Cardiovascular Test BASIC

What does the Cardiovascular Test BASIC include? 

This comprehensive laboratory package comprises numerous specific tests in addition to blood counts. It evaluates parameters indicative of disorders related to glucose metabolism, kidney function (urea, creatinine), liver function (total bilirubin, ALT), and lipid metabolism (cholesterol, triacylglycerols, LDL cholesterol, HDL cholesterol).

 Furthermore, it includes lipid metabolism analysis, specifically assessing small dense LDL particles, the ApoB/ApoA1 ratio, and the atherogenic index of plasma (AIP). Additionally, it covers parameters recognised as independent risk factors for atherosclerosis (uric acid, high-sensitivity CRP, homocysteine, fibrinogen, D-dimer). To assess myocardial status, the package also incorporates creatine kinase and NTpro BNP (a heart failure marker) determinations.

Glucose

Blood glucose concentration (=glycaemia) depends on the balance between uptake (food, supply from the liver between meals—glycogenolysis, gluconeogenesis) and its utilisation by cells, as well as on its hormonal regulation: insulin decreases glycaemia, while glucagon, adrenaline, cortisol, and growth hormone increase it.

ALT

ALT is a crucial enzyme frequently utilised in diagnosing hepatocellular injury, often alongside AST. It catalyses the transfer of an amino group of alanine to ketoglutaric acid. Unlike AST, ALT is predominantly found in the liver and is exclusively located in the cytosol.

Uric acid

Uric acid is a nitrogenous compound produced in humans as an end product of purine metabolism. In individuals with good health, it serves as a potent antioxidant, effectively scavenging free oxygen radicals. It is also included as one of the biomarkers in the metabolic syndrome panel.

Total bilirubin

Bilirubin is a degradation product of haemoglobin. It is transported from the monocytomacrophage system to the liver via albumin. This bilirubin is insoluble in water and is also called indirect or unconjugated bilirubin. In the liver, it is conjugated with glucuronic acid to form conjugated ( direct) bilirubin. Conjugated bilirubin is excreted via the bile duct into the small intestine. In the intestine it is metabolized by bacteria to urobilinogen and stercobilinogen. However, the serum bilirubin value depends not only on the function of the liver, but also on its perfusion and on the intensity of hemoglobin breakdown.

Cholesterol

Cholesterol is an essential component of every cell in the body and serves several vital functions. It exists in the human body either from exogenous sources (obtained from outside through food) or endogenously (produced within the body).

LDL

LDL cholesterol refers to the cholesterol carried within LDL particles. LDL particles are categorised within the apoB family of lipoprotein particles, known to be atherogenic. The apoprotein B100 remains within the LDL envelope and serves as both a structural and ligand apoprotein. LDL cholesterol is a significant marker of cardiovascular risk. It is targeted in the evaluation of cardiovascular risk and the monitoring of pharmacological treatments for hypercholesterolemia.

HDL

HDL cholesterol refers to the cholesterol carried within HDL particles. HDL particles are created from the surplus phospholipids of the VLDL envelope, along with a variable number of apoprotein A molecules during the metabolism of VLDL to LDL. The concentration of serum HDL cholesterol indirectly indicates the quantity of antiatherogenic HDL particles present.

Triglycerides

Triglycerides serve as a primary source of fatty acids for energy metabolism. They constitute approximately 95% of adipose tissue.

ApoA

The apolipoprotein A1 protein plays a crucial regulatory role in lipoprotein metabolism. It is synthesised in both the liver and intestine. Besides its role in structurally stabilising HDL particles, it performs other functions in lipoprotein metabolism. One of its key roles in atherogenesis is activating the lecithin-cholesterol acyltransferase (LCAT) enzyme, which is responsible for cholesterol esterification.

ApoB

Apolipoprotein B100 (apoB) serves as the principal structural apoprotein for the group of apolipoprotein B lipoprotein particles (including VLDL, IDL, LDL, and remnant particles). Each of these particles contains one apoB molecule, making its quantity a reliable indicator of the number of these particles in serum. Additionally, in relation to LDL cholesterol concentration, apoB serves as a marker for the proportion of atherogenic small dense (sdLDL) lipoprotein particles.

