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Super Advanced - Cardiac Profile

Heart

68 parameters

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Report in 36Hrs

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At Home

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Fasting Required

Details

Advanced profile with inflammatory markers.

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Parameters

  • List of Tests
    • Calcium
    • Alkaline Phosphatase
    • hs-CRP
    • Lipoprotein (A)
    • Uric Acid
    • Homocysteine
    • Apoliprotein A1
    • Apoliprotein B
    • Apo B/A1
    • BUN
    • Creatinine
    • BUN/Creatinine
    • GGT
    • Iron
    • TIBC
    • Transferrin Saturation
    • Bilirubin Direct
    • Bilirubin Total
    • Bilirubin Indirect
    • Cholesterol/HDL
    • LDL/HDL
    • Non-HDL
    • VLDL
    • Total Cholesterol
    • Triglycerides
    • HDL
    • LDL
    • Albumin
    • Total Protein
    • A/G Ratio
    • Globulin
    • T3
    • T4
    • TSH
    • HbA1c
    • Estimated Average Glucose
    • CBC - Complete Hemogram
    • 25 OH Vitamin D
    • Vitamin B12
    • Lipoprotein Associated Phospholipase A2

Super Advanced - Cardiac Profile

  • Why is it done?
    • Comprehensive cardiovascular risk assessment: This advanced profile provides a complete evaluation of cardiac risk factors by measuring lipid metabolism, inflammatory markers, and metabolic parameters that contribute to heart disease development
    • Detection of atherosclerosis precursors: Measures Lipoprotein(a), Apolipoproteins, homocysteine, and Lipoprotein-associated Phospholipase A2 (Lp-PLA2) to identify emerging vascular damage and plaque formation before symptoms develop
    • Evaluation of metabolic health: Assesses glucose control (HbA1c, estimated average glucose), thyroid function (TSH, T3, T4), and kidney function (BUN, Creatinine) which are critical for cardiac health
    • Screening for systemic inflammation: High-sensitivity CRP (hs-CRP) detects chronic low-grade inflammation associated with cardiovascular disease risk, independent of cholesterol levels
    • Assessment of liver, kidney, and bone metabolism: Evaluates organ function through Alkaline Phosphatase, GGT, Total/Direct/Indirect Bilirubin, Albumin, Total Protein, and Calcium which influence cardiovascular health
    • Monitoring iron metabolism: Iron, TIBC, and Transferrin Saturation assess for iron overload which can increase cardiac oxidative stress and arrhythmia risk
    • Complete blood count evaluation: CBC assesses anemia, infection, and hematologic abnormalities that can compromise cardiac function and oxygen delivery
    • Assessment of micronutrient status: Vitamin D and Vitamin B12 levels are measured as deficiencies are associated with increased cardiovascular mortality and myocardial infarction risk
    • Primary indications: Acute or chronic chest pain evaluation, family history of premature coronary artery disease, pre-operative cardiac assessment, baseline screening for asymptomatic individuals with multiple risk factors, and monitoring during cardiac disease management
    • Timing and clinical circumstances: Recommended for patients with diabetes, hypertension, obesity, smoking history, or sedentary lifestyle; for risk stratification in asymptomatic middle-aged to older adults; and in patients with established cardiovascular disease for ongoing risk assessment
  • Normal Range
    • Calcium: 8.5 - 10.5 mg/dL (2.1 - 2.6 mmol/L) - Normal values indicate adequate bone health and neuromuscular function
    • Alkaline Phosphatase: 30 - 120 IU/L (0.5 - 2.0 µkat/L) - Normal range suggests healthy bone and liver metabolism
    • hs-CRP: <1.0 mg/L (<1.0 mg/L) - Low inflammation marker indicating reduced cardiovascular risk; 1.0-3.0 mg/L represents intermediate risk; >3.0 mg/L indicates elevated risk
    • Lipoprotein(a): <30 mg/dL (<75 nmol/L) - Normal level represents lower genetic risk for premature cardiovascular disease
    • Uric Acid: 3.5 - 7.2 mg/dL (0.21 - 0.43 mmol/L for men; 2.6 - 6.0 mg/dL or 0.16 - 0.36 mmol/L for women) - Normal range indicates proper purine metabolism
    • Homocysteine: 5.0 - 15.0 µmol/L (<2.0 mg/L) - Normal level minimizes risk for vascular damage and thrombosis
    • Apolipoprotein A1: 120 - 200 mg/dL (1.2 - 2.0 g/L) - Higher levels are protective against cardiovascular disease
    • Apolipoprotein B: 60 - 130 mg/dL (0.6 - 1.3 g/L) - Normal level indicates lower atherogenic lipoprotein burden
    • Apo B/A1 Ratio: <0.9 - Normal ratio indicates favorable lipid particle distribution protective against atherosclerosis
