Everyone knows that high cholesterol, high blood pressure, and diabetes are the big flashing signs that can predict heart disease risk. But why wait to get that sick before figuring out there is a risk? Inflammation is not as well-known but can be an even stronger predictor of your future risk.

Here’s one way to look at it. A heart attack occurs when bad, "corrupted," or oxidized cholesterol builds up a thick layer of plaque which then suddenly ruptures into the blood flow. Plaque does not rupture if it is not inflamed, and the problem is that most doctors don’t check. So wouldn’t it make sense to check for inflammation as well and not just high cholesterol when assessing your risk for heart disease?

There are many tests to assess inflammation and other conditions that can indicate a higher risk for heart disease or a cardiac event.

Early Warning Through Testing

Here is a list of different tests that can help you and your doctor better understand your risks:

Myeloperoxidase or MPO test: MPO is a biomarker for inflammation. Patients with elevated MPO levels are more than twice as likely to experience cardiovascular mortality.

Lipoprotein-associated phospholipase A2 activity or Lp-PLA2 test: The enzyme Lp-PLA2 is a biological marker for vascular inflammation. Greater Lp-PLA2 activity or mass is associated with an increased risk of coronary heart disease.

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Microalbumin test: Albumin is a protein. Microscopic amounts of it are called “microalbumin.” When it is found in the urine, it is a condition called microalbuminuria, which is strongly associated with an increased risk of cardiovascular disease.

High-sensitivity C-reactive protein or hs-CRP test: The Harvard Women’s Health Study found that women with high levels of hs-CRP were twice as likely as those with high LDL cholesterol to die from heart attack or stroke.

Complete Blood Count: The odds of a patient with a high leukocyte count having cardiovascular disease are 40% greater than a patient who does not have a high leukocyte count. High hematocrit levels and erythrocyte sedimentation rates are also associated with coronary heart disease.

Homocysteine test: Homocysteine may elevate blood pressure and oxidative and genotoxic stress, which can increase risk of cardiovascular disease.

Fibrinogen test: An increase in fibrinogen levels indicates a higher risk for coronary heart disease and stroke.

Thromboxane A2 or TXA2 test: Increased TXA may indicate atherosclerotic deposits or other vascular obstructions and thus an increased risk of an ischemic cardiovascular event.

These tests are available through most labs and are often covered by health insurance. But your doctor needs to be trained and familiar with their use, interpretation, and, most importantly, know-how to help you bring your numbers back into normal range.

While prescription drugs can stabilize plaque, prevent plaque rupture, lower blood pressure, and manage diabetes (which is another risk factor that can lead to heart attack), they are a secondary prevention measure. Lifestyle changes such as a low-fat, high-fiber diet, regular exercise, and stress management are all part of the primary prevention of heart disease or heart attack. Furthermore, they work BETTER than drugs to reach target goals. That means lifestyle measures should be taken first.

"Lifestyle changes such as a low-fat, high-fiber diet, regular exercise, and stress management are all part of the primary prevention of heart disease or heart attack."

Make a Change

Do not smoke, vape, dip, or chew tobacco. Nicotine in all forms is a driver of artery inflammation.

Eat a diet with minimal red meat—less than one serving per week. Include four or more servings of brightly colored vegetables with at least one fruit and one cup of beans or legumes daily. Avoid all fried and processed foods. The best evidence for dietary prevention comes from eating a Mediterranean diet. However, it is a good idea before you start a major diet change to take an Apolipoprotein E (APOE) test. This is a genetic test that gives a clear picture of how the body processes cholesterol. A haptoglobin (Hp) gene test is also recommended. Those with the Hp1-2 gene are three times more likely to have a cardiovascular event, and those with diabetes and the Hp 2-2 gene are five times more likely.

Exercise regularly. That means exercising five days per week for a minimum of 22 minutes per day. Include some high-intensity bursts of exercise.

Get enough sleep. It is recommended that adults get seven to eight hours of sleep every night. If you often feel tired even after getting seven to eight hours of sleep, you should be tested for sleep apnea.

Effectively manage stress. Often patients and practitioners can neglect assessing emotional, behavioral, and mental health. The National Institutes of Health recommend visiting a qualified mental healthcare provider, participating in a stress management program, practicing meditation, trying relaxation therapy, talking with friends and family, and connecting with community or religious support systems to help reduce your stress and your risk for a heart attack or angina.

Clean up your environment. The heart muscle is particularly susceptible to being poisoned by environmental toxins. Heavy metal toxicity may be considered in patients suffering from both atherosclerosis and heart failure. Doctors specially trained in environmental medicine can help eliminate metals with a comprehensive gut and systemic detoxification program.

Take good care of your mouth. There are certain types of invisible but stealthy bacteria that live in the mouth that can cause not only periodontal disease but can also generate atherosclerosis and trigger plaque rupture, which can directly elicit a stroke or heart attack. A simple saliva test can identify these bacteria before you have an event. Ask your dentist or dental hygienist if they have advanced programs to restore a healthy oral environment.

A Gift to the Heart

There also are many natural remedies and supplements you can take to help slow heart disease.

Coconut or sesame oil mouth rinses: The activity of using oils as a mouth rinse is sometimes called “oil pulling” and comes from an ancient Ayurvedic practice. The antibacterial and anti-fungal properties of the oils are thought to remove toxins in the mouth.

Fish oil: Deficiencies in omega-3 fatty acids have been linked to cardiovascular disease. Because of this, it is often recommended that patients increase their intake of these polyunsaturated fatty acids that are important to normal metabolism. It is possible to do a blood test to be sure you are on enough fish oil by measuring your omega-3 blood level.

B3 or niacin: Niacin can raise good cholesterol, called HDL, which helps remove plaque from the artery walls. But it is noted that too much niacin can have negative side effects. It should only be used under the direction of your healthcare practitioner.

CoQ10: A shortage of this antioxidant may lead to oxidative stress, which increases the risk for cardiovascular disease.

Vitamin D: Low levels of vitamin D have been linked to increased arterial stiffness and endothelial dysfunction as well as higher blood pressure and blood sugar, all of which can affect heart health.

D-ribose: As a simple sugar molecule, D-ribose may aid in the recovery of adenosine triphosphate (ATP) levels and diastolic function. This can make weak a heart muscle pump stronger.

Probiotics: These friendly bacteria support the development of regulatory T cells in the immune system, which can lower inflammation and the accumulation of cholesterol.

Finding medical and dental practitioners skilled in identifying inflammation and cardiovascular risk, getting the right tests, making the necessary lifestyle changes, and taking targeted supplements are the tools you need to succeed in reducing your risk for stroke, heart disease, or a cardiac event.