Having covered imaging studies for the early detection of cardiovascular disease, I now turn to advanced lipid and biomarker testing which is providing far more information than the traditional lipid panel. We are now able to analyze the lipoproteins which carry cholesterol through the bloodstream and also a number of “biomarkers” which predict risk and can be followed for improvement as interventions are made. We’ll first look at biomarkers and then move on to lipoproteins. The term biomarker refers to something which can be measured in the blood, urine or elsewhere in the body which predicts  or is a result of existing disease but doesn’t necessarily cause disease. The most helpful of these in predicting future disease or imminent danger are the markers of inflammation and oxidation. Evidence is increasing that in the absence of inflammation arterial disease is unlikely to develop or worsen. For this reason, a major goal of prevention is to reduce inflammation in arteries and elsewhere in the body.  Many are familiar with the high-sensitivity C-reactive protein test which is a general test for inflammation. It will go up with rheumatoid arthritis, after surgery, with sinusitis or when arteries are inflamed. A more specific test is for lipoprotein-associated phospholipase-A2 (Lp-PLA2). It measures disease activity within the arterial wall. Other tests are for myeloperoxidase (MPO) and fibrinogen. Each of these gives a different view of what is going on in the arteries and therefore are not redundant when it comes to making decisions for disease prevention reversal. As I previously mentioned, the most exciting application of these tests is to watch inflammatory numbers plummet as lifestyle changes or other therapies are introduced. (and to modify therapy if not dropping). I’ve barely scratched the surface but will have more to say about inflammation/oxidation and other biomarkers in future posts and will tell some stories of how folks have been helped by these tests.