Cardiovascular Test EXPERT

What does the Cardiovascular Test EXPERT include? 

Test of cardiovascular risk is a specialised test package designed to evaluate the risk of cardiovascular diseases stemming from disorders related to fat metabolism, diabetes, and kidney function. It encompasses screening for impaired glucose metabolism and glycated hemoglobin HBA1c, insulin, insulin resistance (HOMA-IR), lipid metabolism (cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, sd LDL cholesterol, and fatty acid profile). 

Additionally, it provides information on atherogenicity through the determination of small dense LDL particles, ApoB/ApoA1 ratio, lipoprotein (a), atherogenic index of plasma (AIP), LDL/HDL (AI1) and CHOL/HDL (AI2) indices. Renal function assessment is conducted by determining glomerular filtration rate (GF-CKD EPI), serum creatinine, microalbuminuria, and other metabolism-related parameters including ALT, GGT, uric acid, homocysteine, hs-CRP, TSH, fibrinogen, D-dimer, and blood count with a differential count.

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.

Glycated haemoglobin (HBA1c)

Glycated haemoglobin is produced in the body through the non-enzymatic binding of glucose to haemoglobin. The level of glycated haemoglobin is influenced by both glucose concentration and the lifespan of erythrocytes. Glycated haemoglobin concentration provides a reflection of glucose levels over the entire lifespan of erythrocytes, which is approximately 120 days. It is utilised to evaluate the management of diabetes over the preceding 6 to 8 weeks before the examination. 

Insulin

Insulin is a peptide hormone with anabolic effects in the body and represents the main regulator of glucose homeostasis. The biosynthesis of the hormone occurs within the β‐cells of the islets of Langerhans, where it is being secreted into the circulation as proinsulin. 

HOMA-IR

Insulin resistance refers to a state where a physiologically normal amount of insulin produces an inadequate biological response, necessitating higher insulin concentrations to achieve the desired effect. The HOMA index is used to quantify insulin resistance.

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.

GGT

GGT, in literature also referred to as GMT, is an enzyme predominantly found in the liver, with the highest concentration therein. It is positioned near the surface (membrane) of liver cells, making it among the first enzymes to be released in cases of liver and bile duct disorders.

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.

non-HDL cholesterol

non-HDL cholesterol is a way of expressing the content of lipoproteins that are involved in the development of atherosclerosis. This calculation parameter is one of the assessment criteria for estimating cardiovascular risk and is also part of several online calculators. At the same time, it is recommended as a secondary treatment target instead of LDL cholesterol in a defined group of patients.

Fatty acid profile

Fatty acids and glycerol are the main components of lipids or lipids. The fatty acid profile provides an overview of the representation of the ten saturated, monounsaturated (omega-9) and polyunsaturated (omega-6 and omega-3) fatty acids and their relative proportions of omega-6 and omega-3. Fatty acids are essential for the body, we get them from food and they play an important role in the development and functioning of the brain and nervous system, they boost immunity and they also have anti-inflammatory effects.

A blood count with differential counts

A blood count with differential counts can detect anaemia, infection or immune disorders.

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.

CRP

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.

TSH

Thyrotropic hormone is a glycoprotein synthesised in the anterior lobe of the pituitary gland. Its secretion varies throughout the day and is regulated by a negative feedback loop involving the hypothalamus-adenohypophysis-thyroid axis. TSH binds to specific receptors on the surface of thyroid follicular cells, stimulating the production of thyroid hormones.

Glomerular filtration rate (GFR)

The CKD-EPI calculation is used to assess and estimate glomerular filtration rate in adults based on serum creatinine concentration, age, sex, and race of the patient adjusted to a standard body surface area of 1.73 m3. It is derived based on data from 10 studies with 8,254 participants. As recommended by the KDIGO, the CKD-EPI equation is currently the preferred equation for calculating GF in adults.

CKD-EPI calculation

The CKD-EPI calculation is included in the result for each adult patient whose creatinine concentration has been determined.

