Hello, my friend!
Happy June, and happy solstice!
Question: How would you know if you were developing diabetes or heart disease?
The answer for many people is they don't. Cardiometabolic diseases often develop silently for years before symptoms appear. In fact, nearly half of adults have at least one major cardiometabolic risk factor, yet many remain unaware until significant damage has already occurred.
Why assessing your cardiometabolic risk factors early can literally save your life
Heart disease, stroke, type 2 diabetes, fatty liver disease, and even some forms of dementia all share many of the same underlying drivers. Collectively, these are known as cardiometabolic diseases, and they are among the leading causes of illness and death in Canada.
The good news? You can assess your health status early so you can be proactive in preventing these problems from causing symptoms, or worse: becoming life-threatening.
What is cardiometabolic health?
Cardiometabolic health refers to how well your body regulates blood sugar, cholesterol, blood pressure, inflammation, and body fat distribution.
Poor cardiometabolic health doesn't necessarily mean you have diabetes or heart disease. It can simply mean that your body is beginning to show signs of dysfunction that increase your risk of developing these conditions in the future.
Common cardiometabolic risk factors include:
• Insulin resistance
• Elevated cholesterol or triglycerides
• High blood pressure
• Chronic low-grade inflammation
• Excess abdominal fat
• Sedentary lifestyle
• Poor sleep
• Chronic stress
• Smoking
• Genetics
Unfortunately, many people with early cardiometabolic dysfunction feel completely well and may not realize there is a problem until significant disease has already developed.
My recommendation: Test. Don't wait.
Most family doctors in BC will typically monitor blood sugar, cholesterol, and blood pressure. Routine monitoring of these should start in your 40s-50s or earlier if you have risk factors such as obesity, are a smoker, certain genetic background, or a family history of cardiometabolic disease.
Many of the people I work with are motivated to optimize their health and do whatever they can to prevent cardiometabolic disease. I'm happy to report there are several other lab tests available that can provide important and detailed information about your health status so you can be proactive.
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Here is the full list of tests I recommend for cardiometabolic health assessment:
1. Fasting Blood Glucose
This measures the amount of sugar in your blood after an overnight fast.
While helpful, fasting glucose is often one of the last markers to become abnormal. Many people have insulin resistance for years before their fasting glucose rises.
2. Hemoglobin A1c (HbA1c)
HbA1c reflects your average blood sugar over approximately three months.
An elevated HbA1c may indicate prediabetes or diabetes, but even values within the conventional "normal" range can sometimes suggest impaired blood sugar regulation.
3. Fasting Insulin
Fasting insulin is one of the most useful tests for identifying insulin resistance, a condition in which cells become less responsive to insulin and the body compensates by producing more of it.
Insulin resistance is associated with:
- Weight gain and difficulty losing weight
- Increased hunger and sugar cravings
- Polycystic ovarian syndrome (PCOS)
- Fatty liver disease
- Prediabetes and type 2 diabetes
- Increased cardiovascular risk
Unfortunately, fasting insulin is not routinely measured in conventional medical care despite its value in detecting metabolic problems early. This one is usually only available through a naturopathic doctor, functional medical doctor, or endocrinologist.
4. HOMA-IR
HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) is a calculated marker derived from fasting glucose and fasting insulin levels.
It provides an estimate of how hard the body is working to maintain normal blood sugar levels and can help identify insulin resistance years before diabetes develops. This calculation can catch insulin resistance even if fasting glucose and fasting insulin test as "normal".
5. Lipid panel (aka cholesterol panel)
A standard lipid panel measures:
- Total cholesterol
- LDL cholesterol
- HDL cholesterol
- Triglycerides
These markers provide useful information, but they don't always tell the whole story.
Some individuals with "normal" cholesterol levels still develop cardiovascular disease, while others with elevated cholesterol may never experience a heart attack or stroke.
6. Apolipoprotein A1 (ApoA1)
ApoA1 is the primary protein component of HDL cholesterol and is often considered the body's "good" apolipoprotein.
Its role is to transport cholesterol away from tissues and artery walls back to the liver, where it can be recycled or removed from the body.
Higher ApoA1 levels are generally associated with a lower risk of cardiovascular disease.
7. Apolipoprotein B (ApoB)
ApoB is found on LDL, VLDL, and other cholesterol-containing particles that can contribute to plaque formation within arteries.
Many experts consider ApoB to be a better indicator of cardiovascular risk than LDL cholesterol alone because it reflects the actual number of potentially artery-clogging particles circulating in the bloodstream.
Higher ApoB levels are associated with an increased risk of heart attack and stroke, and lower levels are generally preferred.
