10 Tests for Your Heart Mileage

10 Tests for Your Heart Mileage

By Tereza Hubkova, MD

A friend of mine called me recently in tears. Her coronary calcium score test (a CT scan of her heart) done as part executive physical revealed that her coronary arteries looked 25 years older than her driving license would suggest.

 “You know me, I eat healthy, I work out 5 days a week. My cholesterol and blood pressure have always been fine,” sobbed my friend. “How is this even possible?”

My friend is sadly not alone suffering from heart disease for which she had “no risk factors.”  Just a week earlier, I saw a previously healthy 54-year-old athlete who almost died from a heart attack while biking across the country.  He, also, was “as healthy as a horse,” according to his primary care physician, until he collapsed off his bike, luckily not too far from a hospital where he got a stent a few hours later.

It turns out that more than half of heart attacks happen in people with normal cholesterol. Do not let that be you!

Just like our cars need to be checked at certain mileage milestones, our bodies deserve at least the same (or better) care.

When it comes to the heart, it is time we look beyond the “traditional” risk factors (high cholesterol, smoking, diabetes mellitus, high blood pressure, abdominal obesity, sedentary lifestyle, and poor diet).  

Here are the 10 Tests Everybody Over 40 Deserves for Their Heart Health

1. High Sensitivity CRP (hs-CRP)

A marker of inflammation. Inflammation seems to predict heart attacks at least as well as cholesterol, and in some groups (such as otherwise healthy menopausal women), it predicts future heart attacks more reliably than cholesterol. Aim for hs-CRP less than <0.9, and if elevated – hunt down the root cause. This can often be inflammation in the gums or periodontal disease, gut dysbiosis (and “leaky gut”), excess belly fat (not always obvious on the outside), or undiagnosed sleep apnea.

2. LDL- P- LDL Particle Number (And Size)

Too many small LDL cholesterol particles do more damage than fewer larger ones by penetrating the lining of the arteries like ping pong balls through a tennis net. We can help you turn them into harmless “beach balls.”

3. Lp(a)

Checking for Lp(a) can indicate an independent risk factor for premature heart disease, often running high in families where heart attacks strike early. Statins worsen this type of heart disease in some people, while berberine, niacin, and flax seeds seem to bring it down.

4. Apo B (apolipoprotein B)

Testing for this protein shows correlations with the risk of heart attack better than cholesterol.

5. OxLDL (oxidized LDL)

OxLDL indicates how much cholesterol has been made oxidized (unstable, and thus more damaging). This could be due to eating fast food, eating “rancid“oils, or toxic exposure. The goal of oxLDL is <60 ng/mL.

6. Homocysteine

Homocysteine is a marker of poor methylation (such as the infamous MTHFR gene), poor detoxification, or excessive stress. High homocysteine could also indicate a deficiency of vitamins B6, B12, folate, choline, magnesium, zinc, or selenium. The optimal homocysteine result is probably < 8 micromol/L. Besides more heart attacks, it has been linked to strokes, dementia, and osteoporosis as well.

7. TMAO (Trimethylamine Oxide)

This substance is made in the digestive tract by “bad microbes,” mostly from eggs and red meat. High TMAO is associated with a higher risk of atherosclerosis, heart attacks, strokes, blood clotting, kidney disease, and even colon cancer. It can be normalized by dietary adjustments (cutting back on red meat and eggs) and/or improving gut microbiome.

8. Omega 3 Index

This test looks mostly at your fish oil intake. A deficit of omega 3 compared to omega 6 (from vegetable oils and processed foods) and saturated fats increases risk of sudden death. The goal omega 3 index is > 8%.


This test will show how well you respond to insulin. Insulin resistance precedes type 2 diabetes by many years. The optimal result is < 1.2.

10. ADMA

ADMA is a marker of nitric oxide production. Nitric oxide helps blood flow as well as energy production, and our levels decrease with every decade of life, as well as with the use of common medications, such as proton pump inhibitors, oral contraceptives, antidepressants, or common nonsteroidal pain killers.

At InSpero, we offer these tests to everybody who wants to enjoy good health and add years to their life.  Abnormalities can often be corrected with dietary changes, exercise, several supplements, and, if necessary, prescription medication.

Are you ready to do your mileage tests? Call us at 970-569-2030