How does Boston Heart Improve the Quality of Care?

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1. Boston Heart Cholesterol Balance Test – Cholesterol Absorption/Production Rates. (PDF)
2. Boston Heart HDL Map – Measure HDL particle quality and reverse cholesterol transport. (PDF)
3. ApoA-1 – Protein that provides structure to HDL particles.
4. Apo-B – Particle carrying atherogenic lipoprotein particles.
5. ApoB/ApoA-1 – Ratio is a strong predictor of heart disease risk.
6. Lp(a) – Atherogenic LDL/protein. Genetically influenced.
7. sdLDL-C – Denser and more atherogenic LDL-particles. sdLDL-C risk in the Pooling Project
8. Direct LDL-C – Measure of the amount of cholesterol in the atherogenic low-density lipoproteins.
9. HDL-C – Measure of high density cholesterol particles.
10. HDL-C/TG Ratio – Low levels of this ratio are very strongly linked to diabetes, insulin resistance, and metabolic syndrome.
11. HDL Particle Number – Tested with NMR.
12. LDL Particle Number – Tested with NMR.
13. Non-HDL-C – Calculation that represents the cholesterol carried by all atherogenic particles including: Chylomicron remnants, VLDL, IDL, LDL, Lp(a).
14. Total Cholesterol – Measure of the amount of cholesterol in all cholesterol-containing lipoproteins.
15. TC/HDL-C Ratio – Calculated by dividing total cholesterol by HDL cholesterol.
16. Triglycerides – Composed of three fatty acids attached to glycerol that function as fat storage.
17. VLDL-C – Type of lipoprotein made in the liver that carries triglycerides and cholesterol.
18. VLDL-C/TG Ratio – A high ratio is linked to abnormal lipid metabolism and increased risk of CVD events.

1. Boston Heart Fatty Acid Balance ™ – Balancing fatty acids can improve cholesterol and triglyceride levels, improve immune system function as well as reduce inflammation and rate of heart disease. (PDF)
2. Boston Heart Beta Cell Function and Risk Score – Calculation based on fasting glucose and insulin (or c-peptide) designed to give insights into beta cell function. (PDF)
3. Boston Heart Prediabetes Assessment® – Helps healthcare providers identify patients at higher risk of developing diabetes, with 92% accuracy. (PDF) (Learn More)
4. Glucose – Major short term source of energy for the body, and is obtained from the diet, as well as being produced in the liver.
5. Adiponectin – Measure of the amount of a hormone produced by fat cells that protects against developing heart disease and diabetes.
6. Glycated Serum Protein (GSP) – amount of glucose attached to total serum proteins that indicate the average amount of glucose in the blood over the previous two to three weeks.
7. HbA1c – Measures the concentration of glucose attached to the hemoglobin in red blood cells. It assesses the average amount of glucose in the blood over the last two to three months.
8. Insulin – Insulin is a hormone responsible for the transportation and storage of glucose in cells. It regulates glucose levels in blood. This test measures the amount of insulin in blood.
9. C-Peptide –  is a polypeptide produced by β-cells of the pancreas along with insulin. It serves as an accurate measure of insulin production, even in patients receiving insulin treatment.
10. HOMA-B (Beta Cell Activity) – Predictive measurement for diabetes
11. HOMA-IR  – (Insulin Resistance) Standard measure of insulin resistance is the homeostasis model, based on both fasting insulin and fasting glucose level. Also called Homeostasis Model of Insulin Resistance (HOMA-IR).
12. HOMA-S (Insulin Sensitivity) – Measurement to determine the potency of and individuals produced insulin.

