
High Sensitivity Cardiac C-Reactive Protein (CRP) has been
shown to be predictive of future coronary heart disease (CHD) events in
several studies. Researchers have proposed that assessment of C-reactive
protein levels may provide a useful method to assess cardiovascular risk,
thus improving treatment decisions and, ultimately, patient outcomes. In
January 2003, the American Heart Association and the Centers for Disease
Control and Prevention (AHA/CDC) released a scientific statement regarding
clinical assessment of inflammatory markers including C-reactive protein.
This guideline concluded that there was evidence in favor of usefulness and
efficacy for testing C-reactive protein in patients with other Coronary Risk
Factors, but that mass population screening was unwarranted.
Inflammation plays a major role in coronary artery
disease, and measurement of inflammatory markers such as High-Sensitivity
C-Reactive Protein (HSCRP) may provide a novel method for detecting
individuals at high risk of plaque rupture. Several large-scale prospective
studies demonstrate that HSCRP is a strong independent predictor of future
myocardial infarction and stroke among apparently healthy men and women and
that the addition of HSCRP to standard lipid screening may improve global
risk prediction among those with high as well as low cholesterol levels.
Because agents such as aspirin and statins seem to attenuate inflammatory
risk, HSCRP may also have utility in targeting proven therapies for primary
prevention. Inexpensive commercial assays for HSCRP are now available; they
have shown variability and classification accuracy similar to that of
cholesterol screening. Risk prediction algorithms using a simple quintile
approach to HSCRP evaluation have been developed for outpatient use. Thus,
although limitations inherent to inflammatory screening remain, available
data suggest that HSCRP has the potential to play an important role as an
adjunct for global risk assessment in the primary prevention of
cardiovascular disease. (From the Center for Disease Control)
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Homocystein Level (Fasting
necessary)
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What is Homocystein?
Homocystein (say: "ho-mo-sist-een")
is an amino acid (a building block of protein) that is produced in the human
body.
Epidemiological studies have shown that
too much Homocystein in the blood (plasma) is related to a higher risk of
coronary heart disease, stroke and peripheral vascular disease.
Homocystein may irritate
blood vessels
and damage the inner lining of arteries and
promote blood clots,
leading to blockages in the arteries (called
atherosclerosis).
Why is a high Homocystein level harmful?
High Homocystein levels in
the blood can cause cholesterol to change to something called oxidized
low-density lipoprotein, which is more damaging to the arteries. In addition,
high Homocystein levels can make blood clot more easily than it should,
increasing the risk of blood vessel blockages. A blockage might cause you to
have a stroke or a problem with blood flow. Up to 20% of people with heart
disease have high Homocystein levels.
What causes a high Homocystein level?
Plasma Homocystein levels are strongly
influenced by diet, as well as by genetic factors. The dietary components with
the greatest effects are folic acid and vitamins B6 and B12. Folic acid and
other B vitamins help break down Homocystein in the body. Several studies have
found that higher blood levels of B vitamins are related, at least partly, to
lower concentrations of Homocystein. Other recent evidence shows that low blood
levels of folic acid are linked with a higher risk of fatal coronary heart
disease and stroke.
Homocystein is normally
changed into other amino acids for use by the body. If your Homocystein level is
too high, you may not have enough B vitamins to help this process. Or you may
not have enough of the chemicals (enzymes) to process Homocystein.
Most people with a high
Homocystein level don't get enough folate (also called folic acid), vitamin B6
or vitamin B12
in their diet. Replacing these vitamins helps return the Homocystein level to
normal. Other possible causes of a high Homocystein level include low levels of
thyroid hormone, kidney disease, psoriasis, some medicines, or inherited
deficiencies in the enzymes used to process Homocystein in the body.
Recent findings suggest that laboratory
testing for plasma Homocystein levels can improve the assessment of risk. It may
be particularly useful in patients with a personal or family history of
cardiovascular disease, but in whom the well-established risk factors (smoking,
high blood cholesterol, high blood pressure) do not exist.
How is the Homocystein level measured,
and what do the results mean?
Homocystein is measured
using a simple blood test. It can be measured at any time of day. It is not
necessary to prepare in any special way for the blood test (such as fasting).
