1st order laboratory parameters – obligatory laboratory tests.
- Small blood count
- Inflammatory parameters – CRP (C-reactive protein).
- Fasting glucose (fasting blood glucose) (annual control) [oGTT is more appropriate as a screening parameter – see below. oGTT]
- HbA1c [linear association with CHD in non-diabetics; moreover, independent association of HbA1c level with disease severity (1)]
- Thyroid parameters – TSH
- Atherosclerosis parameters 1st order (annual control):
- Total cholesterol, LDL cholesterol, HDL cholesterol.
- Triglycerides
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- Oral glucose tetolerence test (oGTT) [120-minute value in the oGTT: ≥ 7.8 mmol/l allows an indication of the risk of cardiovascular events (cardiovascular-related death, nonfatal myocardial infarction (heart attack), apoplexy (stroke), or hospital admission for heart failure/heart failure)]
- 2nd order atherosclerosis parameters):
- Homocysteine [determination required only once].
- Lipoprotein (a) – lipoprotein electrophoresis, if necessary [in men, a single determination of lipoprotein (a) is sufficient; in women, a determination before and after menopause is required]
- Apolipoprotein E – genotype 4 (ApoE4) [determination required only once]
- Fasting insulin
- Fibrinogen [determination required only once]
- High-sensitivity cardiac troponin T (hs-cTnT) or troponin I (hs-cTnI) – in unstable angina pectoris.
- D-dimers – acute diagnosis of suspected fresh venous thrombosis (see also under “Venous Thrombosis/Physical Examination” Wells score to determine clinical probability of venous thrombosis, DVT)[positive D-dimers are not specific for thrombosis or pulmonary embolism; however, negative D-dimers rule out thrombosis or pulmonary embolism with greater than 99%. Probability exclude]
Preventive laboratory diagnostics
- Trimethylamine oxide (TMAO), more specifically trimethylamine N-oxide (TMAO); pro-atherogenic and prothrombotic metabolite produced from gut microbiome metabolism of dietary trimethylamine (TMA)-containing nutrients such as choline or carnitine; indications:
- Determination of near- and long-term risks for cardiovascular events (still in the evaluation phase).
- Increases in TMAO levels between 1989/90 and 2000-2002 correlated with a significant 58% increase in CHD-associated events (myocardial infarction/heart attack and death from coronary artery disease (CAD; coronary artery disease)) by 2016; for every one standard deviation increase in TMAO, the risk increased by 33%
Further notes
- Creatinine should be checked annually in CHD patients.
- Lipoprotein (a) is an independent predictor of coronary heart disease severity for individuals with type 2 diabetes.
- Fasting insulin serum levels may be elevated without basal glucose serum levels.
- In acute myocardial infarction (heart attack), troponin T is detectable within 3-4 hours in circa 50% of patients. Sensitivity (percentage of diseased patients in whom the disease is detected by the use of the test, i.e., a positive test result occurs) is 100% when measured between 10 hours and 5 days after the acute event, with very high specificity (probability that actually healthy people who do not have the disease in question are also detected as healthy in the test) 82%.
- In patients with stable coronary artery disease, elevated D-dimers (> 273 ng/ml) tell the following about the long-term prognosis of patients:
- Risk for patients to have a serious coronary or cardiovascular event within the next 6 years was 45% higher than in patients with low D-dimer concentration (≤ 112 ng/ml).
- Risk of venous thromboembolism (VTE) increased more than 4-fold.
- All-cause mortality was increased by 65%.