1. Inflammation Overview – (PDF)
2. hs-CRP – CRP is an acute phase inflammatory plasma protein synthesized by the liver. The “high sensitivity” CRP test is needed to detect very low levels of CRP that may be seen with vascular and/or systemic inflammation.
3. LpPLA2 Activity – Increased blood levels of LpPLA2 are associated with soft, active growing plaque.*
4. Myeloperoxidase (MPO) – Elevated levels of MPO may indicate the presence of unstable plaque or buildup in the arterial wall and an increased risk of plaque rupture. In patients with high levels of MPO, careful evaluation of CVD risk should be considered by the healthcare professional. (PDF)
5. Fibrinogen – Fibrinogen or Factor I is an acute phase inflammatory plasma protein synthesized by the liver and is an essential component in the clotting cascade.
6. IL-6 (Reference Ranges for CVD or COVID19) – cytokine produced by macrophages in response to acute or chronic inflammatory conditions. Elevated levels of IL-6 are associated with an excess of cholesterol-laden macrophages in arterial walls, systemic arterial inflammation, and increased risk of cardiovascular events.
7. OxPL-apoB – Oxidized phospholipids are found on all apoB-containing lipoproteins, namely, LDL, VLDL, and especially Lp(a). When taken up by the artery wall, oxidized lipoproteins accelerate atherosclerosis. (PDF)
8. Ox-LDL – OxLDL is readily taken up by macrophages and is converted to cholesterol-rich foam cells, leading in turn to the fatty streaks and lipid-rich plaques, which are the hallmark of atherosclerosis.
9. TMAO – Trimethylamine N-oxide levels in blood quantified by reverse phase liquid chromatography-mass spectrometry (LC-MS/MS) to help clinicians optimize wellness and longevity related to the interaction between diet and intestinal bacteria. (PDF)

1. ApoE (CVD/Dementia Risk) – Apolipoprotein E is a critical protein component of very low-density lipoprotein (VLDL) and chylomicrons.
2. Factor V Leiden (Clot Formation) – Factor V is a coagulation protein produced by the liver. The genetic test identifies individuals with defects in clotting factors, thus allowing the physician to determine the need for more aggressive thrombosis prevention measures.
3. Factor II (Clot Formation)* – Another coagulation protein produced by the liver. Use testing as an aid in selection of appropriate thrombosis prevention regimens.
4. CYP2C19 (Clopidogrel Response) – CYP2C19 polymorphisms are inherited variations in the DNA sequence of the gene that codes for the cytochrome P450 (CYP) enzyme 2C19. This enzyme is found in the liver and converts the pro-drug clopidogrel (PLAVIX®) to its active form.
5. SLCO1B1 (Statin-Induced Myopathy)* – SLCO1B1 gene is critical to the body’s uptake and metabolism of statins, drugs prescribed to reduce LDL-C levels for the prevention of heart attacks or strokes. (PDF)
6. MTHFR (Folate Metabolism)* – Enzyme responsible for metabolizing folate methyl folate which, in turn, is essential for converting homocysteine to methionine.
7. LPA (Aspirin Benefit)* – Test identifies individuals who are at risk of having elevated plasma lipoprotein (a) and may have greater than two-fold risk of cardiovascular disease (CVD).
8. KIF6 (Statin Benefit)* – Test identifies individuals with a gene variant associated with increased risk of coronary heart disease (CHD). Carriers have enhanced CHD risk reduction when treated with statin therapy.
9. 9p21 (Premature CVD Risk)* – Test identifies individuals who may be at an increased risk of premature CVD which allows for risk reclassification and more aggressive management of modifiable risk factors.
10. 4q25 (Atrial Fibrillation Risk)* – Test identifies individuals with an increased risk of atrial fibrillation (AF) and stroke.
11. Haptoglobin (Vitamin E in Diabetes)* – Test identifies individuals with diabetes or advanced kidney disease who may benefit from vitamin E supplementation. (PDF)