Most hospital labs can measure Homocystein, or a blood sample can be sent out to
a special lab.
A healthy Homocystein
level is less than 12 µmol per L. A level greater than 12 µmol per L is
considered high. If your Homocystein level is 12 to 15 µmol per L and you have
blockages in any blood vessel, you need to lower your Homocystein to less than
12 µmol per L. If you have no other major risk factors for cardiovascular
disease and you do not have atherosclerosis, it may be okay for you to have a
modestly high level of Homocystein (12 to 15 µmol per L).
While no studies have
proved that lowering Homocystein levels ultimately helps reduce strokes, heart
attacks and other cardiovascular events, it is a good idea to lower a high
Homocystein level because it is a risk for heart disease.
How can I lower a high Homocystein
level?
Eating more fruits and
vegetables (especially leafy green vegetables) can help lower your Homocystein
level by increasing how much folate you get in your diet. Good sources of folate
include many breakfast cereals, lentils, chickpeas, asparagus, spinach and most
beans. Folate is sometimes called "folic acid."
If adjusting your diet is
not enough to lower your Homocystein, you will also need to take specific
vitamins. You may need to take a fairly large amount of folate (about 1
milligram per day). Additional vitamin B6
and vitamin B12 also help the body process Homocystein. Vitamin B
supplements generally have no side effects.
The usual recommended
vitamin and folate doses for lowering Homocystein levels are as follows:
- A daily
multivitamin containing 400 µg of folate and less than 5 mEq of iron
- An additional 800
µg of folate per day for 8 weeks
If taking these vitamins
doesn't lower your Homocystein level, your doctor may have you try a higher
dose. Or you may need to have some tests to see if you have a health condition
that causes high Homocystein levels.
What happens next?
It is important to get
your Homocystein level rechecked after you have been taking the multivitamin and
folate for 8 weeks. If your Homocystein level remains high, your doctor may
change your treatment. You may need to take more folate (2 mg per day). If you
have had a high Homocystein level, you will probably need to have your level
checked regularly - maybe 2 or 3 times a year.
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Blood Sugar Tests
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Random Blood Sugar (RBS) |
no fasting needed |
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Fasting Blood Sugar
(FBS) |
requires 12-14 hours fasting |
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Post-Prandial Blood Sugar (PPS) |
2 hours after you main meal. |
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Glucose Tolerance Test
(GTT) |
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These are not finger
prick testing and require a blood draw. Plasma testing is more
accurate.
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Blood Sugar (Glucose) is the primary energy source for all
body tissues. The sugars and carbohydrates you eat are ordinarily converted into
glucose, which can be either used to produce immediate energy or stored as
"Glycogen" in the liver or as fat throughout the body. Glycogen and fat thus
serve as sources of reserve energy. The body can also manufacture glucose from
fats and amino acids. Glucose can be measured in either the blood or the urine.
When you wish to have your blood tested, we recommend that you have fasted for
12-14 hours (fasting blood sugar, or FBS).
Another useful measurement of your blood sugar is two hours after your main
meal. (2-hour postprandial blood sugar, or 2-hour pp).
When neither a fast nor a special meal is observed prior to the test, it is
called a random blood sugar (RBS).
Urine normally contains very little or no sugar. A positive urine test for sugar
requires that you check your blood glucose. However, when the blood sugar level
is very high, as in diabetes, the ability of the kidney to keep sugar out of the
urine may be exceeded. The level of blood glucose at which glucose spills into
the urine is called the "renal threshold", and is usually between 160 and 180
milligrams per deciliter. Sugar that spills into the urine carries a large
volume of water with it, producing the two classic symptoms of diabetes:
excessive urination and thirst.
MILD ELEVATION of your blood sugar (120 to 150 mg/dl) may be caused by diabetes,
pregnancy, hypertension, hyperthyroidism, excessive pituitary function,
excessive adrenal function, obesity, thiazide diuretics, or a recent heavy meal.
MODERATE ELEVATION of your blood sugar (150 to 500 mg/dl) may be caused by
diabetes, recent anesthesia, carbon monoxide poisoning, infectious disease, or
disease of the central nervous system.