ApoB/ApoA1

It represents a ratio between atherogenic (apoB) and antiatherogenic (apoA1) plasma lipoprotein particles. It reflects cholesterol transport in lipoprotein particles and is a more accurate indicator of cardiovascular risk than other parameters of lipid metabolism.

sd LDL Cholesterol

The LDL particle population varies in size and metabolic activity. Large LDL particles primarily serve as cholesterol donors for cells requiring cholesterol as a substrate for metabolic activities. However, the cardiovascular risk is attributed to small LDL particles, as they possess the capability to penetrate into subendothelial spaces where they aggregate and undergo oxidation.

Atherogenic index of plasma

The calculated AIP takes into account not only the absolute values of the parameters from which it is calculated (TG and HDL cholesterol), but also the size of the lipoprotein particle subpopulations. The atherogenicity of lipoprotein particles depends on their composition and size.

hsCRP

C-reactive protein (CRP) is comprised of five identical unglycated globular subunits, each with a molecular mass of 25 kDa. These subunits are organised by non-covalent bonds into a single disc. It is classified as a pentraxin. It is synthesised in the liver in response to stimulation by cytokines, primarily IL-6, IL-13, and TNF-α. High-sensitivity CRP (hs-CRP) measurement is employed in assessing cardiovascular risk. The hs-CRP level correlates with the risk of developing metabolic syndrome, type 2 diabetes mellitus, and arterial hypertension.

Urea

Urea is the primary nitrogenous waste product of amino acid and protein metabolism. It is synthesised in the liver from ammonia produced as a result of deamination reactions during amino acid metabolism.

Urea is filtered by the kidneys and excreted into the urine through glomerular filtration.

Creatinine

Creatinine is produced in muscle tissue after the cleavage of phosphate from creatine phosphate, which acts as an energy source for muscles. It is primarily eliminated by the kidneys through glomerular filtration at a relatively consistent rate.

Fibrinogen

Fibrinogen, also known as coagulation factor I, is a glycoprotein found in relatively high concentrations in plasma compared to other coagulation factors. It is synthesised in the liver and megakaryocytes. As the final step in the coagulation cascade, fibrinogen is converted by thrombin to fibrin, which is a crucial component of the final red thrombus. This is facilitated by calcium and fibrin-stabilising factor XIII.

D-dimer

D-dimer is a highly sensitive marker that indicates activation of fibrinolysis. The most common manifestation of venous thromboembolism is deep vein thrombosis, or pulmonary embolism, which is directly related to an increase in blood D-dimer levels.

Homocysteine

Homocysteine (Hcy) is a sulfur-containing amino acid involved in methionine metabolism. Approximately 1–2% of homocysteine circulates in the blood in its free reduced form, some as disulfides, and 70–90% is bound to proteins. The measurement of homocysteine levels is important for assessing the risk of developing vitamin B12, B6, and folate deficiencies, as well as the risk of ischemic heart disease (IHD).

Creatine kinase (CK)

Creatine kinase is an enzyme that facilitates the transfer of macroergic phosphate from ATP to creatine, forming creatine phosphate. It plays a crucial role in energy metabolism in muscle tissue. The majority of this enzyme is located in the cytosol in the form of three isoenzymes: CK-MM, CK-MB, and CK-BB. CK-MM is predominant in skeletal muscle tissue.

NT-proBNP

B-type natriuretic peptide (BNP) shares similar biological effects with A-type natriuretic peptide (ANP). Under normal conditions, both peptides are produced in the atria of the heart. ANP is stored in granules, whereas BNP is stored only in small amounts, requiring de novo synthesis to increase its levels. However, in heart failure (HF), BNP production occurs in the myocardium of the ventricles.

We do not recommend entry of patients/clients with clinical signs of disease (temperature, cough, signs of respiratory tract infection, etc.) to undergo this test.
We recommend hand disinfection prior to entry to the clinics/collection points.

It is advised to fast for a minimum of 8 hours by refraining from eating or drinking anything expect water. Faiing to fast before the test may affect result quality. If you are currently on medications, consult your healtcare provider to determine whether you should continue taking them prior to the test.

PREPARATION FOR BLOOD COLLECTION
The recommended time to collect blood is between 7 a.m. and 9 a.m., to obtain comparable results from different blood draws. To assess the numerical test result, so-called reference intervals are used, which are based on morning fasting collections and are used for population comparison. This time interval is also recommended in light of the biological cycles that naturally take place in the body.