1. Hormones Overview – (PDF)
2. Aldosterone – Hormone secreted by the adrenal glands that regulates levels of sodium and potassium, fluid volume and blood pressure.
3. Cortisol – A steroid hormone, in the glucocorticoid class of hormones. It is produced and secreted by the adrenal glands.
4. DHEA-S – is an androgenic steroid secreted by the adrenal cortex and is the major androgen precursor in females.
5. Estradiol – Estradiol is the most potent naturally occurring estrogen.
6. FSH – one of the gonadotropins of the anterior pituitary gland that stimulates the growth and maturity of graafian follicles in the ovary and spermatogenesis in the testes.
7. LH – Luteinizing Hormone is one of the gonadotropins of the anterior pituitary gland that works with FSH to induce ovulation of mature follicles and secretion of estrogen by the ovary.
8. Progesterone – a steroid hormone secreted by the corpus luteum and placenta.
9. Prolactin – a hormone secreted by the pituitary gland that has many functions.
10. PSA Total – Total serum PSA assay is an adjunct to a rectal examination for the screening of prostate cancer, as well as for follow-up of patients with diagnosed prostate cancer.
11. PSA, Total with reflex to Free PSA – is secreted by epithelial cells of the prostate gland and is present in small quantities in the serum of men with healthy prostate glands.
12. SHBG – is a glycoprotein that binds to sex hormones, specifically testosterone and estradiol.
13. Testosterone Free – is a measurement of testosterone that is not bound to SHBG.
14. Testosterone, Total – is a measurement of free and protein-bound testosterone and is the most potent naturally occurring androgen.
15. TSH – Thyroid Stimulating Hormone is a peptide hormone synthesized and secreted by the anterior pituitary gland. TSH regulates thyroid gland function.
16. TSH with reflex to TT3 and FT4 – TSH is a peptide hormone synthesized and secreted by the anterior pituitary gland. TSH regulates thyroid gland function.
17. T3, Total – Total T3 (triiodothyronine) is a hormone generated by converting T4 to T3 in the body’s tissue.
18. T3, Free – Free T3 is the amount of T3 hormone that is freely circulating in the blood.
19. T4 Total – Total T4 (thyroxine) is a hormone produced by the thyroid gland and is converted in the body’s tissue to the major active thyroid hormone T3.
20. T4, Free – Free T4 is the amount of T4 hormone that is freely circulating in the blood.
21. Thyroglobulin Antibody (Anti-TG) – An antibody directed against the thyroid-specific protein thyroglobulin (Tg).
22. Thyroid Peroxidase (TPO) – This assay measures antibodies against thyroid peroxidase (TPO), an enzyme expressed mainly in the thyroid involved in the production of thyroid hormones T3 and T4.
23. Parathyroid Hormone – a hormone secreted by the parathyroid glands that is important in bone remodeling.

LIVER

1. ALT – Enzyme that has been reported as present in a variety of tissues. The liver is the major source of ALT.
2. AST – Enzyme that is widely distributed in tissue, mainly hepatic, cardiac, muscle, and kidney.
3. Alkaline Phosphatase – Enzyme that is found primarily in liver and biliary tract cells, as well as bone.
4. Bilirubin Total – Measures total and indirect forms of bilirubin. Bilirubin is a protein and natural by-product of red blood cell breakdown.
5. Bilirubin Direct – Protein and natural by-product of red blood cell breakdown. Measures amount of bilirubin formed in the liver to become water soluble.
6. Gamma Glutamyl Transferase – Used in the diagnoses and monitoring of hepatobiliary disorders such as fatty, alcoholic and chronic liver diseases.