    • BUN (Blood Urea Nitrogen): 7 - 20 mg/dL (2.5 - 7.1 mmol/L) - Normal range indicates adequate kidney filtration function
    • Creatinine: 0.7 - 1.3 mg/dL (62 - 115 µmol/L for men; 0.6 - 1.1 mg/dL or 53 - 97 µmol/L for women) - Indicates baseline kidney function important for drug metabolism and cardiac hemodynamics
    • BUN/Creatinine Ratio: 10 - 20 - Normal ratio suggests adequate glomerular filtration rate and renal perfusion
    • GGT (Gamma-Glutamyl Transferase): 0 - 65 IU/L (0 - 1.1 µkat/L) - Normal level indicates healthy liver detoxification and minimal liver stress
    • Iron: 60 - 170 µg/dL (10.7 - 30.4 µmol/L for men; 50 - 170 µg/dL or 9.0 - 30.4 µmol/L for women) - Normal level balances oxygen transport with antioxidant protection
    • TIBC (Total Iron Binding Capacity): 250 - 425 µg/dL (45 - 76 µmol/L) - Normal range indicates appropriate iron transport capacity
    • Transferrin Saturation: 20 - 50% - Normal percentage indicates balanced iron metabolism without overload or deficiency
    • Bilirubin Total: 0.1 - 1.2 mg/dL (1.7 - 20.5 µmol/L) - Normal level indicates effective liver conjugation and bile flow
    • Bilirubin Direct: 0.0 - 0.3 mg/dL (0 - 5.1 µmol/L) - Normal conjugated bilirubin indicates patent bile ducts
    • Bilirubin Indirect: 0.1 - 0.9 mg/dL (1.7 - 15.4 µmol/L) - Normal unconjugated bilirubin indicates effective hepatic processing
    • Total Cholesterol: <200 mg/dL (<5.18 mmol/L) - Desirable level; 200-239 mg/dL represents borderline high risk
    • LDL Cholesterol: <100 mg/dL (<2.59 mmol/L) - Optimal level; 100-129 near optimal; 130-159 borderline high; >160 high
    • HDL Cholesterol: >40 mg/dL (>1.04 mmol/L for men); >50 mg/dL (>1.30 mmol/L for women) - Higher is protective against cardiovascular disease
    • Triglycerides: <150 mg/dL (<1.69 mmol/L) - Normal level; 150-199 borderline high; ≥200 high
    • VLDL Cholesterol: <30 mg/dL (<0.78 mmol/L) - Calculated from triglycerides; normal indicates minimal very low-density lipoprotein production
    • Total Cholesterol/HDL Ratio: <5.0 - Optimal ratio indicating good lipid profile balance; >5.0 increases cardiovascular risk
    • LDL/HDL Ratio: <3.0 - Optimal ratio; 3.0-5.0 moderate risk; >5.0 indicates elevated cardiovascular risk
    • Non-HDL Cholesterol: <130 mg/dL (<3.37 mmol/L) - Normal; represents total atherogenic particles independent of triglycerides
    • Albumin: 3.4 - 5.4 g/dL (34 - 54 g/L) - Normal level indicates adequate hepatic protein synthesis and nutritional status
    • Total Protein: 6.0 - 8.3 g/dL (60 - 83 g/L) - Normal range indicates adequate protein nutrition and liver function
    • Albumin/Globulin Ratio: 1.0 - 2.5 - Normal ratio indicates balanced immune function and hepatic synthesis
    • Globulin: 2.0 - 3.5 g/dL (20 - 35 g/L) - Normal level indicates adequate immune protein production
    • TSH (Thyroid Stimulating Hormone): 0.4 - 4.0 mIU/L (0.4 - 4.0 mIU/L) - Normal range indicates appropriate thyroid hormone regulation
    • T4 (Thyroxine) Total: 5.0 - 12.0 µg/dL (64 - 155 nmol/L) - Normal level indicates sufficient thyroid hormone for metabolism
    • T3 (Triiodothyronine) Total: 80 - 200 ng/dL (1.2 - 3.1 nmol/L) - Normal level indicates adequate active thyroid hormone
    • HbA1c: <5.7% (39 mmol/mol) - Normal; 5.7%-6.4% indicates prediabetes; ≥6.5% indicates diabetes
    • Estimated Average Glucose (eAG): <100 mg/dL (<5.6 mmol/L) - Calculated from HbA1c; normal indicates good glycemic control
    • 25-OH Vitamin D: 30 - 100 ng/mL (75 - 250 nmol/L) - Normal level; <20 ng/mL indicates deficiency; 20-29 ng/mL represents insufficiency
    • Vitamin B12: 200 - 900 pg/mL (148 - 664 pmol/L) - Normal level supports neurologic function and cardiac energy metabolism
    • Lp-PLA2 (Lipoprotein-associated Phospholipase A2): <200 ng/mL (<200 ng/mL) - Normal level indicates low vascular inflammation and plaque destabilization risk
    • CBC (Complete Blood Count) - 28 parameters including: RBC (4.5-5.9 million/µL for men; 4.1-5.1 million/µL for women), WBC (4.5-11.0 thousand/µL), Hemoglobin (13.5-17.5 g/dL for men; 12.0-15.5 g/dL for women), Hematocrit (38.8-50% for men; 34.9-44.5% for women), MCV (80-100 fL), Platelets (150-400 thousand/µL) - All within normal range indicate adequate oxygen transport, immunity, and hemostasis
  • Interpretation
    • Calcium elevated (hypercalcemia): May indicate hyperparathyroidism, vitamin D toxicity, or malignancy; increases cardiac arrhythmia risk. Decreased (hypocalcemia): May suggest hypoparathyroidism, vitamin D deficiency, or kidney disease; impairs cardiac contractility and increases arrhythmia risk
