The Heart Disease Marker Your Doctor Doesn’t Test

An increasing number of cardiologists are challenging the current theory of high cholesterol and heart disease. For example, in the words of cardiologist Stephen Sinatra: “One of my top missions has been to educate people on the true cause of heart disease, and it’s not cholesterol. Most doctors and cardiologists are still testing their patients’ cholesterol numbers and wearing out their prescription pads with orders for prescription-lowering statin drugs. Meanwhile the true cause of heart disease, inflammation, is still largely ignored.”

Dr. Sinatra rightly proclaims that the link between high levels of total cholesterol and heart disease is all theoretical and has never been proven. His theory is that focusing on traditional cholesterol levels is a scam designed to stuff the coffers of drug companies who sell cholesterol lowering drugs to the tune of billions of dollars annually!

This is a valid point since it has been well known in conventional medicine that cholesterol levels are a poor predictor of heart attacks and heart disease. Case in point, approximately 50% of people that have a heart attack do not have high cholesterol!

If your doctor is still evaluating your cardiovascular risk with an antiquated lipid panel that includes total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, then you should be concerned. You need to get a much better assessment, especially markers of inflammation which fuel the flames of artery damage and resulting plaque formation.

Now you may be thinking that LDL cholesterol is the villain when it comes to heart disease. Most labs have a normal reference for LDL to be less than 130 mg/dL (unless one has diabetes or existing heart disease the reference range is lower). A large study published in the American Heart Journal analyzed the data of more than 230,000 people hospitalized with coronary artery disease. Researchers found that about 50% of these people had LDL levels less than 100 mg/dL!

Now let’s look at some good science for heart disease risk. I want to tell you about one of the most important markers of inflammation. It is known as Lipoprotein-associated phospholipase A2, which is abbreviated Lp-PLA2. This is an enzyme that accumulates in artery plaque and is thought to play an important role in plaque formation and rupture. An increased value on a lab test is linked to initial and recurrent heart attacks, stroke, cardiovascular disease, and peripheral artery disease. Those with elevated Lp-PLA2 activity are twice as likely to experience a heart attack and coronary heart disease-related death at 5 years after Lp-PLA2 value is identified as elevated.

A 2015 article in the World Journal of Cardiology had this summary about this important cardiovascular marker: “…compelling evidence indicate that high Lp-PLA2 activity levels predict an increased risk of cardiovascular events in the general population, as well as in patients with metabolic syndrome, diabetes, and coronary heart disease.”

It is also a good marker to assess stroke risk. For example, people that have normal systolic blood pressure (pressure inside arteries when your heart pumps out blood) but high Lp-PLA2 are twice as likely to have a stroke. Those who have elevated systolic blood pressure and Lp-PLA2 levels are a whopping 7 times more likely to suffer a stroke!

Typical labs that doctors around the country use can test Lp-PLA2. I use this test with patients to detect if inflammation of plaque is occurring and their overall cardiovascular risk. You then can take proactive steps to halt and reverse this inflammation with holistic methods such as a Mediterranean diet, exercise, fish oil, omega 7 fatty acids, turmeric, or more intensive programs such as chelation therapy. As you incorporate these healthy regimens into your program you will find your Lp-PLA2 levels decreasing.



Dr. Stephen Sinatra. The Great Cholesterol Myth. Accessed January 21, 2017 at the-great-cholesterol-myth

Sachdeva A et al. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009 Jan;157(1):111-117.

Jenny NS, Solomon C, Cushman M, et al. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and risk of cardiovascular disease in older adults: Results from the Cardiovascular Health Study. Atherosclerosis. 2010;209:528-532.

Cushman M, Judd S, Kissela B, et al. Lipoproteinassociated phospholipase A2 (Lp-PLA2) activity and coronary heart disease risk in a biracial cohort: The reasons for geographic and racial differences in stroke (REGARDS) cohort [abstract EAS-0541]. Atherosclerosis. 2015; 241: e1-e31

Koenig W, Twardella D, Brenner H, et al. Lipoprotein-associated phospholipase A2 predicts future cardiovascular events in patients with coronary heart disease independently of traditional risk factors, markers of inflammation, renal function, and hemodynamic stress. Arterioscler Thromb Vasc Biol. 2006;26:1586-1593.

Giuseppe M et al. Lipoprotein-associated phospholipase A2 prognostic role in atherosclerotic complications. World J Cardiol. 2015 Oct 26; 7(10): 609–620.

Gorelick PB. Lipoprotein-associated phospholipase A2 and risk of stroke. Am J Cardiol. 2008; 101 (suppl): 34F-40F



Adapted with permission from Dr. Mark Stengler’s Health Revelations