The Blood Inflammation Tests You Need to Assess Your Heart Disease Risk

by Dr. Stephen Sinatra

Learn which tests check for toxic blood indicators of heart disease

As more and more research indicates, inflammation in the body is a silent-but-deadly problem that undermines arterial health. In fact, I’m a firm believer that inflammation is the core cause of heart disease. That’s why the blood tests I order for patients go way beyond the traditional blood work done by most cardiologists. To more accurately predict heart disease risk, I believe it is necessary to test blood for markers of inflammation, which include:

C-Reactive Protein (CRP)

C-reactive protein (CRP) is a marker for inflammation that is directly associated with overall heart and cardiovascular health. In multiple studies, CRP has been identified as a potent predictor of future cardiovascular health—and, in my opinion, one that is far more reliable than elevated cholesterol levels.

Biological characteristics that are associated with high CRP levels include infections, high blood sugar, excess weight, and hypercoagulability of blood (sticky blood).

Fortunately, there is a simple test that your doctor can conduct to find out how much CRP is in your blood. Just make sure they use the high sensitivity test (hs-CRP). This test doesn’t take much time; typically, blood is drawn from a vein located either on the forearm or from inside your elbow. The blood is then analyzed in several tests to determine the level of CRP present.

My Sinatra Smart Zone recommendation for an optimal CRP level is less than 0.8 mg/dL.

Serum Ferritin

Iron (ferritin) is necessary throughout life for stimulating the production of hemoglobin, the red blood cell pigment that carries oxygen to our cells. However, newer research indicates that iron overload can actually contribute to heart disease risk. This overload can be caused by hemochromatosis, an acquired or hereditary defect of iron metabolism in which excess iron is deposited in tissues and is not available for oxygen transport. It can also be caused by such factors as high iron intake or low turnover of red blood cells.

A Finnish study examined the role of iron in heart disease. After studying 1,900 men ages 42 to 60 for five years, researchers found that those with excessive levels of ferritin were more than twice as likely to have heart attacks, and that every one percent increase in ferritin translated into a four percent increase in heart attack risk. To find out if your iron levels are healthy, ask your doctor to perform a special iron test called serum ferritin.

My Sinatra Smart Zone recommendation for an optimal serum ferritin level is less than 80 mg/L (for women); less than 90 mg/L (for men).

Fibrinogen

Fibrinogen is a coagulation-type protein that determines the stickiness of your blood by enabling your platelets to stick together. You need adequate fibrinogen levels to stop bleeding when you’ve been injured, but you also want to balance your fibrinogen levels to support optimal blood circulation.

If you have a family history of heart concerns, you must check your serum fibrinogen level. Women who smoke, take oral contraceptives, or are postmenopausal usually have higher fibrinogen levels and should also get this simple test done.

My Sinatra Smart Zone recommendation for an optimal fibrinogen level is 180 to 350 mg/dL.

Homocysteine

Homocysteine is an amino acid that causes your body to lay down sticky platelets in blood vessels. Having some homocysteine is normal, but an excess may affect your heart health.

If you’ve had a heart attack or other cardiovascular event, you have a family history of early heart disease, or if you have hypothyroidism or have lupus or kidney disease, you should consider asking your doctor to test your homocysteine levels. Finally, if you take drugs that tend to elevate homocysteine—theophylline (for asthma), methotrexate (for cancer or arthritis), or L-dopa (for Parkinson’s)—you should be tested.

My Sinatra Smart Zone recommendation for an optimal homocysteine level is between 7–11 umol/L. If it's greater than 11 umol/L, B-vitamin support sould be considered.

Interleukin-6

Interleukin-6 is important because it stimulates the liver to produce CRP. And, in addition to heart disease, we are learning that this cytokine has a strong association with asthma (asthma is the result of airways swelling and constricting, so it makes sense that an inflammatory agent is behind the curtains here as well). The Iowa 65+ Rural Health Study demonstrated that elevations of interleukin-6 and CRP were associated with increased risk of both heart disease and general mortality in healthy older people.

I’m convinced that interleukin-6 may be an even better marker for inflammation than CRP because these “precursor” levels rise earlier. Therefore you should ask your doctor to conduct an interleukin-6 test if you are concerned about inflammation and its impact on your heart health.

My Sinatra Smart Zone recommendation for an optimal interleukin-6 level is 0.0 to 12.0 pg/mL.

Lipoprotein(a), or Lp(a)

A specific type of small LDL cholesterol particle, lipoprotein(a), or Lp(a), is the most dangerous of the blood lipids. Lp(a) inflames the blood and makes it sticky—making it more prone to clotting.

Unfortunately, some traditional blood lipid tests won’t assess the levels of Lp(a) in your blood. So you should ask your doctor about having either the Vertical Auto Profile (VAP) test or the Lipoprotein Particle Profile (LPP) test. Find out more about these two cholesterol tests.

My Sinatra Smart Zone recommendation for an acceptable Lp(a) level is less than 30 mg/dL for a standard blood test or less than 10 mg/dL for a VAP test.

More Dr. Sinatra Advice on Heart Disease Tests

What other heart disease tests should you consider? Get information on the array of heart disease tests I use when evaluating and treating my own patients.

Undergoing heart disease testing but unsure what your scores indicate? Get my Sinatra Smart Zone values for a wide array of heart health tests to ensure optimal heart health.

Want to read detailed questions and answers about different heart disease tests? Check out the Q&A section of my Heart Disease Tests Health Center.

The Blood Inflammation Tests to Assess Your Heart Disease Risk