    • Alkaline Phosphatase elevated: May indicate bone disease, liver cirrhosis, hepatitis, or bone metastases; chronic elevation suggests ongoing tissue remodeling stress. Decreased: Rare but may indicate hypophosphatasia or severe malnutrition
    • hs-CRP elevated: Indicates systemic inflammation independent of cholesterol levels; strong independent predictor of acute coronary events and stroke. Values 1-3 mg/L warrant lifestyle modification; >3 mg/L may indicate need for anti-inflammatory therapy or further investigation for occult infection or malignancy
    • Lipoprotein(a) elevated: Strong independent cardiovascular risk factor particularly associated with premature myocardial infarction and stroke; largely genetically determined with limited modifiability through lifestyle alone. May warrant consideration of aggressive LDL lowering or PCSK9 inhibitors
    • Uric Acid elevated: Associated with gout, kidney disease, and metabolic syndrome; increased levels correlate with hypertension, heart failure, and sudden cardiac death risk. May be marker of oxidative stress. Decreased levels may indicate xanthine oxidase inhibitor use or severe malnutrition
    • Homocysteine elevated: Independent risk factor for atherosclerosis, thrombosis, and cognitive decline; increases risk of myocardial infarction and stroke; may indicate deficiencies in folate, B6, or B12. Levels 15-30 µmol/L associated with moderately increased risk; >30 µmol/L represents markedly elevated risk
    • Apolipoprotein A1 decreased: Associated with reduced HDL and increased cardiovascular risk; marker of insufficient reverse cholesterol transport. Elevated levels are protective and associated with cardiovascular longevity
    • Apolipoprotein B elevated: Represents total number of atherogenic particles; better predictor of cardiovascular risk than LDL cholesterol alone. May indicate need for more aggressive lipid-lowering therapy regardless of LDL levels
    • Apo B/A1 Ratio elevated: Indicates unfavorable lipoprotein particle composition with predominance of atherogenic particles; strong predictor of myocardial infarction risk independent of traditional lipid markers
    • BUN elevated: May indicate dehydration, reduced kidney filtration, high protein diet, or catabolic states; in context of normal creatinine may suggest prerenal azotemia or volume depletion affecting cardiac perfusion. Decreased: May indicate malnutrition, liver disease, or third trimester pregnancy
    • Creatinine elevated: Indicates reduced glomerular filtration rate and chronic kidney disease; strong predictor of cardiovascular mortality and renal failure progression; may impact cardiac drug metabolism and clearance. Accurate assessment requires consideration of age, sex, and muscle mass
    • BUN/Creatinine Ratio elevated (>20): Suggests prerenal etiology of azotemia or dehydration; may indicate inadequate renal perfusion from hypotension or heart failure. Decreased ratio: May indicate intrinsic kidney disease or excessive protein loss
    • GGT elevated: Non-specific marker of liver or bile duct disease; also associated with oxidative stress, metabolic syndrome, and increased cardiovascular mortality even after adjustment for liver disease. Marked elevation may indicate alcohol use disorder, hepatitis, or cirrhosis
    • Iron elevated: May indicate hemochromatosis or repeated transfusions leading to iron overload; excess iron generates free radicals causing myocardial damage, conduction abnormalities, and arrhythmias. Decreased iron: Indicates iron deficiency anemia which impairs oxygen delivery and increases cardiac workload; causes fatigue and potential angina
    • TIBC elevated: Indicates iron deficiency state with increased iron binding capacity; suggests iron deficiency anemia. Decreased TIBC: May indicate liver disease or malnutrition affecting transferrin synthesis
    • Transferrin Saturation elevated: Indicates iron overload and increased cardiovascular risk; >60% suggests hemochromatosis requiring phlebotomy. Decreased saturation: Indicates iron deficiency anemia requiring iron supplementation or investigation of bleeding source
    • Bilirubin Total elevated: May indicate hemolysis, liver disease, or biliary obstruction; mild elevation may represent Gilbert's syndrome (benign). Significant elevation may indicate hepatitis, cirrhosis, or biliary pathology affecting overall health status
