Cardiovascular disease diagnosis with laboratory tests

Early diagnosis saves fatal end Cardiovascular diseases on the trackThe tables of the Federal Statistical Office speak a clear language. Half of the ten most frequent causes of death are diseases of the cardiovascular system. This list is headed by chronic ischemic heart disease, i.e. the long-term circulatory disorder of the heart muscle, directly followed by heart attack. Heart failure, heart disease as a result of high blood prere, and atrial fibrillation and flutter are the other three diseases in this top 10 list. In Germany, about 340 people die each year.000 or just under 40 percent of all people suffer from the consequences of vascular diseases.

Last revised April 2020

Contents

How cardiovascular diseases can be detected in the laboratory?

The classic risk factors are: Smoking, lack of exercise, unbalanced diet, obesity and diabetes. If the risks are identified in good time, it is possible to make positive changes to behavior that poses a risk to health and often prevent the onset or progression of the disease. A drop of blood is often enough for the doctor to recognize these risks.

Health check-up

For early detection, the statutory health insurance funds offer comprehensive health examinations. Between the ages of 18 and 34, insured persons can undergo a one-time health check-up. From the age of 35. After their 60th birthday, all people with health insurance are entitled to a health check-up every three years. Every person with health insurance should take advantage of this screening offer, because it also specifically looks for early stages of cardiovascular and kidney diseases as well as diabetes mellitus. In addition to the physical examination, laboratory tests of the blood for lipid metabolism profile and glucose and of the urine for protein, glucose, nitrite and red and white blood cells are performed.

Further examinations

In addition to these standard examinations, there are further laboratory tests that can be used to detect possible functional disorders of the heart or blood vessels at an early stage. They do not belong to the preventive services of the statutory health insurances. Are therefore not financed by them. However, if there is a well-founded suspicion of illness, the health insurance company will also pay for such additional laboratory tests.

Risks for heart and circulation

These life-threatening diseases are caused or at least promoted by arteriosclerosis, a hardening of the blood vessel walls, commonly known as vascular calcification. It develops over years from injuries to the innermost arterial wall layer and ultimately causes the deposition of calcium-like substances in the vessel walls, the so-called plaques.

Dangerous deposits

Plaques not only restrict blood flow. If the deposits continue to grow, the artery may be completely blocked. If they detach from the body's arteries and clog coronary vessels, a heart attack is imminent. If they paralyze the blood flow through the large neck arteries to the head, the affected person suffers a stroke.

Inflammatory markers reveal risk

Inflammatory processes are behind all phases of arteriosclerosis. Measuring inflammatory markers, which are detectable in the blood long before acute problems, therefore helps to identify high-risk patients.

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Fatty foods increase the risk of deposits in the blood vessels.

Obesity and lack of exercise put a strain on the heart and circulatory system.

Just one cigarette a day increases risk of heart attack and stroke.

Precautionary tests for heart attack risk

In myocardial infarction, the heart muscle is irreversibly damaged by lack of oxygen due to occlusion of one or more coronary arteries. Today, the risk of suffering a heart attack within ten years can be determined according to the PROCAM score approximate. This risk calculation was developed on the basis of the Prospective Cardiovascular Munster Study, an observational study by the University of Munster on the development of heart attacks.

Calculate heart attack risk with laboratory values

For this purpose, it is necessary to determine the upper blood prere value as well as the blood sugar and the blood lipids LDL cholesterol, HDL cholesterol and triglycerides. Furthermore, age, gender, smoking habits, cases of infarction of close relatives as well as existing diabetes are included in the calculation. However, surveying these factors by no means captures all high-risk individuals. Two-thirds of all heart attacks occur in people who have only a low or medium risk of heart attack. In order to identify such individuals, laboratory medical research has developed additional tests to.

Without fats and sugar it does not work

Among the laboratory tests used to assess the risk of heart attack, blood lipids and blood glucose are the most important.

