How to keep tabs on cardiovascular disease?
Published Jan 22, 2020 • By Camille Dauvergne
We take you on a exploration of lipid anomalies, blood sugar levels, and ways to monitor blood pressure, weight, and blood work. Read our guide to discover how the progression of cardiovascular diseases is measured and understand what needs to be done after a test.
The tests presented below are important for keeping tabs on cardiovascular disease in general, such as high blood pressure, heart failure, irregular heartbeat or stable angina. Still, every condition is different and should be monitored by a doctor.
Keeping an eye on cardiovascular risk factors
Lipid Profile (LP)
A Lipid Profile is a biological examination that is regularly conducted to detect cardiovascular disease. Dyslipidemia (which includes high levels of cholesterol or triglycerides in the blood) is one of the main risk factors for cardiovascular disease. A typical blood test will look for levels of:
|Total Cholesterol||4.10 – 5.20 mmol/L||1.6 – 2.0 g/L|
|Triglycerides||0.40 – 1.70 mmol/L||0.35 – 1.50 g/L|
|HDL Cholesterol||> 1 mmol/L||> 0.40 g/L|
|LDL Cholesterol||< 4.1 mmol/L||< 1.60 g/L|
+ To be done on an empty stomach
These tests should be conducted "fasted" ( patient has consumed no food or drink for at least 12 hours), and at least once a year as a safeguard. The above values are those of a patient with normal levels and no risk factors. If the patient presents risk factors, the target values will depend on the level of cardiovascular risk.
Why take this test?
It allows your physician to catch any dyslipidemia, evaluate your cardiovascular risks, and monitor the patient they're treating.
Fasted blood sugar levels & glycated hemoglobin
You should get your blood sugar and glycated hemoglobin levels tested at least once to check for diabetes risks or 2 to 4 times a year for a patient who is already diabetic (to make sure the diabetes is under control and responding to treatment). You'll need to take a "fasted" blood test:
|Glucose||3.90 – 5.50 mmol/L||0.70 – 1.00 g/L|
|Hemoglobin A1c / Total hemoglobin||< 0.06
|< 6% in a healthy subject
< 7% in a diabetic patient or patient with known risk factors
Why take this test?
Having diabetes greatly increases the risk of cardiovascular disease.
Blood pressure test
A healthy level would be around 140 mmHg for systolic blood pressure and 90 mmHg for diastolic blood pressure, or 140/90 mmHg at together.
Getting these numbers just once does not mean your blood pressure is fine. To make sure, you should measure your blood pressure several times and in the following conditions:
- Sitting quietly for 5 minutes before testing
- Taking 3 consecutive measures with at least one minute between tests
- Abstaining from tobacco or stimulants (coffee, tea, etc.) for 30 minutes to 1 hour before the test
- Noting all the results obtained
- Testing your blood pressure three days before visiting your doctor
Only a doctor can say for sure if you have high blood pressure after running a series of additional tests.
Why take this test?
High blood pressure is a chronic condition and major risk factor for cardiovascular diseases. It's very important to regularly monitor your blood pressure levels.
Measuring weight and waist circumference
Measuring your weight and waist circumference will allow you to calculate your Body Mass Index (BMI):
|Normal||18.5 < IMC < 25|
|Overweight||25 < IMC < 30|
|Moderately Obese||30 < IMC < 35|
|Severely Obese||35 < IMC < 40|
|Morbidly Obese||> 40|
As a general rule of thumb, waist circumference should be no more than 94 cm (37 inches) for men and 80cm (31 inches) for women.
Why do this test?
Being overweight or obese are important risk factors for cardiovascular disease. If you find yourself rapidly gaining weight over a short period of time (a few days or weeks) it may be due to the presence of edemas which could be a sign of decompensated heart failure. You should see your doctor immediately.