    • Bilirubin Direct elevated: Indicates conjugated hyperbilirubinemia suggesting biliary obstruction or hepatocellular injury; may indicate cirrhosis, pancreatitis, or bile duct stones requiring imaging and further evaluation
    • Bilirubin Indirect elevated: Indicates unconjugated hyperbilirubinemia suggesting hemolysis, impaired hepatic uptake, or genetic disorders like Gilbert's syndrome; marked elevation may indicate severe hemolytic anemia requiring transfusion
    • Total Cholesterol elevated (>200 mg/dL): Indicates hypercholesterolemia increasing atherosclerosis risk; >239 mg/dL high risk requiring pharmacotherapy consideration. Value combined with HDL/LDL/triglycerides determines overall cardiovascular risk stratification
    • LDL Cholesterol elevated: Atherogenic particle directly causes atherosclerotic plaque formation; primary target of lipid-lowering therapy. <100 mg/dL optimal; <70 mg/dL recommended for very high-risk patients (prior MI, diabetes with CAD, peripheral arterial disease)
    • HDL Cholesterol decreased: Major cardiovascular risk factor as HDL provides reverse cholesterol transport; <40 mg/dL in men and <50 mg/dL in women represents independent risk factor. Elevation through exercise and moderate alcohol associated with improved cardiovascular outcomes
    • Triglycerides elevated: Increases cardiovascular risk especially when combined with reduced HDL; >200 mg/dL may cause acute pancreatitis; indicates poor glycemic control or metabolic syndrome. Values 200-499 mg/dL borderline; >500 mg/dL very high risk
    • VLDL Cholesterol elevated: Carries triglycerides and cholesterol; increases atherogenicity when elevated; typically normalized by triglyceride reduction through dietary modification or medications like statins or fibrates
    • Total Cholesterol/HDL Ratio: Used for cardiovascular risk assessment; <5.0 favorable; 5.0-10.0 moderate risk; >10.0 high risk despite potentially normal component levels. More predictive than total cholesterol alone
    • LDL/HDL Ratio: Superior predictor of atherosclerotic risk than LDL alone; <3.0 optimal; 3.0-5.0 moderate; >5.0 indicates need for intensified therapy and lifestyle modification
    • Non-HDL Cholesterol: Represents all atherogenic lipoprotein particles (LDL, VLDL, Lp(a)); secondary lipid target; should be 30 mg/dL lower than LDL target. Particularly useful in patients with hypertriglyceridemia where LDL may be misleading
    • Albumin decreased: Indicates malnutrition, liver disease, nephrotic syndrome, or malabsorption; reduces oncotic pressure predisposing to edema and volume overload in heart failure. Severe hypoalbuminemia (<2.5 g/dL) associated with poor prognosis
    • Total Protein decreased: Suggests malnutrition, liver disease, or kidney disease; may affect drug binding and cardiac medication efficacy. Elevated Total Protein: May indicate dehydration causing hemoconcentration
    • Albumin/Globulin Ratio decreased: Suggests immunologic compromise or liver disease; may indicate chronic infection or malignancy affecting immune competence and cardiovascular stability
    • Globulin elevated: Indicates active immune response potentially from infection, autoimmune disease, or malignancy; may suggest systemic inflammation affecting cardiovascular function
    • TSH elevated: Indicates primary hypothyroidism; may cause elevated cholesterol, bradycardia, cardiomyopathy, and increased cardiovascular mortality if untreated. Decreased: May indicate hyperthyroidism increasing arrhythmia risk and cardiac workload
    • T4 Total elevated: May indicate hyperthyroidism or increased thyroid binding proteins; increases metabolic rate and cardiac oxygen demand predisposing to arrhythmias and myocardial ischemia. Decreased: Indicates hypothyroidism requiring thyroid hormone replacement
    • T3 Total elevated: Indicates hyperthyroidism with accelerated peripheral conversion; increases cardiac oxygen consumption and arrhythmia risk. Decreased: Seen in hypothyroidism and euthyroid sick syndrome in acute cardiac illness
    • HbA1c elevated (5.7-6.4%): Indicates prediabetes with impaired glucose tolerance; increases cardiovascular risk requiring lifestyle intervention and monitoring. ≥6.5%: Diagnostic for diabetes; associated with significantly increased MI and stroke risk; requires pharmacotherapy with glucose-lowering agents
    • Estimated Average Glucose elevated: Correlates with HbA1c; indicates average blood glucose over preceding 2-3 months; >126 mg/dL diagnostic for diabetes. Used for patient counseling regarding glycemic control and cardiovascular risk
