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Health Protocols

Lab Testing

Cardiovascular Health

Oxidized LDL

Oxidized LDL, the “bad” cholesterol that has been modified by oxidation, triggers inflammation leading to the formation of plaque in the arteries. High levels of oxidized LDL are associated with an increased risk of metabolic syndrome and coronary artery disease. Oxidized LDL is often measured with myeloperoxidase and/or F2-isoprostanes.


Myeloperoxidase (MPO) is an enzyme released by white blood cells when they attack. It causes death to microbes and amplifies inflammation and immune cell recruitment. This is great if there is a foreign invader, but terrible if it is happening in the arteries in response to oxidized LDL. It amplifies inflammation there and causes problems that increase plaque and often the worse kind of plaque, the soft vulnerable plaque that is prone to rupture. To make matters worse, MPO also oxidizes LDL, making it more plaque-promoting, and even oxidizes HDL (ie, good cholesterol) rendering it dysfunctional so it can no longer be helpful. These effects result in inflammation linked to plaque buildup inside the artery wall. Thus, MPO is a very interesting cardiovascular marker that is worth checking, especially in those with family history of cardiovascular disease or who make poor lifestyle choices.

F2-Isoprostanes (Urinary Test)

F2-Isoprostanes (F2-IsoPs) are a biomarker for oxidative stress. Oxidative stress occurs when free radicals react with neighboring molecules causing a cascade of damage in cells, which initiates destructive pathways that can lead to heart disease. F2-IsoPs may be elevated at the earliest stages of plaque development. F2-IsoPs are often measured along with oxidized LDL and/or MPO.

Lipoprotein (a) (serum or plasma)

The lipoprotein (a) test is used to measure excess small dense lipoprotein. Elevated lipoprotein (a) is a strong indicator of premature coronary disease and atherosclerotic vascular disease and is associated with increased risk of cardiac death in patients with coronary heart disease and stroke (Erqou 2009).

  • Reference Range: <75 nmol/L

Apolipoprotein B (ApoB)

The apolipoprotein B (apo B) blood test measures the number of potentially dangerous lipoprotein particles that can lead to the atherosclerotic process.

  • Reference Ranges:
    • Desirable: <90 mg/dL
    • Borderline High: 90-99 mg/dL
    • High: 100-130 mg/dL
    • Very High: >130 mg/dL
  • LE’s Optimal Range:
    • <80 mg/dL
    • <60 mg/dL (for those with high risk of arterial occlusion)

Coenzyme Q10 (plasma, frozen and protected from light)

Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of all cells. It is known to be highly concentrated in heart muscle cells due to the high energy requirements of this cell type (Fotino 2013).

CoQ10 blood levels are reported to decrease with age and to be low in patients with chronic diseases such as heart conditions, neuromuscular diseases, Parkinson disease, cancer, diabetes, and HIV/AIDS. Some prescriptions like statin medications can also lower CoQ10 levels (DiNicolantonio 2015; Artuch 2009; Mischley 2012; Cobanoglu 2011; Chai 2010; Folkers 1988; Shen 2015).

  • Reference Range: 0.37-2.20 µg/mL
  • LE’s Optimal Range: 3-7 µg/mL (those with cardiovascular disease or neurodegenerative disease likely need to be at the upper end of the optimal range)

Fibrinogen Activity (whole blood or plasma)

Fibrinogen is a key clotting protein that is an independent risk factor for cardiovascular disease and ischemic stroke (Franchini 2012; Montalescot 1998; Fukujima 1997).

  • Reference Range: 193-507 mg/dL (age 17 and above)
  • LE’s Optimal Range: 295-369 mg/dL

Homocysteine (plasma; serum is acceptable)

Homocysteine is an independent risk factor for coronary heart disease. High blood levels may directly damage the delicate endothelial cells that line the inside of arteries and result in vascular inflammation, blood clot formation, and arterial plaque rupture. Studies have shown that even moderate levels of homocysteine pose an increased risk for arterial plaque formation when compared with the lowest 20th percentile (<7.2 µmol/L) of population controls.

  • Reference Range: 0.0-15.0 µmol/L
  • LE’s Optimal Range:
    • Good: <12 µmol/L
    • Ideal: <8 µmol/L

Additional information about methods for maintaining cardiovascular health can be found in the Atherosclerosis and Cardiovascular Disease protocol.