Specialized Tests for Cardiovascular Disease Risks:
More of the New Beginnings Difference.

By Patricia Deckert, D.O.

It’s so very important that you Services-SpecializedTestsSknow your potential risks of cardiovascular disease (CVD). Following are perhaps the most important markers that can only be assessed by certain specialized tests. These tests are not found in most medical practices, yet they guide us to suggest necessary changes in lifestyle and/or to prescribe certain medication.

Needed by everyone;
rarely provided.



This test reflects cardiac muscle stretch. Factors that put stress on the heart muscle include age, high blood pressure and atherosclerosis.

I refer to this as my “happy heart” test. It can give us a good sign that a patient’s blood pressure is under good control and that there hasn’t been damage to the heart muscle by silent ischemia (lack of blood flow).


This is one of my favorite tests as it represents vascular-specific inflammation. It is well accepted that the presence of plaque in the arteries is not as important as when that plaque is inflamed. Inflamed plaque puts the patient at risk of plaque rupture. Finding LpPLa2 elevated would make us want to more aggressively treat cardiovascular risk factors. It may also lead us to doing a carotid ultrasound to assess the presence of plaque in the arteries leading to the brain, and to measure the thickness of the artery walls (see CIMT).

Myleoproxidase (MPO)

MPO is an enzyme that defends the artery wall from invading pathogens. When plaque accumulates it can become thick enough that the middle of it can undergo necrosis (die off) and be invaded by leukocytes (white blood cells that protect the body from infection and disease). If this happens, it triggers the release of MPO. Where LpPLa2 represents inflammation in plaque, MPO represents plaque at greater risk of rupturing.

MDVIP chose this test as the best marker of cardiovascular risk and requires all MDVIP patients to take it.

ApoE Genotype

This is a genetic test to identify the genotype of ApoE. ApoE is a class of apo lipoprotein produced by the liver. It is the primary binding protein for LDL (bad cholesterol) receptors in the liver, where it mediates cholesterol metabolism.

We all carry two of the three ApoE genes that can be inherited. The three genes are ApoE 2, 3 or 4.

To have two “3” genes is the most common and has the lowest cardiovascular risk. People with the “2” or “4” gene have somewhat increased risk. These genes have somewhat opposite effects and guide us into different diet suggestions where the “2s” typically do better with a low carbohydrate diet and the “4s” need to watch carbohydrates and fats. ApoE 4 has the most risk associated with it and has even been implicated with increased risk of dementia.

MTHFR Genetic Marker

This is another genetic test. The gene is involved with how the body is able to utilize folic acid.

Folic acid is involved in multiple reactions in the body and is one of the nutrients that donate a “methyl” group in a process known as methylation. Most toxins and even hormones have to go through this process to be effectively eliminated. Having a genetic single nucleotide polymorphism (SNP) here affects our ability to eliminate things that need to be eliminated.

Almost everything including cancer, cardiovascular risk, memory concerns, mood issues etc. that affects our health as we age is influenced by this mutation but can be easily treated with activated (methylated) forms of folic acid and other nutrients.


Homocysteine is an intermediate and toxic by-product in the metabolism of methionine from protein. When it builds up it is an indication that the body’s methylation process isn’t happening as effectively as it should.

Methylation is the process whereby a methyl group is added to a molecule – in this case folate and vitamin B12 – to turn it into the active form used in a particular metabolic pathway. When this process is compromised and homocysteine builds up, the lining of the arteries can be damaged. This raises the risk of platelets clumping and causing a blood clot.

People with an MTHFR SNP are more at risk of homocysteine buildup. Taking the activated (methylated) form of folic acid and vitamin B12 in supplement form can help to lower it.


This is the most atherogenic of all the particles that carry bad cholesterol. This particle is inherited and has nothing to do with diet or lifestyle. Also, statin drugs that lower cholesterol do nothing to lower Lp(a) numbers. It is like an LDL particle with Velcro. It likes to stick to and invade the artery wall. When this particle is present it is even more important to lower treatable risk factors such as LDL.

ContactUsButton3about the specialized CVD tests that provide peace of mind or the knowledge required to take action.