Advanced Heart Disease Risk Blood Test

Cholesterol is an essential fat (lipid) in the body. Although it has a bad reputation it has some important functions, including building cell membranes and producing a number of essential hormones including testosterone and oestradiol. Cholesterol is manufactured in the liver and also comes from the food we eat. Although there are a number of different types of cholesterol, the two main components of total cholesterol are HDL (high density lipoprotein) which is protective against heart disease and LDL (low density lipoprotein) which, in high levels, can contribute to cardiovascular disease. Your total cholesterol result on its own is of limited value in understanding your risk of heart disease; high levels of HDL cholesterol can cause a raised total cholesterol result but may actually be protective against heart disease. Equally, you can have a normal total cholesterol level but have low levels of protective HDL cholesterol. The most important factors are how much HDL and LDL cholesterol you have, and what proportion of your total cholesterol is made up of protective HDL cholesterol. We give a detailed breakdown of the components of your total cholesterol in the rest of this cholesterol profile.

LDL cholesterol (low-density lipoprotein) is a molecule made of lipids and proteins which transports cholesterol, triglycerides and other fats to various tissues throughout the body. Too much LDL cholesterol, commonly called 'bad cholesterol', can cause fatty deposits to accumulate inside artery walls, potentially leading to atherosclerosis and heart disease.

Your total cholesterol is broken down into 2 main components; HDL (good) cholesterol and LDL (bad). There are more types of harmful cholesterol in your blood than just LDL - these include VLDL (very low-density lipoproteins) and other lipoproteins which are thought to be even more harmful than LDL cholesterol. Non-HDL cholesterol is calculated by subtracting your HDL cholesterol value from your total cholesterol. It therefore includes all the non-protective and potentially harmful cholesterol in your blood, not just LDL. As such, it is considered to be a better marker for cardiovascular risk than total cholesterol and LDL cholesterol. The recommended level of non-HDL cholesterol is below 4 mmol/L.

HDL cholesterol (high-density lipoprotein) is a molecule in the body which removes cholesterol from the bloodstream and transports it to the liver where it is broken down and removed from the body in bile. HDL cholesterol is commonly known as 'good cholesterol'.

The cholesterol/HDL ratio is calculated by dividing your total cholesterol value by your HDL cholesterol level. It is used as a measure of cardiovascular risk because it gives a good insight into the proportion of your total cholesterol which is good (i.e. high-density lipoprotein HDL). Heart disease risk tools (such as QRisk) use the cholesterol/HDL ratio to calculate your risk of having a heart attack.

Triglycerides are a type of fat (lipid) that circulate in the blood. After you eat, your body converts excess calories (whether from fat or carbohydrates) into triglycerides which are then transported to cells to be stored as fat. Your body then releases triglycerides when required for energy.

Apolipoprotein A1, or ApoA1, is the main protein found in high-density lipoprotein (HDL) cholesterol. The higher your Apo1 result, the more HDL cholesterol particles you have. HDL cholesterol helps clear cholesterol from the blood by removing cholesterol from organs and tissues to be broken down by the liver. A low ApoA1 level, especially with a raised ApoB result, is associated with an increased risk of cardiovascular disease. ApoA1, alongside other risk factors, can help to build a picture of your overall cardiovascular risk and likelihood of heart attack and stroke in later years.

Apolipoprotein B, or ApoB, is the main protein found in lipoproteins such as low-density lipoprotein (LDL) cholesterol and ultra-low-density lipoproteins (chylomicrons). Each of these lipoproteins contains one ApoB particle. So, your ApoB levels can tell you the number of these lipoproteins in the blood, which is why ApoB is considered a better predictor of heart disease risk than LDL cholesterol measurements. ApoB plays a crucial role in transporting lipids (fats) around the body, but too much ApoB is linked to conditions like atherosclerosis, heart attacks, and strokes, which can affect your lifespan and your quality of life in later years.

Lipoprotein(a), or Lp(a), is a type of lipoprotein made by the liver. Lp(a) is very similar to LDL cholesterol but is more "sticky" as it also contains a protein called Apo(a). Lp(a) is thought to play an important role in the blood's clotting system, but raised levels are linked to a higher risk of cardiovascular disease, including heart attacks and strokes. Knowing your level can help stratify your risk. The amount of Lp(a) in your blood is determined by your genes and not affected by your age or sex.

The enzyme lipoprotein-associated phospholipase A2 (Lp-PLA2) plays a role in the inflammation of blood vessels, promoting the build up of plaque in the coronary arteries. Lp-PLA2 is a risk marker for cardiovascular disease and because it is produced in the plaque itself, Lp-PLA2 is thought to be more sensitive at assessing cardiovascular disease risk than traditional inflammatory markers, such as CRP.

C-Reactive Protein (CRP) is an inflammation marker used to assess whether there is inflammation in the body - it does not identify where the inflammation is located. High Sensitivity CRP (CRP-hs) is a test used to detect low-level inflammation thought to damage blood vessels which can lead to a heart attack or stroke. When you suffer a serious injury or infection you experience significant inflammation around the site of injury - such as the swelling around a twisted ankle. Any injury like this will cause your CRP-hs to rise.