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.

Microalbuminuria

Increased urinary albumin excretion serves as an early indicator of glomerular damage and is predictive of the progression of renal disease, particularly in individuals with diabetes and hypertension. Elevated levels of albuminuria also pose a risk factor for cardiovascular disease, even among individuals without diabetes, serving as a marker of endothelial dysfunction.

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).

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.

PREPARATION FOR URINALYSIS

If you have chosen a chemical analysis of urine and urine sediment based on the first morning urine sample, do not forget to obtain a collection tube, either at the pharmacy or at any of our sampling points. If urine culture is tested, this tube must be sterile.
 

INSTRUCTIONS TO FOLLOW
It is recommended to follow the standard drinking regime prior to urine collection, to avoid coffee and alcohol (in the case of adult clients) that are diuretic and could dilute the urine as a result of its increased production. 24 hours prior to urine collection, sexual intercourse is not appropriate because the number of cellular particles and protein in the urine will increase.
Girls and women undergo this test outside their menstrual cycle, it is not recommended to collect urine samples 3 days before or 3 days after the cycle, when red blood cells that are not produced in the urinary tract may be present. The results can be evaluated as false positives.
 

HYGIENE
Immediately before the urine collection, it is important to thoroughly clean the genitourinary tract so that urine is not contaminated with mucus, bacteria or soap. When urinating, women and girls will separate their labia and wash their external genital organs with lukewarm water. Men and boys will pull back their foreskin and wash their penis. Your hands must be clean when doing so.
 

PROCEDURE
The medium (released after one third of the urine has been emptied) morning urine should be collected. Allow the first part of the urine to end in the toilet to ensure that bacteria from the outer urinary tract have been removed and cells peeled from the urethral meatus have been eliminated. The second (medium) part of the urine shows the actual state of the urinary tract. Urine should be collected directly into a 10 ml collection tube. The remaining urine is drained back into the toilet. Close the tube tightly and rinse with water. Carefully close with the test tube cap. Do not touch the bottom of the cap with your hands, and do not place its inner side on washbasins or bathtubs. Hold the cap of the test tube only around its outer perimeter to prevent any contamination of the collected urine by bacteria on your hands or furniture. Do not pour the urine from other containers, as it may get contaminated by bacteria or fibres attached to such containers. Always collect urine samples directly into the tube.
 

STORAGE AND TRANSPORT
The sample should be delivered for analysis within 4 hours after its collection and should be maintained at 4-8 °C to avoid the decomposition of cellular elements in the urine or the bacterial proliferation at higher temperatures. Biochemical quantitative urine assay A sample of spontaneous urination is collected for examination. A urine collection tube should be prepared in the evening before the test date. If you do not have an original urine collection tube, a 3dcl jar is sufficient. The jar must be clean, rinsed with boiling water and left to dry. Collect all of the urine in the jar after performing morning genitourinary tract hygiene, then pour approximately 10 ml of urine into the collection tube. You will obtain a mixed representative sample needed to determine creatinine, total protein, albumin levels or urine electrophoresis.
One common, clean urine collection tube, usually with a yellow cap, is sufficient for the chemical analysis of urine and urinary sediment. For culture testing, urine should be collected in a sterile tube, usually with a red cap. The use of empty bottles and other household urine collection containers is not appropriate due to the presence of bacteria and other components. One common, clean urine collection tube, usually with a yellow cap, is required for a quantitative biochemical assay. Proper preparation prior to the urine collection is a must for a correct result. A correct result is one of the conditions to reach the correct diagnosis.
 

SPECIFIC SITUATIONS
In order to obtain relevant answers to your questions through laboratory tests, it is important to accurately inform about the following facts before your blood test:
•    regularly used medicines and supplements (ideally present a written list right before the blood test)
•    infectious diseases you suffer from (HIV, hepatitis, mononucleosis...)
•    contact with an infected person or presence in an infectious environment

[1] Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020; 76:2982.

[2] Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347.

[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.