5 "unusual" cardometabolic risk tests I recommend
(that your doctor probably won't order):
Lipoprotein(a) (done once)
Apolipoprotein A-1
Apolipoprotein B
Homocysteine
Fasting Insulin
Lipoprote
Alaina Rollington · Culinary Masters
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8. ApoB:ApoA1 Ratio
The ApoB:ApoA1 ratio provides an estimate of the balance between cholesterol particles that may contribute to plaque buildup and those involved in cholesterol removal.
A higher ratio is associated with increased cardiovascular risk, while lower ratios are generally considered more favourable.
As a rough guide:
- Less than 0.5 – considered optimal
- Less than 0.8 – generally considered acceptable
- Greater than 0.9 – associated with increased cardiovascular risk
These values should always be interpreted in the context of a person's overall health and risk factors.
9. Lipoprotein(a) – Lp(a)
Lp(a) is a genetically determined cholesterol particle associated with an increased risk of heart attack, stroke, and aortic valve disease.
Unlike many other cardiovascular risk factors, lifestyle changes have little effect on Lp(a) levels.
Because it is largely inherited, many experts recommend measuring Lp(a) at least once during adulthood, especially if there is a family history of premature cardiovascular disease.
10. High-Sensitivity C-Reactive Protein (hs-CRP)
This test measures low-grade inflammation within the body.
Inflammation contributes to the development and progression of atherosclerosis, insulin resistance, and many chronic diseases.
An elevated hs-CRP does not diagnose a specific disease, but it can indicate increased cardiometabolic risk.
11. Liver Enzymes
Markers such as ALT, AST, and GGT can provide clues about liver health.
Non-alcoholic fatty liver disease is increasingly common and is strongly associated with insulin resistance and metabolic dysfunction.
12. Homocysteine
Homocysteine is an amino acid that may become elevated due to genetic factors, nutrient deficiencies (particularly folate, vitamin B6, and vitamin B12), kidney dysfunction, or certain medications.
Elevated homocysteine levels have been associated with cardiovascular disease and stroke, although researchers continue to debate whether lowering homocysteine directly reduces cardiovascular risk.
13. Kidney Function Tests
Kidney function markers such as creatinine, estimated glomerular filtration rate (eGFR), and urine albumin can help identify early kidney damage related to diabetes, hypertension, and cardiovascular disease.
Additional Testing
Some individuals at particularly high risk for cardiovascular disease may benefit from additional testing, such as fasting C-peptide measurements or coronary artery calcium scoring. These investigations are generally ordered through specialists and may not be appropriate for everyone.
Can my doctor order these tests?
First, it's important to understand that physicians order laboratory tests based on clinical guidelines, symptoms, and whether the results are likely to change management. Our public healthcare system is designed primarily to diagnose and treat disease, rather than to optimize health or identify subtle risk factors before problems arise. That said, there are several tests your family doctor can order that provide valuable information about your cardiometabolic risk.
Your doctor can order:
- Fasting glucose
- Hemoglobin A1C
- Lipid panel
- High sensitivity C-reactive protein
- Liver enzymes
- Homocysteine (maybe)
- Kidney function tests
Your doctor likely cannot order (but you can ask!):
- Fasting insulin
- HOMA-IR (calculation using fasting glucose + fasting insulin)
- Apolipoprotein A1
- Apolipoprotein B
- Lipoprotein(a)
Should everyone have these tests?
Not necessarily, but if you simply want a detailed snapshot of your current status or a clearer understanding of your long-term health risks, these tests can help catch problems early (or put your mind at ease if results are normal).
The most appropriate testing depends on your age, personal medical history, family history, symptoms, and overall risk factors.
However, detailed laboratory assessment may be worth considering if you:
- Carry excess weight around your abdomen
- Have a family history of diabetes or heart disease
- Have high blood pressure
- Have a high-sugar/high carb diet
- Are a smoker or consume alcohol
- Have a sedentary lifestyle
- Have PCOS
- Struggle with sleep and/or stress
- Have been told you have elevated cholesterol
- Experience difficulty losing weight despite healthy habits
- Have fatty liver disease
- Have a history of gestational diabetes
BLOG POST:
10 Signs You Could Be Insulin Resistant
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Prevention Matters
Cardiometabolic disease does not develop overnight.
For many people, there is a long window of opportunity where changes to nutrition, exercise, sleep, stress management, and targeted treatment can meaningfully reduce future risk.
Understanding your current health status can help you make informed decisions today that may benefit your health for decades to come.
If you'd like to discuss whether cardiometabolic testing is appropriate for you, feel free to book an appointment. Together, we can review your personal risk factors and determine which investigations may provide the most useful information for your situation.
That's all for this month!
Comments? Questions? Just reply to this email! I'd love to hear what you think!
Psst!!
If you're in BC and looking for a personal health detective, I'd be happy to help you. Simply click below to book an appointment or a discovery call.
www.okanagannaturopath.com
hello@drericavolk.com
Tel: 778.760.3400 Fax: 844.991.3601
1025 Tamarack Drive | Kelowna, BC | V1X 1E3