    • 25-OH Vitamin D deficiency (<20 ng/mL): Associated with osteoporosis, increased cardiovascular mortality, hypertension, and sudden cardiac death. Insufficiency (20-29 ng/mL): Suboptimal levels associated with increased infection risk and impaired immune function affecting cardiac vulnerability
    • Vitamin B12 decreased: Causes elevated homocysteine, neurologic dysfunction, and impaired cardiac energy metabolism; associated with increased cardiovascular events. Levels 200-300 pg/mL considered low-normal with potential for neurologic symptoms; <200 indicates frank deficiency requiring B12 supplementation
    • Lp-PLA2 elevated: Independent cardiovascular risk marker reflecting vascular inflammation and plaque destabilization; >250 ng/mL associated with increased MI and stroke risk. Predicts cardiovascular events even among patients with low LDL cholesterol; may warrant intensified therapy
    • CBC abnormalities: Anemia (low RBC, hemoglobin, hematocrit) increases cardiac workload and reduces oxygen delivery; polycythemia (elevated RBC) increases viscosity and thrombosis risk. Elevated WBC suggests infection or inflammation; decreased WBC indicates immunosuppression or bone marrow disease. Low platelets increase bleeding risk; elevated platelets increase thrombosis risk
  • Associated Organs
    • Calcium: Primarily associated with bones and parathyroid glands; directly affects cardiac muscle contraction force and excitability; abnormalities cause arrhythmias (hypercalcemia) or tetany (hypocalcemia); related conditions include hyperparathyroidism, osteoporosis, and vitamin D disorders
    • Alkaline Phosphatase: Produced primarily by liver and bones; indicates bone remodeling or hepatic injury; elevated levels associated with cirrhosis, hepatitis, bone metastases, and Paget's disease; reflects overall hepatic synthetic function
    • hs-CRP: Produced by liver in response to systemic inflammation; elevated levels reflect vascular and systemic inflammation; associated with atherosclerosis progression, vulnerable plaque, and acute cardiac events; also elevated in infection, malignancy, and autoimmune diseases
    • Lipoprotein(a): Produced by liver; genetically determined lipoprotein particle; directly contributes to atherosclerotic plaque formation; major independent risk factor for premature myocardial infarction and aortic valve stenosis; related conditions include familial lipoprotein(a) elevation and genetic dyslipidemia
    • Uric Acid: Produced by liver via purine metabolism; associated with kidneys (risk factor for kidney stone formation and chronic kidney disease); elevated levels indicate metabolic syndrome, gout, and hyperuricemia; marker of oxidative stress and endothelial dysfunction
    • Homocysteine: Produced by liver and kidneys in amino acid metabolism; elevated in deficiencies of folate, B6, and B12; increases vascular thrombosis risk and accelerates atherosclerosis; associated with endothelial damage and arterial stiffness
    • Apoliproteins A1 and B: Produced by liver and intestines; A1 is component of HDL mediating reverse cholesterol transport; B is component of LDL and VLDL mediating cholesterol delivery; their ratio predicts atherosclerotic risk; related conditions include genetic dyslipidemias and metabolic syndrome
    • BUN and Creatinine: Markers of kidney function; elevated levels indicate reduced glomerular filtration and chronic kidney disease; kidney disease increases cardiovascular mortality risk; both drugs and electrolytes are cleared by kidneys affecting cardiac function
    • GGT: Produced by liver and kidneys; marker of liver disease and bile duct obstruction; elevated levels associated with hepatic steatosis, cirrhosis, hepatitis, and pancreatitis; independent predictor of cardiovascular mortality reflecting oxidative stress
    • Iron, TIBC, Transferrin Saturation: Primarily associated with liver (storage), blood (transport), and gastrointestinal tract (absorption); iron critical for hemoglobin oxygen transport; excess iron causes myocardial damage and arrhythmias (hemochromatosis); deficiency causes anemia compromising oxygen delivery
    • Bilirubin (Total, Direct, Indirect): Produced by liver via hemoglobin metabolism; indicators of hepatic conjugation capacity and biliary flow; elevated levels associated with liver cirrhosis, hepatitis, biliary obstruction, and hemolysis; reflects overall hepatic function and synthetic reserve
