Doctor’s Tip: Tests to determine if you have fire in your arteries

Dr. Greg Feinsinger
Doctor's Tip
Dr. Greg Feinsinger.

Christiaan Barnard, M.D., the South African surgeon who preformed the first heart transplant, said, “I have saved the lives of 150 people by heart transplants. If I had focused on preventive medicine earlier, I might have saved 150 million.”

Heart attacks remain the number one cause of death in America, which is a shame because they are preventable. This is the third in a series of columns about the evidence-based Bale Doneen Method (BDM) of heart attack prevention. Last week’s column was about how oxidative stress causes inflammation of the endothelium that lines the inside of arteries, and about how this inflammation results in arterial plaque. Heart attacks and most stroke occur when this plaque ruptures, and the resultant blood clot blocks blood flow in an artery. Bale and Doneen call arterial inflammation “fire in the arteries.”

Today’s column is about “The Fire Panel: Simple Tests to Check for Heart Attack and Stroke Risk,” taken from Bale and Doneen’s latest book “Healthy Heart, Healthy Brain,” and from their most recent preceptorship:

F2 ISOPROSTANE is a blood test that assesses oxidative stress. A high level means the body is “oxidizing, or breaking down rapidly,” i.e. aging more quickly more quickly than normal. High levels are related to unhealthy lifestyle such as tobacco use, lack of exercise, unhealthy diet, and stress. High levels are seen in over exercisers as well — people who do ultramarathons, repeated marathons, ironman triathlons (exercise is good but there is such a thing as too much). Normal levels are <0.86, but optimal results are < 0.25.

FIBRINOGEN is a protein produced by the liver, which plays a role in blood clotting such as after an injury. It is also a marker of inflammation, including vascular inflammation. Normal levels for this blood test are < 370.

HIGHLY SENSITIVE C-REACTIVE PROTEIN (hsCRP) is an inexpensive blood test done in most labs, that measures inflammation. Elevation can indicate vascular inflammation but it can also be due to other inflammatory conditions such as infection, arthritis, and even a recent hard workout. Normal is < 1.0, optimal is < 0.5.

URINE MICROALBUMIN/CREATINE RATIO (MCR) is an inexpensive urine test that can be done in most labs. It detects small amounts of a protein called albumin the urine—amounts that wouldn’t be picked up on a regular urinalysis. Normal values are < 7.5 in women and < 4 in men. Elevation means inflammation and dysfunction of the endothelial that lines the inside of arteries. People with elevated MCR levels are at significantly higher risk for a heart attack or stroke.

LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A-2 (Lp-PLA2) is an FDA-approved blood test that is elevated if “arterial plaque… is ‘hot’ and growing” and is more apt to rupture. Lp-PLA2 is not only a marker for presence of dangerous plaque but it also plays a role formation of plaque. Interestingly, people with periodontal disease tend to have high levels of LpPLA2, which come down when this condition is treated. Normal values are < 200.

MYELOPEROXIDASE (MPO) is an FDA-approved blood test that measures an “inflammatory enzyme that the immune system uses to fight infection.” This enzyme “produces numerous oxidants that make all cholesterol compounds — [even HDL or ‘good cholesterol’] — more inflammatory.” It also reduces nitric oxide, necessary for the health of the endothelium that lines arteries. MPO “is a specific biomarker of blood vessel inflammation and vulnerable plaque” (the kind that’s apt to rupture and cause a heart attack or stroke). Normal level is < 480. If MPO is elevated dental infections need to be looked for and treated.

These are not obscure, expensive tests, but are relatively inexpensive tools used by doctors who are interested in heart attack prevention. They are offered by Boston Heart Diagnostics, Cleveland HeartLab, Quest Diagnostics, LabCorp, and other medical laboratories. Medicare and other insurances usually cover them.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment, or email

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