GENERAL PRE-SAMPLING INSTRUCTIONS
• It is necessary to come to the testing site earlier, so that you can rest in the waiting room for approximately 20 minutes to have a relatively relaxed body and mind.
• It is not advisable to draw blood before collection.
• It is necessary to arrive on an empty stomach for the collection itself, in the case of collections at a later time in the day, at least three hours on an empty stomach. At home, it is desirable to drink a sufficient amount of pure water (at least up to half a liter) - this is important for a successful blood collection. Mineral water, juice, coffee and tea are not recommended.
Herbs included in tea may contain substances affecting the blood count. Coffee and black tea increase gastric acid production and release insulin from the pancreas, thereby affecting glucose metabolism. Since everything in the body is interrelated, they can impact other tests. Another extreme is when your body is running out of fluids. In this case, the number of red blood cells, the level of protein and lipids bound to the protein increase and the level of urea in the blood can also increase. It is therefore advisable to drink pure water when you wake up.


Generally, it is recommended to:
• around 6 p.m. eat only light meals, do not eat fatty food (cheese, butter, cream, meat, smoked meat, bacon) and sweet meals,
• fast for 10-12 hours (Attention: it is not advisable to starve for more than 16 hours!), in the case of later collection (after 9:30 a.m.), a lighter breakfast is allowed, no later than 3 hours before collection,
• drink non-alcoholic beverages and drinks without sugar in the usual quantity, in the case of adult clients 24 hours before blood collection (Alcohol in the blood changes lipid levels, the level of glucose is reduced, uric acid levels increase and liver enzymes are released into the blood),
• take only prescribed medicines in the evening,
• avoid increased physical activity, and strength and endurance exercise the day before blood collection (Lipid, glucose, some enzyme levels in the blood and other parameters may change during physical activity. The recovery of normal values to maintain the accuracy of laboratory results may take a longer time, depending on the duration of the exercise, your physical fitness in general and other factors. We recommend maintaining normal daily physical activity such as light stretching, short cycling to work, gardening, etc.),
• avoid psychological stress, which raises blood glucose levels and causes the release of stress hormones in particular,
• avoid smoking for at least 6 hours prior to blood collection because it increases the level of carbonylhemoglobin produced by the reaction of the blood dye with carbon monoxide and alters the permeability and elasticity of the vessels, affecting the ratios of blood analytes,
• do not chew gum for at least 6 hours before blood collection, as this may affect glucose and enzyme levels,
• do not undergo stressful diagnostic or therapeutic interventions for at least 24 hours prior to blood collection.
If any of the tests you have selected require special preparation, you will be informed of the fact by email with the order and blood collection instructions attached. These specific instructions have priority over the general recommendations for preparation.


MEDICINES
It is recommended to have blood collected before the planned doses of medicines. If it is not possible to take the medicine later, you should inform the nurse during blood collection and specify what medication you have taken.
Take the medicines prescribed by your doctor in the morning or bring them with you to take them after blood collection (thyroid medicines, antihypertensive medicines, blood thinners, contraceptives, etc.) In the case of later collection (after 9:30 a.m.), you can take the prescribed medication in the morning.
Do not take iron, vitamin, nutritional supplements or other supplements, including homeopathics, for at least three (3) days prior to blood collection.


SPECIFIC SITUATIONS
In order to obtain the appropriate answers to your questions with regard to the laboratory tests, it is important to accurately notify the nurse at the healthcare provider about the following facts prior to your blood test:
• regularly used medicines and supplements (ideally come with a written list to the blood collection site),
• infectious diseases you suffer from (e.g., HIV, hepatitis, mononucleosis...),
• contact with an infected person or presence in an infectious environment,
• if you have received an infusion within the last 5 days, specify into which limb,
• intramuscular injections within 3 days prior to the blood collection date,
• long-term immobilisation, lost ability to move,
• activities at higher altitudes,
• allergy to common band-aids,
• if you feel unwell when looking at blood or needles, please also notify our blood collection staff of the fact.


OTHER FACTORS
Please note that prolonged use of medication or other important factors may affect the values measured by the tests you have selected. For more information, please see the description of the specific test. To obtain objective test results, take the time to properly prepare for your blood collection.

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[3] Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation 2015; 132:1667.

[4] Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121:586.