    • Lipid Panel (Cholesterol, LDL, HDL, Triglycerides, VLDL): Primarily associated with liver (synthesis and metabolism) and cardiovascular system (deposition in arteries); cholesterol essential for cell membranes and hormone production but atherogenic in excess; elevated lipids directly promote atherosclerosis and myocardial infarction
    • Albumin, Total Protein, A/G Ratio, Globulin: Produced by liver (albumin and most globulins); reflect hepatic synthetic function and nutritional status; albumin critical for maintaining plasma osmotic pressure and carrying cardiac medications; globulins represent immune proteins affecting resistance to infection
    • TSH, T3, T4: Produced by thyroid gland under pituitary control; thyroid hormones regulate metabolic rate and cardiac function; hypothyroidism causes bradycardia and elevated cholesterol; hyperthyroidism causes tachycardia, atrial fibrillation, and myocardial stress; critical for cardiac chronotropic and inotropic function
    • HbA1c and Estimated Average Glucose: Reflects pancreatic beta cell function and glucose metabolism; elevated values indicate diabetes which accelerates atherosclerosis, increases inflammation, and damages myocardium; diabetes increases MI risk 2-4 fold; requires intensive blood pressure and lipid management for cardiovascular protection
    • CBC: Reflects bone marrow function and circulating blood cells; indicates oxygen-carrying capacity (via hemoglobin and hematocrit), immune competence (via WBC), hemostatic function (via platelets); abnormalities affect cardiac oxygen delivery, infection risk, and thrombosis propensity
    • 25-OH Vitamin D: Produced in skin via sunlight exposure and processed by liver and kidneys; deficiency associated with osteoporosis, increased cardiovascular mortality, hypertension, and sudden cardiac death; vitamin D deficiency impairs immune function increasing infection risk
    • Vitamin B12: Produced by bacteria and stored in liver; deficiency causes elevated homocysteine and neurologic complications; B12 essential for myelin formation, DNA synthesis, and cardiac energy metabolism; deficiency increases cardiovascular event risk and sudden cardiac death
    • Lp-PLA2: Produced by inflammatory cells and associated with lipoprotein(a); marker of vascular inflammation and plaque destabilization; elevated levels independently predict coronary events and stroke; reflects ongoing vascular inflammation despite normal cholesterol levels
  • Follow-up Tests
    • Calcium abnormalities: PTH (Parathyroid Hormone), 1,25-dihydroxyvitamin D, phosphate, and magnesium for evaluation of mineral metabolism disorders; DEXA scan for osteoporosis assessment; imaging studies (chest X-ray, EKG) to evaluate for cardiac calcification or arrhythmias
    • Alkaline Phosphatase elevation: Liver function tests (AST, ALT, GGT, bilirubin), albumin for hepatic assessment; bone-specific alkaline phosphatase and P1NP if bone disease suspected; abdominal ultrasound or imaging if liver pathology suspected; alkaline phosphatase isoenzyme fractionation to differentiate source
    • hs-CRP elevation: ESR (Erythrocyte Sedimentation Rate) for additional inflammation assessment; repeat hs-CRP in 2-3 weeks to confirm elevation and assess response to therapy; consider infection workup (blood cultures, imaging) if markedly elevated; CAD risk assessment with calcium scoring or coronary angiography; assessment for autoimmune/rheumatologic diseases
    • Lipoprotein(a) elevation: Genetic lipid panel to identify familial patterns; consider cascade screening of family members; intensified LDL cholesterol lowering with statins and ezetimibe; discussion regarding PCSK9 inhibitors for very high-risk patients; annual re-testing for monitoring; CAD risk assessment with stress testing or coronary calcium scoring
    • Uric Acid elevation: 24-hour urine uric acid to assess for overproduction versus underexcretion; kidney function assessment (creatinine, eGFR, urinalysis); consider xanthine oxidase inhibitor therapy (allopurinol, febuxostat) if recurrent gout; dietary modification counseling; periodic monitoring every 6 months after therapy initiation
    • Homocysteine elevation: Folate, vitamin B6, and vitamin B12 levels for micronutrient deficiency assessment; MTHFR genetic testing if recurrent elevation; initiation of supplementation with folate (1-5 mg daily), B6 (25-50 mg daily), and B12 if deficient; repeat homocysteine after 2-3 months of supplementation; consider methylenetetrahydrofolate reductase (MTHFR) inhibitor variants
    • Apolipoprotein abnormalities: Genetic lipid panel; repeat lipid profile after dietary modification and/or pharmacotherapy initiation; cascade screening of family members if genetic dyslipidemia suspected; consider consultation with lipidologist for complex cases; CAD risk assessment