KIDNEY

1. BUN – Urea is the major end product of protein nitrogen metabolism. Urea is synthesized in the liver and excreted mostly by the kidneys.
2. BUN/Creatinine Ratio – Calculation using blood (serum) urea nitrogen (BUN) and creatinine.
3. Creatinine – Break-down product of creatine phosphate in muscle and is usually produced at a fairly constant rate.
4. eGFR/Creatinine Ratio – Automatically calculated when serum cystatin C is ordered. It provides a measure of kidney filtering capacity.
5. Cystatin C – Most reliable available serum marker of kidney function and is superior to creatinine in estimating glomerular filtration (eGFR) rate as it is much less affected by age, gender, muscle mass, and/or ethnic background.
6. eGFR/Cystatin C Ratio -Total GFR can be used as an index of functioning renal mass. eGFR using cystatin C performs significantly better in prediction models than eGFR calculated from creatinine.
7. Urine Albumin/Creatinine Ratio – A recommended method to identify albuminuria, an increased excretion of urinary albumin and a marker of kidney damage

1. Albumin – is the major plasma protein responsible for regulating plasma osmotic pressure as well as providing transport for large organic anions and some drugs.
2. Amylase – Amylase is an enzyme that helps you digest carbohydrates. Most of the amylase in your body is made by your pancreas and salivary glands.
3. Calcium – Calcium is an important mineral needed for blood clotting and bone health. 
4. CBC with or without Differential – Measures and reports the following: White Blood Count (WBC), Red Blood Count (RBW), Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelets, MPV
5. Chloride – Chloride is a negatively charged electrolyte that helps regulate the body’s salt/water and acid/base balance.
6. CO2 -Bicarbonate is an electrolyte used by the body to maintain acid/base balance. (pH).
7. CoQ10 – Coenzyme Q10 (CoQ10), also known as ubiquinone, is an endogenously produced lipid-soluble cofactor that has a significant role in the formation of energy within cells. It also serves as a potent antioxidant and is very effective in inhibiting the oxidation and modification of low density lipoproteins (LDLs).
8. Creatine Kinase – CK is an enzyme that is found in muscle, heart, and brain tissues.
9. Ferritin – Ferritin is a blood cell protein that contains iron. It is the primary form of iron stored inside of cells.
10. Folate – Folate is necessary for normal metabolism, DNA synthesis and red blood cell regeneration. Untreated deficiencies may lead to megaloblastic anemia. One of the most important folate-dependent reactions is the conversion of homocysteine to methionine.
11. Homocysteine – Homocysteine is a thiol-containing amino acid formed from methionine. Values >15 µmol/L have been associated with increased risk of cardiovascular disease.
12. Iron – Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron. If you don’t have enough iron you can’t make hemoglobin.
13. TIBC – Total iron binding capacity is a blood test to see if there is too much or too little iron in the blood.
14. UIBC – Unsaturated Iron Binding Capacity measures levels of transferrin that has not bound iron
15. Magnesium – Magnesium is a mineral that is vital for energy production, muscle contraction, nerve function, and the maintenance of bone health.
16. NT-proBNP – Brain natriuretic peptide (BNP) is a neurohormone that affects body fluid homeostasis via diuresis and natriuresis. Elevated levels are seen in patients with congestive heart failure and a decreased ejection fraction. NT-proBNP is the precursor molecule for BNP.
17. Phosphorus – Phosphates are vital for energy production, muscle and nerve function, and bone growth, and play an important role as a buffer, helping to maintain the body’s acid-base balance.
18. Potassium – Potassium is an electrolyte vital to cell metabolism.
19. Protein, Total – Total protein is a measure of albumin—the main protein in the blood produced by the liver and globulins which include enzymes, antibodies, hormones, carrier proteins.
20. Sodium – Sodium is an electrolyte present in all body fluids and is vital to normal body function, including nerve and muscle function. It helps cells function normally and helps regulate the amount of fluid in the body.
21. Troponin T Gen 5 – Troponins are structural proteins of cardiac myocytes that are released into circulation after cardiac myocyte cell damage providing earlier identification of myocardial injury.
22. Uric Acid – is the final product of purine metabolism.
23. Vitamin B12 – is required for proper red blood cell formation, neurological function, and DNA synthesis. Vitamin B12 also functions as a cofactor for homocysteine metabolism.
24. Vitamin D – 25-hydroxy vitamin D is a hormone precursor that promotes bone, calcium and phosphorus metabolism.