For all Americans that have a heart attack, the very first symptom will be either sudden death or a full heart attack and nearly half of first heart attack patients will die from that event. (

Heart disease, diabetes, and their respective processes often do their work in silence, without noticeable symptoms.

Until the disease progresses, and the symptoms get worse.

Some folks are “lucky” and experience only a “mild” heart attack or TIA, transient eschemic attack. Then there are the real lucky ones who have a doctor who believes in prevention and testing.

I’m big on testing rather than guessing.

Test results can be the wake-up call needed to take action.

In last week’s article I made the case that cholesterol is an important molecule for health and that lowering it at all costs is a prescription for disaster.

This week the focus is the other indicators. Most are easy to test for. They reveal more about the state of our cardiovascular health than cholesterol alone.

Two of the more important factors that contribute to heart disease, diabetes, and stroke are:

  • inflammation
  • insulin resistance

First, we’ll explore these two critical markers of health. Then you’ll learn what tests will give you a full picture of where you are on a scale of healthy to danger zone.

Inflammation is not always a bad thing — it’s one of your body’s natural defense mechanisms. Cut your finger and you want that response to send white blood cells to prevent infection and begin the healing process.

When inflammation is systemic — throughout the body — and chronic it will damage the heart and other organs in the body.

Dr. Stephen Sinatra, cardiologist and expert in what really causes heart disease says, “There are many causes of chronic inflammation, including infections, high blood sugar, being overweight, and having sticky blood. Any one of these situations literally feeds pro-inflammatory mediators, ratcheting up the chances that you’ll develop atherosclerosis.

Unlike a scraped knee, damage to your arteries is chronic, which creates a constant state of inflammation in your body. At that point, instead of preventing heart disease, inflammation causes heart disease.”

How do you know if you have elevated CRP? Enter test one on the list of tests to ask for: CRP or C-reactive protein.

Here’s what The Harvard Health Newsletter says about it:

“There are other ways to measure inflammation. But a study in the March 23, 2000, New England Journal of Medicine concluded that C-reactive protein was a better predictor of cardiovascular events (heart attacks, strokes, bypass surgery, or angioplasty) than other inflammatory markers.”

This same study put results into 4 categories;

  1. High CRP/Low LDL
  2. High CRP/High LDL
  3. Low CRP/High LDL
  4. Low CRP/Low LDL

Here’s Dr. Sinatra again:

“Most cardiologists would have expected that women with higher levels of LDL would have been at the highest risk for inflammation and heart disease. But in this study, not only was elevated CRP the best indicator of risk, women with high LDL and high CRP were also at high risk. This is because inflammation caused LDL cholesterol to oxidize and form into plaque which can clog your arteries.

In this study, elevated CRP was the strongest predictor of future cardiac events for postmenopausal women — and other research has shown that these same findings hold true for men.”

Ask your doc to include CRP in your next round of tests.

Insulin Resistance

You likely know that insulin is a hormone released by the pancreas in response to increased glucose levels — commonly after eating or drinking. Its job is to move glucose into cells to be converted to energy. Excess glucose gets stored by the liver so energy is available whenever we need it. (Or not used, in which case the muffin top rises,)

Insulin resistance, also known as impaired insulin sensitivity, is the result of more blood sugar than the hormone can shift into cells.

Tia Ghose writes, on “That’s a problem because insulin doesn’t just play a role in helping the body use blood sugar as fuel; it’s critical for many other bodily processes as well. Being insulin resistant can put people on the path towards developing Type 2 diabetes and is the single best predictor of who will develop diabetes 10 or 20 years down the line. Once someone is pre-diabetic or diabetic, the pancreas simply can’t produce enough insulin to make the cells sufficiently take up glucose and blood sugar levels rise. Insulin resistance also raises the risk of other disorders, such as heart disease.”

Who becomes insulin resistant?

One of the primary causes of insulin resistance is excess body fat but not everyone who is fat becomes insulin resistant and normal weight people can suffer from this condition.

The hypothesis of why this is so would take us away from the focus of this article so let’s look instead at a few side effects of this condition—more of the markers of trouble up ahead.

A1C levels, Fasting Blood Sugar and Triglycerides

A1C test is a blood test used to diagnose pre-diabetes and diabetes. It measures your average blood sugar levels over the past 3 months. If you click that link, you’ll see a table of what’s normal, pre-diabetic, and diabetic. Most annual blood screenings, for people over 50, will include it these days but if you aren’t familiar with this number ask to include it in your next round. It’s a highly accurate predictor of problems.

Why are we discussing blood sugar and diabetes in an article about preventing heart disease? Because diabetes guarantees heart problems, end of story.

And “Pre-diabetes is diabetes” says Jonny Bowden.

You can easily test your blood sugar at home, first thing in the morning, before consuming anything or exercising. Buy a simple blood sugar monitor, prick your finger tip, read the results.

Here is a chart from the CDC with blood level ranges

CDC - Road to Type 2 Diabetes


The Cleveland Clinic’s definition of triglycerides, “Triglycerides are a type of fat found in the blood. The blood level of this type of fat is most affected by the foods you eat (such as sugar, fat or alcohol) but can also be high due to being overweight, having thyroid or liver disease and genetic conditions. High levels of triglycerides are related to a higher risk of heart and blood vessel disease.”

This number is included when you have your lipid panel done.

Here’s a nifty little bit of math you can do once you have your lipid numbers.

According to Jonny Bowden and Dr. Stephen Sinatra in their book, The Great Cholesterol Myth, “The ratio of triglycerides to HDL is one of the best predictors of both heart disease and insulin resistance. People with high triglyceride to HDL ratio have a 16X greater risk of heart disease. That’s a 1600 % increase!”

To get your number: divide your triglyceride number — say, 100 — by the HDL — say, 50 — you get a ratio of 2. This is excellent. Anything lower is a bonus, higher, not such good news.

Are you exhausted yet?


Is there a simple way to put this all together?

Yes. Here are the tests to ask for.

Your standard lipid panel alone won’t cut it anymore. This panel includes 5 tests, Total Cholesterol, HDL, LDL, HDL/LDL ratio and triglycerides.

Conventional medicine would say that lipid particle testing–which tells you if you have good, bad, or super bad LDL and HDL particles—is only necessary for people with a family history of heart disease, diabetes, or are currently experiencing those. I think everyone who can, should get one.

I’m in the more information is better camp.

The test is a VAP test or vertical Auto Profile test. The site explains it this way, “Not only does this test include the basic cholesterol tests seen in the Lipid Panel, but it also gives a detailed report of individual lipoprotein subclasses and apolipoprotein subclasses. It identifies any cholesterol abnormalities that may be a precursor to heart disease or diabetes.”

Make sure you add CRP and A1C and you will have a comprehensive look at what’s going on inside your amazing body.

If you’ve had blood work but didn’t get a copy of the results, don’t assume all is well under the hood. Unless things are way out of range you might not hear back from your doctor. Prevention works best when it starts early. By the way, you have a right to have your test results on paper or electronically. If you aren’t offered, ask.

If you got results that you didn’t expect but don’t know what to do about it, or you know you have to shift some habits into the age better zone, I might be able to help.

We don’t get a crystal ball to peak into to see our future — and information alone won’t change anything — but we can access practical information about the future of our health by using the best of western medicine’s offerings.

You now have the big picture on cholesterol, statins, and women’s health. What you need are the recipes for reversing scary numbers and preventing them in the first place. All of that and more is coming your way in the weeks ahead.

Til then, be well,