This panel contains the following tests:

• Oxidized LDL (OxLDL) - LDL cholesterol (the “bad” cholesterol) that has been modified by oxidation, triggering inflammation leading to the formation of plaque in the arteries.
• Myeloperoxidase (MPO) - An enzyme released by white blood cells that measures your body’s response to damage in your artery walls.
• F2 Isoprostanes (F2-IsoPs) - Produced when free radicals react with neighboring molecules in a process called "oxidative stress," causing a cascade of damage in our cells initiating destructive pathways which lead to disease. F2-IsoPs may be elevated at the earliest stages of plaque development, and research has shown that people with high levels of F2-IsoPs are 30 times more likely to develop heart disease.¹

If you have normal cholesterol levels, you may assume you're not at risk for a heart attack or stroke. But that's not necessarily the case. Nearly 50% of all heart attacks occur in people with "normal" cholesterol levels. That's because dangerous inflammation present in the walls of your arteries is often the primary contributor of risk, contributing to both vulnerable plaque formation and rupture. The good news is that inflammation can be easily measured to determine your inflammatory status and cardiovascular risk.

Oxidized LDL is LDL cholesterol (the "bad" cholesterol) that has been modified by oxidation, triggering inflammation leading to the formation of plaque in the arteries. Why should you get your oxidized LDL levels tested? The facts speak for themselves:

• Individuals with high levels of OxLDL are 4 times more likely to develop metabolic syndrome in the next five years.²
• Increased OxLDL levels are associated with the presence of coronary artery disease^3-5
• Levels of OxLDL increase in a step-wise fashion as the severity of coronary artery disease increases.⁶

MPO oxidizes LDL making it atherogenic, and HDL (your good cholesterol) rendering it dysfunctional. This results in inflammation linked to plaque buildup inside the artery wall. Still not concerned that you are at risk for a heart attack? Read on …

• Individuals with elevated MPO levels are more than twice as likely to experience cardiovascular mortality.⁷
• Elevated MPO levels predict the risk of heart disease in subgroups otherwise associated with low risk.^8,9
• MPO levels are not likely to be elevated due to chronic infections or rheumatologic disorders due to the fact that MPO in the blood is a specific marker of vascular inflammation and vulnerable plaque.

F2 IsoPs are produced by the reaction of free radicals with arachidonic acid. They cause blood vessels to constrict, blood pressure to raise, and promotion of blood clots. Additionally, F2-IsoPs may be elevated at the earliest stages of plaque development and research has shown that people with high levels of F2-IsoPs are 30 times more likely to develop heart disease!¹

Instructions

Fasting is not required for this test. Take all medications as prescribed. This panel requires collection of a random urine specimen at the same time your blood is drawn.

References

1. Schwedheim E et al. Urinary 8-iso-prostaglandin F2a as a risk marker in patients with coronary heart disease: A matched case-control study. Circulation. 2004; 109: 843-848
2. Holvoet P et al. Association between circulating oxidized low-density lipoprotein and incidence of the metabolic syndrome. JAMA. 2008; 299: 2287-2293
3. Holvoet P et al. Circulating oxidized LDL is a useful marker for identifying patients with coronary artery disease. Arterioscler Thromb Vasc Biol. 2001; 21: 844-848.
4. Nishi K et al. Oxidized LDL in carotid plaques and plasma associates with plaquie instability. Aterioscler. Thromb Basc Biol. 2002; 22: 1649-1654
5. Tsimikas S et al. Oxidized phospholipids, Lp(a) lipoprotein, and coronary artery diseae. N Engl J Med, 2005; 353: 46-57
6. Ehara D et al. Elevated levels of oxidized low density lipoprotein show a positive relationship with the severity of acute coronary sndromes. Circulation, 2001: 103:1955-1960
7. Heslop CL et al. Myeloperoxidase and C-reactive protein have combined utility for long-term prediction of cardiovascular mortality after coronary angiography. J AM Coli Cardiol. 2010; 55: 1102-1109
8. Meuwese MC et al. Serum myeloperoxidase levels are associated with the future risk of coronary artery disease in apparently healthy individuals: The EPIC-Norfolk prospective population study. J Am Coli Cardiol. 2007; 50: 159-165
9. Karakas M eta al. Myeloperoxidase is associated with incident coronary heart disease independently of tradional risk factors: Results from the MONICA/KORA Augsburg study. J Intern Med. 2012; 271: 43-50