Vital in moderation

The best known blood fat is cholesterol. It occurs mainly as LDL cholesterol (low density lipoprotein) and HDL cholesterol (high density lipoprotein). We cannot live without cholesterol. It is an important component of cell membranes. If you have too much LDL cholesterol in your blood, it can be deposited in the walls of your blood vessels; they "calcify", resulting in arteriosclerosis. In contrast to the LDL, the HDL can release the cholesterol from the vessels again and return it to the liver.

Unhealthy in high concentration

In addition to cholesterol, there are also the neutral fats, the triglycerides. If their concentration in the blood exceeds normal values, this can represent a further risk of vascular calcification. Elevated triglycerides primarily affect people with diabetes, obesity, gout, and hypertension.

Important precursors

Because cholesterol and triglycerides are not soluble in water, they are surrounded by solubilizers in the blood. Among other things, proteins known as apolipoproteins are used for this purpose. The most important are the apolipoproteins A-I and B. Apolipoprotein A-I is part of HDL and thus represents a protective factor. Low levels indicate high risk. Apolipoprotein B is found in LDL. The ratio of apolipoprotein B to apolipoprotein A-I has a special informative value. If it is high, the risk of coronary artery calcification is also high. Lipoprotein (a) is a complex of LDL and apolipoprotein (a). Lp(a) is an independent risk factor for atherosclerosis, and its danger seems to increase in people who already have coronary heart disease. The determination of Lp(a) is particularly useful for people with coronary heart disease. Since it is hardly possible to lower Lp(a) by diet or medication, the other risk factors (LDL cholesterol, high blood prere) must be well controlled.

Diabetes increases risk of cardiovascular disease

Measurement of blood glucose is also essential, as diabetes carries one of the highest risks for arteriosclerosis and heart attack. In diabetic men it increases the risk about twofold, in diabetic women even threefold.

Homocysteine and vitamin deficiency

Homocysteine is a sulfur-containing amino acid. Under normal conditions, it is rapidly degraded or metabolized in the body and thus rendered harmless. An increase in homocysteine is associated with a significant increase in the risk of heart attack. If it is elevated, the other risk factors that can be influenced must be addressed particularly intensively. In addition, a high homocysteine level can indicate a clinically significant deficiency of folic acid and B vitamins very early on.

Atherosclerosis: inflammatory markers for diagnosis

Since atherosclerosis is associated with inflammation in the vascular system, even slight elevations of the inflammatory marker C-reactive protein (CRP) can indicate an increased risk of heart attacks. When C-reactive protein is measured in the blood using particularly sensitive detection methods, it is referred to as "highly sensitive" hs-CRP. The inflammations often occur many years before the onset of truly life-threatening vascular changes. Therefore, they can be detected with the hs-CRP at an early stage of the disease.C-reactive protein (CRP) is a non-specific marker for inflammatory processes, so it can also be elevated when inflammation is not in the vessel wall but in other organs.

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Screening tests for heart failure

Typical symptoms of cardiac insufficiency – in medical terms, the decreasing pumping capacity is referred to as insufficiency – are decreasing physical resilience, shortness of breath, fatigue and a feeling of weakness, as well as water retention, so-called edema, which usually occurs in the lower legs. If the heart is stretched more than normal, the heart muscle releases so-called "natriuretic peptides". They have the task of relieving the heart muscle by increasing salt and water excretion and by dilating the vessels. Measurement of these peptides, essentially BNP (brain natriuretic peptide) or NT-pro-BNP (a stable fragment of BNP), in the blood provides early indications of dysfunction, such as can occur as a result of reduced blood flow to the heart muscle in coronary artery disease. Elevated values should always be clarified by a heart specialist.

Laboratory diagnostics at a glance

Tests atherosclerosis, heart attack and stroke risk:
LDL/ HDL / Lp(a) / hs CRP / Lp-PLA2 / Apo A-I / Apo B / Triglycerides

Heart failure risk test
Natriuretic peptides

These laboratory tests are only paid for by the statutory health insurance if there is a concrete suspicion of disease. Health-conscious people who want to be on the safe side have to finance these tests themselves. The physician must explain this before the examination, point out the costs and conclude a written treatment contract.

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