Monitoring your blood work after diagnosis
A specific marker: BNP (Brain Natriuretic Peptide)
BNP plays an important role in diagnosis, prognosis and treatment in patients suspected of suffering from heart failure as this neuro-hormone is produced by the body in response to raised blood pressure and particularly in the case of heart failure.
|BNP < 100 pg/mL||100 < BNP < 400 pg/mL||BNP > 400 pg/mL|
|Heart failure unlikely. Physician should test for other conditions||Uncertain. Physician should order a diagnostic ultrasound||Heart failure likely. Patient should be hospitalized.|
Note: patients on ENTRESTO, should test for NT-proBNP and not BNP whose value will not be interpretable.
Why take this test?
To catch heart failure at its earliest stages.
Monitoring effects of treatments
The treatments used to control cardiovascular disease need to be regularly monitored, biological exams should especially be conducted on hematological (blood), renal (kidneys) and hepatic (liver) functions, to make sure the treatments are not provoking serious side effects.
INR (International Normalized Ratio)
To medically treat cardiovascular disease, a patient may be directed to take blood thinners or platelet inhibitors. However, this increases the patient's risk of internal bleeding. This is why it's very important to test INR before and during a new treatment, especially for vitamin K antagonists (VKA) and Unfractionated Heparins.
Treatment is safe when INR levels are between 2 and 4.5 on two consecutive tests. If INR levels are between 4.5 and 6, the patient's GP should be immediately alerted so as to reduce the dosage or change the treatment entirely. If INR levels are at 6 or above, the patient is at serious risk for hemorrhaging and should be hospitalized and taken off treatment.
Why take this test?
To monitor and treat if necessary the side effects of certain treatments.
Kidney function & electrolytes
The following should be monitored:
|Men||Se or Pl Creatinine||60 – 115 µmol/L||7 – 13 mg/L|
|Women||Se or Pl Creatinine||45 – 105 µmol/L||5 – 12 mg/L|
|Men||dU Creatinine||10 – 18 mmol||1100 – 2000 mg|
|Women||dU Creatinine||9 – 12 µmol/L||1000 – 1350 mg/L|
|/||Renal creatinine clearance||1.50 – 2.30 mL/s||90 – 140 mL/min|
|/||Pl Sodium||135 – 145 mmol/L||/|
|/||Pl Potassium||3.5 – 4.5 mmol/L||/|
The values indicated above are typical values. This test is particularly important if the treatment includes diuretics (such as FUROSEMIDE, HYDROCHLOROTHIAZIDE, SPIRONOLACTONE).
Liver function & enzymes
The following should be monitored :
|ALT||< 45 UI/L||< 34 UI/L|
|AST||< 35 UI/L||< 35 UI/L|
|CK||< 171 UI/L||< 145 UI/L|
|Haemoglobin||130 – 170 g/L||120 – 160 g/L|
Why take these tests?
The degradation of liver or kidney functions can cause serious problems because medications will no longer be correctly metabolized or eliminated: this increases the risk of overdose and toxicity for the patient, with intensified side-effects. These parameters should be check at least once or twice a year.
This exam traced onto paper reflects the heart's electrical activity. It should be done by a trained professional around once a year to monitor heart activity and detect any potential irregular heartbeats which could have serious consequences for someone with a weak heart. It's painless and risk-free. It's part of a clinical exam and may be accompanied by an echocardiography.
Cardiac stress test (or exercise test)
This test allows a doctor to measure the cardiovascular aptitudes of a person suffering from cardiovascular issues or may be part of a clinical cardiovascular exam. It's especially recommended for persons who regularly practice intense athletic activity or for sedentary individuals above a certain age who want to begin practicing a sport. It generally lasts between 10 and 30 minutes and is conducted by a cardiologist.
Other more specialized exams may be called for to explore cardiac functions such as a scintigraphy, a myocardial scintigraphy or a coronagraphy. A clinical exam is also very important, whether for diagnosing or monitoring cardiovascular disease. If you have a persistent cough, find yourself unexpectedly getting out of breath, unusually tired, or if you're getting heart palpitations, regular headaches or oedemas (this list is not exhaustive), see your GP.
Warning, this article is meant as an overview and not medical advice. It does not take into account variations among individual patients . Every patient is different and should consult their doctor before making any changes to their treatment!
Article written by Camille Dauvergne, 4th year pharmacy student, reviewed by Louise Bollecker, Carenity Content Manager.