    • BUN/Creatinine abnormalities: Repeat creatinine with calculated eGFR (MDRD or CKD-EPI) for accurate kidney function assessment; urinalysis and urine albumin-to-creatinine ratio (UACR) for proteinuria detection; renal ultrasound if kidney disease unexplained; cystatin C for improved GFR estimation; monitoring frequency varies based on stage of CKD (annually for stage 1-2, every 6-12 months for stage 3)
    • GGT elevation: Liver function panel (AST, ALT, ALP, bilirubin), albumin for hepatic assessment; abdominal ultrasound if cirrhosis or fatty liver suspected; hepatitis B and C serology if risk factors present; alcohol use assessment and counseling; repeat GGT quarterly if persistently elevated to monitor trend
    • Iron metabolism abnormalities: Serum ferritin for iron stores assessment; liver function tests if iron overload suspected; genetic testing (HFE mutation) for hemochromatosis; liver biopsy if cirrhosis suspected; phlebotomy therapy initiation if hemochromatosis confirmed; repeat iron studies after therapy to assess response; for iron deficiency: evaluation of bleeding source (GI endoscopy if indicated), celiac serology, intrinsic factor antibodies if pernicious anemia suspected
    • Bilirubin abnormalities: Fractionated bilirubin (direct and indirect) if total elevated; liver function panel (AST, ALT, ALP, GGT), albumin; hepatitis B and C serology; abdominal ultrasound if cholestasis suspected; genetic testing if Gilbert's syndrome or Crigler-Najjar syndrome considered; blood smear if hemolysis suspected; reticulocyte count to assess bone marrow response
    • Lipid Panel abnormalities: Repeat lipid panel in 2-4 weeks after fasting for confirmation; calculate 10-year ASCVD risk using Framingham or pooled cohort equations; repeat lipid panel 4-12 weeks after initiation of statin therapy; if LDL not at goal consider adding ezetimibe, PCSK9 inhibitor, bempedoic acid, or inclisiran; stress testing or coronary calcium scoring for risk assessment; dietary counseling and lifestyle modification counseling; referral to lipidologist if complex case or familial dyslipidemia
    • Protein and albumin abnormalities: Complete metabolic panel including kidney function and electrolytes; liver biopsy if cirrhosis suspected; malnutrition assessment and nutritional consultation if albumin low; evaluation for nephrotic syndrome (urine protein, serum albumin) if proteinuria present; repeat protein studies after dietary modification or treatment of underlying cause; albumin monitoring every 3-6 months in chronic disease
    • Thyroid function abnormalities: Free T4 (fT4) and free T3 (fT3) if TSH abnormal to better assess thyroid status; thyroid peroxidase (TPO) and thyroglobulin antibodies to assess for autoimmune thyroiditis; thyroid ultrasound if nodules palpated or suggested on imaging; TSH monitoring every 6-8 weeks after levothyroxine dose adjustment until euthyroid; annual TSH monitoring during maintenance therapy
    • HbA1c elevation: Fasting glucose, random glucose, and oral glucose tolerance test for diabetes confirmation; metabolic panel for kidney and liver assessment; lipid panel for cardiovascular risk assessment; urine albumin-to-creatinine ratio for diabetic nephropathy screening; EKG for baseline cardiac assessment; ophthalmology referral for retinopathy screening; podiatry referral for neuropathy assessment; HbA1c monitoring every 3 months initially, then quarterly during intensified therapy
    • CBC abnormalities: Peripheral blood smear for morphology assessment; reticulocyte count if anemia present to assess bone marrow response; iron studies if microcytic anemia (iron deficiency); B12 and folate levels if macrocytic anemia (megaloblastic); bone marrow biopsy if severe cytopenias or unexplained findings; flow cytometry if leukemia/lymphoma suspected; hemoglobin electrophoresis if hemoglobinopathy suspected; blood cultures if elevated WBC with clinical signs of infection
    • 25-OH Vitamin D deficiency: Vitamin D supplementation initiation (ergocalciferol or cholecalciferol) with dosing based on baseline level; repeat vitamin D level after 6-8 weeks of supplementation to assess adequacy of dosing; calcium and phosphate assessment; PTH level to evaluate secondary hyperparathyroidism; DEXA scan for osteoporosis assessment; dietary counseling regarding vitamin D intake; monitoring every 6-12 months during supplementation