HIGH LEVELS of blood sugar are always associated with diabetes.
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Lipoprotein
(a) |
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Many
studies have demonstrated elevated levels of the lipoprotein Lp(a) in
patients who show evidence of coronary artery blockage. As the blood
Lp(a) level rises above normal, the odds ratio for progression of coronary
artery disease also rises, such that when the level is greater than or equal
to 30 mg/dL, the risk is more than doubled. Another study has related
Lp(a) levels to the Total cholesterol/HDL-cholesterol ratios (TC/HDL-C) such
that when Lp(a) is greater than 50 mg/dL and the plasma TC/HDL-C ratio is
greater than 5.8, the relative odds for CAD is 8.0-9.6
Elevated
Lp(a) is a strong independent risk factor for CHD. In the conventional
lipoprotein profile, Lp(a)-C is included in the LDL-C result, but because
Lp(a)-C comprises such a small fraction of the total serum cholesterol, even
marked elevations in Lp(a) are obscured by the more prevalent LDL-C. Thus,
those individuals at high risk because of an inherited elevated Lp(a) level,
with otherwise unremarkable levels in the other lipoproteins, would be
misclassified as low risk using the conventional lipoprotein profile. The
VAP cholesterol test provides a direct measure of Lp(a)-C.
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ELECTROLYTES |
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The
electrolyte panel is used to detect, evaluate, and
monitor electrolyte imbalances. It may be ordered as
part of a routine exam or to help evaluate a chronic or
acute illness. It may be ordered at intervals to help
monitor conditions, such as kidney disease and
hypertension, and to monitor the effectiveness of
treatment for known imbalances.
As part of routine health
screening, when your doctor suspects that you have an
excess or deficit of one of the electrolytes (usually
sodium or potassium), or if your doctor suspects an
acid-base imbalance.
Electrolytes are electrically charged minerals that are
found in body tissues and blood in the form of dissolved
salts. They help move nutrients into and wastes out of
the body’s cells, maintain a healthy water balance, and
help stabilize the body’s pH level. The electrolyte
panel measures the main electrolytes in the body: sodium
(Na+), potassium (K+), chloride (Cl-), and carbon
dioxide (total CO2).
The
Fluids & Electrolytes Panel includes:
Sodium - One of
the major salts in the body fluid; sodium is important
in the body's water balance and the electrical activity
of nerves and muscles.
Sodium is a mineral that is vital to normal body
function. It is an electrolyte, a positively charged
molecule that works with other electrolytes, such as
potassium, chloride and total carbon dioxide ( CO2), to
help regulate the amount of fluid in the body. Sodium is
present in all body fluids but is found in the highest
concentration in the blood and in the fluid outside of
the body’s cells. We get sodium in our diet, from table
salt (sodium chloride or NaCl), and to some degree from
most of the foods that we eat. Most people have an
adequate intake of sodium. The body uses what it
requires and the kidneys excrete the rest in the urine
to maintain sodium concentration within a very narrow
range. It does this by: producing hormones that can
increase (natriuretic peptides) or decrease (aldosterone)
sodium losses in urine, producing a hormone that
prevents water losses (antidiuretic hormone [ADH), and
controlling thirst. (Even a 1% increase in blood sodium
will make you thirsty and cause you to drink water,
returning your sodium level to normal.)
Abnormal blood sodium is usually due to some problem
with one of these systems. When the level of sodium in
the blood changes, the water content in your body also
changes. These changes can be associated with
dehydration or excess fluid (edema), especially in the
legs.
Chloride - Similar
to sodium, it helps to maintain the body's electrolyte
balance.
Chloride is an electrolyte, a
negatively charged molecule that works with other
electrolytes, such as potassium, sodium, and total
carbon dioxide (CO2), to
help regulate the amount of fluid in the body and
maintain the acid-base balance.
Chloride is present in all body fluids but is found in
the highest concentration in the blood and in the fluid
outside of the body’s cells. Most of the time, chloride
concentrations mirror those of sodium, increasing and
decreasing for the same reasons and in direct
relationship to sodium. When there is an acid-base
imbalance, however, blood chloride levels can change
independently of sodium levels as chloride acts as a
buffer. It helps to maintain electrical neutrality at
the cellular level by moving into or out of the cells as
needed.
