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Getting the right tests is a big part of preventing, assessing, managing, and even reversing cardiovascular disease. Conventional medical wisdom tends to look at traditional metrics like cholesterol and blood-pressure levels, age, gender, family history, and whether or not you’re a smoker.

Progressive-minded docs look at those variables as well, but they dig deep for other cardiovascular risk factors, including inflammation, imbalances in blood sugar and insulin, and oxidative stress, which affect things like cholesterol and blood pressure.

Looking to measure your overall cardiovascular disease (CVD) risk? Here are some tests to consider in partnership with your healthcare provider.

Advanced Lipid Tests: Unlike the standard lipid panel, advanced tests like the NMR Lipid Profile or the Cardio IQ Lipoprotein Fractionation look at the all-important particle size of LDL and HDL. “You should have less than 1,000 total LDL particles and no more than 400 small particles (although ideally you shouldn’t have any!),” notes Mark Hyman, MD, director of the Center for Functional Medicine at the Cleveland Clinic, in his new book, Eat Fat, Get Thin: Why the Fat We Eat Is the Key to Sustained Weight Loss and Vibrant Health.

High-Sensitivity C-Reactive Protein Test: This marker of inflammation is a big clue to your overall CVD risk. “When your inflammation is high for whatever reason — maybe it’s certain foods you eat, or gut dysbiosis, or the presence of pro-inflammatory visceral fat — it can cause the walls of our blood vessels to become leaky and inflamed as well, which makes it a lot easier for the tiny, dense LDL cholesterol particles to squeeze through the cracks and trigger the cycle of plaque buildup,” says functional-medicine internist Yousef Elyaman, MD, IFMCP, the founder and medical director of Absolute Health, a primary-care practice in Ocala, Fla.

Glucose and Insulin-Tolerance Test: Insulin resistance can cause elevated lipids and is associated with an increased risk of cardiovascular disease. “Your fasting sugar should be between 70 and 80 mg/dl and your one- and two-hour sugars should be less than 120 mg/dl,” Hyman notes.

Hemoglobin A1c Test: In order to identify CVD risks early, notes Hyman, it’s a good idea to do this test, which measures average blood sugar over the previous six weeks, as well as the above glucose- and insulin-tolerance testing. “Anything over 5.5 percent is high,” he notes.

Homocysteine, 25-Hydroxy Vitamin D, Vitamin B12 Tests: These tests measure levels of key heart-protective nutrients. “Your homocysteine measures your folate status and should be between 6 and 8 micromoles per liter,” Hyman states.

Oxidized LDL Test: This test measures the amount of oxidized LDL in the blood. When small, dense LDL particles become oxidized or rancid, they can trigger the process that leads to heart disease.

Lp-PLA2 Test: Both Elyaman and integrative cardiologist Mimi Guarneri, MD, FACC, a functional-medicine cardiologist in La Jolla, Calif., recommend this test, which measures an enzyme that contributes to inflammation and atherosclerosis.

Carotid Intima-Media Thickness (CIMT) Test: This high-resolution ultrasound test identifies plaque in the arteries in your neck, which is associated with cardiovascular-disease risk. “We want to know how inflamed your major vessels are and how much plaque you are creating, so we look at your carotid arteries, which highly correlate with what’s happening in the heart vessels,” says P. Michael Stone, MD, MS, a family physician who practices functional medicine in Ashland, Ore., and a faculty member at the Institute for Functional Medicine.

For more on new ways to prevent and treat heart disease, see “Rethinking Heart Health.”

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