    • Vitamin B12 deficiency: Folate level assessment; intrinsic factor and anti-parietal cell antibodies to identify pernicious anemia; Schilling test or methylmalonic acid/homocysteine levels if diagnosis unclear; B12 supplementation initiation (oral, sublingual, or parenteral based on etiology); repeat B12 level after 3-4 weeks of supplementation to assess adequacy; neurologic evaluation if neuropathy symptoms present; MRI brain if cognitive symptoms present; B12 monitoring every 6-12 months during supplementation
    • Lp-PLA2 elevation: Risk assessment for coronary artery disease with stress testing or coronary calcium scoring; intensified lipid management including statin therapy; inflammatory marker assessment (hs-CRP, IL-6); evaluation for other thrombotic/inflammatory conditions; repeat Lp-PLA2 after 3-6 months of intensive lipid therapy to assess response; consideration of darapladib (Lp-PLA2 inhibitor) in high-risk patients as clinical trial data emerges
    • General follow-up recommendations: Repeat comprehensive cardiac profile annually for baseline screening; more frequent testing (every 3-6 months) for patients with multiple abnormal results or established cardiovascular disease; stress testing or coronary calcium scoring based on risk stratification; carotid ultrasound for subclinical atherosclerosis assessment if multiple risk factors present; ankle-brachial index for peripheral arterial disease screening; echocardiography if signs of heart failure; holter monitor if arrhythmia symptoms present; medication optimization and adherence assessment at each visit
  • Fasting Required?
    • Yes, fasting is required for the Super Advanced - Cardiac Profile
    • Required fasting duration: 8-12 hours (overnight fast is recommended with blood draw ideally performed in early morning between 7-9 AM when most labs are collected)
    • Fasting specifics: No food or caloric beverages after midnight or 12 hours prior to testing; water intake is permitted and encouraged to maintain hydration; coffee, tea, juice, milk, and any food items must be avoided
    • Medications to address: Most medications should be continued with water (do not skip routine doses unless specifically instructed by physician); however, notify laboratory staff of all medications being taken; some medications may affect test results and should be continued as prescribed
    • Medications that may require adjustment: Lipid-lowering medications (statins): continue as prescribed; avoid skipping doses as fasting may not increase levels significantly; hypoglycemic agents (insulin, metformin): consult with physician as some recommend holding morning dose if fasting >2 hours; diuretics (furosemide): typically continued with water
    • Other specific patient preparation: Avoid strenuous exercise for 24 hours before testing as exercise can temporarily elevate certain markers; avoid alcohol for 24 hours before testing as alcohol can elevate triglycerides and other lipid parameters; get adequate sleep (7-9 hours) the night before testing as stress and poor sleep affect metabolic markers
    • Dietary restrictions: No alcohol for 24 hours before testing; minimize consumption of high-fat meals for 2-3 days prior as they may elevate triglycerides; maintain normal diet in days prior to testing (not unusually restricted or high-fat); avoid chewing gum or use of tobacco products in the hour before testing
    • Timing considerations: Schedule fasting blood draws in early morning (7-9 AM) when possible for consistency; afternoon fasting draws may yield different reference ranges for some parameters; ensure fasting period is documented on laboratory order form
    • Clinical notes: Fasting is essential for accurate triglyceride and lipid assessment as postprandial triglycerides can significantly elevate values; lipoproteins are most accurately measured in fasting state; glucose and insulin are affected by fasting status; failure to fast may result in falsely elevated lipid and glucose values requiring repeat testing
    • Special populations: Diabetic patients: consult with physician regarding holding or delaying morning hypoglycemic medications; hypoglycemia during fasting should prompt immediate glucose intake and rescheduling; pregnant patients: fasting should generally be safe but consult OB/GYN; very elderly or debilitated patients: shortened fasting period (8 rather than 12 hours) may be appropriate; renal failure patients: shorter fasting period acceptable due to reduced oral intake tolerance

How our test process works!

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