Chloride is taken into the body through food and table
salt, which is made up of sodium and chloride molecules.
Most of the chloride is absorbed by the gastrointestinal
tract, and the excess is excreted in urine. The normal
blood level remains steady, with a slight drop after
meals (because the stomach produces acid after eating,
using chloride from blood).
Potassium - Helps to
control the nerves and muscles. Potassium is an
electrolyte, a positively charged molecule that works
with other electrolytes, to help regulate the amount of
fluid in the body, stimulate muscle contraction, and
maintain a stable acid-base balance. Potassium is
present in all body fluids, but most potassium is found
within your cells. Only about two percent is present in
fluids outside the cells and in the liquid part of the
blood (called serum or plasma). Because the blood
concentration of potassium is so small, minor changes
can have significant consequences. If potassium levels
go too low or too high, your health may be in
considerable danger: you are at risk for developing
shock, respiratory failure, or heart rhythm
disturbances. An abnormal concentration can alter the
function of neuromuscular tissue; for example, the heart
muscle may lose its ability to contract.
CO2
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The CO2 test measures the total amount of carbon dioxide
in the blood, mostly in the form of bicarbonate (HCO3-).
Bicarbonate is a negatively charged electrolyte that is
excreted and reabsorbed by the kidneys. It is used by
the body to help maintain the body’s acid-base balance
(pH) and secondarily to work with sodium, potassium, and
chloride to maintain electrical neutrality at the
cellular level. Since the CO2 test measures all three
forms of carbon dioxide in the blood (bicarbonate, H2CO3
[also known as carbonic acid], and dissolved CO2) as a
total CO2, it will give a rough estimate but not an
exact determination of the bicarbonate concentration.
When
CO2 levels are higher or lower than normal, it suggests
that your body is having trouble maintaining its
acid-base balance or that you have upset your
electrolyte balance, perhaps by losing or retaining
fluid. Both of these imbalances may be due to a wide
range of dysfunctions.
Some
drugs may increase blood carbon dioxide levels
including: fludrocortisone, barbiturates, bicarbonates,
hydrocortisone, loop diuretics, and steroids.
Calcium
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Blood calcium
is tested to screen for, diagnose, and monitor a range of conditions
relating to the bones, heart, nerves, kidneys, and teeth. Blood calcium
levels do not directly tell how much calcium is in the bones, but
rather, how much total calcium or ionized calcium is circulating in the
blood.
Calcium levels in the blood are regulated and stabilized by a
feedback loop that includes: calcium, Parathyroid Hormone (PTH) ,
Vitamin D, Phosphorus, and magnesium. All these elements need to be in
balance. Conditions and diseases that disrupt this feedback loop can
cause inappropriate elevations or decreases in calcium and lead to
symptoms of high (hyper) or low (hypo) blood calcium. For example, when
parathyroid hormone (PTH) from the parathyroid gland is released, PTH
level rises, calcium also rises, and phosphorus drops. In some kidney
problems, a high phosphorus level in blood can depress calcium levels.
Large fluctuations in free calcium can cause the heart to slow down or
to beat too rapidly, can cause muscles to go into spasm (tetany), and
can cause confusion or even coma.
Calcium can be used as a diagnostic test if you go to your doctor with
symptoms that suggest:
kidney
stones,
bone disease,
or
neurologic
(nerve-related) disorders.
Your doctor also
may order a calcium test if:
you have
kidney disease, because low calcium is especially common in those
with kidney failure;
you have
symptoms of too much calcium, such as fatigue, weakness, loss of
appetite, nausea, vomiting, constipation, abdominal pain, urinary
frequency, and increased thirst;
you have
symptoms of low calcium, such as cramps in your abdomen, muscle
cramps, or tingling fingers; or
you have
other diseases that can be associated with abnormal blood calcium,
such as thyroid disease, intestinal disease, cancer, or poor
nutrition.
Your doctor may
order an ionized calcium test if you have numbness around the mouth and
in the hands and feet and muscle spasms in the same areas, which are
symptoms of low levels of ionized calcium. If calcium levels fall
slowly, however, many people have no symptoms at all.
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