4 markers of heart disease

Molecular biologists and cardiology researchers are always looking for new markers for heart disease. Below are four that have been shown to be among the potentially most significant.

At higher-than-normal levels, this amino acid — created when the body breaks down proteins in food, especially animal proteins — is related to a doubled risk of coronary heart disease.

The good news is that research suggests that you can reverse the risk if you take folic acid. But large trials are still needed to see whether such treatment would be safe in the long term. And questions remain.

Does a high level of homocysteine cause or contribute to heart disease, or does it simply indicate some other condition?

And, will lowering levels cut risk?

As homocysteine may damage artery linings and promote blood clotting, many specialists are searching for evidence that raised levels of homocysteine in the blood are associated with an increased risk of cardiovascular disease.

A variety of conditions can lead to raised homocysteine levels including folic acid deficiency — the body uses folic acid and vitamins B6 and B12 to break down homocysteine for use as energy. But eating a diet rich in vegetables, including asparagus, dried beans and peas, and leaf vegetables (eaten fresh or just lightly cooked to preserve their folic acid), such as spinach, and fresh fruit and orange juice will supply your body with the vitamin.

Are you at risk? 

Many experts believe that elevated levels of homocysteine are further evidence of the need to treat raised cholesterol levels and other risk factors. So if your cholesterol levels are high, you should ask your doctor about your homocysteine levels

Apolipoproteins, known as apo(a) and (b), play an important role in the production and transportation of cholesterol around the body. Each type bonds with cholesterol in the blood — apo(a) with "good" HDL molecules and apo(b) with "bad" LDLs. So you want more (a)s and fewer (b)s: high apo(b) levels are associated with increased heart disease risk.

Are you at risk? 

There's no widely used test for this emerging risk factor, but doctors are beginning to suspect that these fat-plus-protein particles may assist in predicting the risk of heart disease, particularly in women and in people with high triglycerides.

A renegade variation of LDL cholesterol, lp(a) — or lipoprotein(a) — is a combination of apo(a) and LDL.

These particles have cholesterol cores and are wrapped in a sticky protein coating that seems to promote blood clotting. Lp(a) also binds LDLs more easily to artery walls, prompting the formation of plaque.

High lp(a) is an important risk factor for early atherosclerosis. Over 10 years, it increases your heart risk by 70 per cent, and it can exist in people with otherwise normal cholesterol levels.

Are you at risk? 

Lp(a) seems to be genetic (it appears to be more common among people of Afro-Caribbean descent). In women, higher levels may be linked to higher body weight.

This tiny molecule is a big player in heart health: it keeps blood vessels relaxed, which maintains healthy blood pressure, and makes artery walls more like Teflon so that white blood cells and clot-producing platelets can't stick to them and so discourages atherosclerosis.

Nitric oxide also suppresses overgrowth of muscle cells in artery walls — which keeps blood vessels from thickening — and it helps cut production of free radicals.

Are you at risk? 

Your artery linings produce their own supply of nitric oxide. If the lining is not healthy, production drops. At present, there is no widely available test for nitric oxide levels, but you may well be producing less than you should if you are overweight, inactive, a smoker, or if you have high cholesterol levels.

Use this information about these four heart disease markers when you next see your doctor to help start a conversation about your heart health.