Description

This advanced test evaluates risk factors for cardiovascular disease (CVD) plus metabolic factors associated with metabolic syndrome and type II diabetes.  In addition to the traditional CVD risk factors, the test includes much more clinically sensitive atherogenic lipoprotein sub-species, the primary apolipoproteins, arterial inflammation and the activity of the lipoprotein- associated phospholipase- A2 (PLAC).  PLAC activity is a very sensitive indicator of active atherogenesis and instability of advanced arterial plaque.  Metabolic syndrome (MetS) is centered around insulin resistance and atherogenic dyslipoproteinemia, and is a risk factor associated with CVD and kidney disease. The test includes cystatin C to better assess glomerular filtration, and 1,5-anhydroglucitol (Glycomark®) that is a better indicator of hyperglycemic episodes than HbA1C.  The primary adipokines associated with insulin sensitivity and hepatic fatty acid metabolism are also addressed.

This test is useful for

• Family or personal history of CVD
• Excess abdominal fat
• Obesity
• Insulin resistance
• Fatty liver disease

Detailed Information

Cardiovascular disease (CVD) remains the second leading cause of death in North America. Metabolic syndrome (MetS) is a risk factor for CVD and renal damage. Therefor this comprehensive test evaluates risk for CVD plus too often associated MetS. Many of the risk factors and metabolic abnormalities associated with both CVD and MetS are lifestyle related. Objective advanced laboratory assessment of abnormalities in glucose, lipid and lipoprotein metabolism and adipokines facilitate individualized clinical intervention and can improve clinical outcomes. 
Cardiovascular Risk 
Well beyond the traditional levels of serum total lipids and lipoprotein cholesterol levels, this test assesses the levels of the most highly atherogenic apolipoprotein B containing lipoproteins. Formulas can used to calculate the levels of low density (LDL) and very low density VLDL) lipoprotein cholesterol, but when plasma triglycerides (TG) are high the calculated LDL and VLDL cholesterol values may be markedly underestimated. Assessment of non-HDL lipoprotein cholesterol levels, irrespective of TG levels provides accurate assessment of cholesterol transported in atherogenic LDL sub-species, VLDL, IDL and remnant particles. The levels of the real LDL culprits such as oxidized LDL, small dense LDL and lipoprotein(a) have much greater predictive power than LDL-cholesterol. The levels of the important protein constituents of anti-atherogenic HDL (apo AI) and atherogenic LDL species (apo B) are also reported. CVD is an inflammatory condition so artery-specific hsCRP levels are reported. The enzymatic activity of lipoprotein-associated phospholipase-A2 (PLAC^®) provides an indication of very significant atherogenic disease activity, inflammation and increased risk for rupture of advanced plaque. Elevated PLAC activity is a very strong predictor of coronary events and CVD-related mortality regardless of cholesterol levels. 
Metabolomics 
MetS with core features of insulin resistance, central adiposity and mixed dyslipidemia is associated with risk for CVD and kidney disease. Fasting glucose and insulin levels are augmented with a sensitive biomarker of hyperglycemic episodes that are missed using HbA1C. Low serum levels of the dietary glucose-like sugar 1,5-anhydroglucitol (1,5-AG, Glycomark^®) indicate daily hyperglycemic episodes over the past two weeks. Postprandial hyperglycemia is associated with cardiovascular disease and renal damage, and reduction of hyperglycemic events appears to decrease macro- and microvascular complications in diabetic patients. Cystain C is an excellent maker of glomerular filtration. As glomerular function declines, the serum levels of cystatin C rise. Cystatin C is an extracellular cysteine protease inhibitor that is produced by almost all cells. As such it is considered to be a better indicator of GFR than serum creatinine or calculated estimated GFR (eGFR).
Adipokines, hormones produced by fat cells, are regulators of insulin sensitivity, inflammation, oxidative stress and hepatic fatty acid oxidation and secretion of plasma triglycerides. With increased adiposity the level of adiponectin declines. Low levels of adiponectin are associated with marked increases in risk for developing metabolic syndrome, type II diabetes and coronary artery disease. In contrast levels of leptin increase due to leptin resistance that is associated with loss of appetite regulation (satiety). A high of leptin to adiponectin ratio (LAR) is associated with diminished anti-inflammatory, anti-atherogenic, anti-diabetic, anti-oxidative properties, and endothelial dysfunction. There is increased concern with respect to CVD when a high LAR is concomitant with elevated hsCRP (3-10 mg/L).