What happens in the weeks following a cardiac event can make or break your metabolic health. Yet most of my practice’s patients say they left the hospital with just a prescription and a pamphlet, and very little guidance on how to actively monitor their recovery.
In my 30+ years of experience as a heart surgeon, the best way to know if you are improving cardiometabolic health is to look at data. This should include biannual bloodwork, but although standard labs are a necessary place to start, there are several other markers that matter more to your heart’s longevity.
This is particularly true if you’ve already experienced a cardiac event.
Below are a few of the most important so you can keep an eye on your heart from home.
Article overview
- After a heart attack, fasting insulin, NT-proBNP, hs-TnI, and MPO can give you a far more detailed picture of your cardiac recovery than standard lab work alone.
- Consistent improvements in diet, exercise, sleep, and stress management should show up in your biomarkers in as little as 12 weeks.
- Standard labs are still a starting point for people both before and after a cardiovascular event.
Cardiometabolic markers to check outside of your usual labwork
I’d like to start by saying that getting any bloodwork done at least once a year will help you catch many dangerous heart problems early. You can’t manage what you can’t measure, as the saying goes, so any intelligence-gathering helps to keep tabs on what you’re up against.
There are, however, several other metabolic biomarkers that are useful post-heart attack, although they fall outside standard blood work panels
Here are four in particular to keep in mind:
Fasting insulin
The vast majority of people who have suffered from heart attacks have no idea they’re insulin resistant. And yet, even major news outlets find it’s “increasingly eyed as an underlying cause of cardiometabolic disorders.” One study found that “insulin resistance increases the occurrence of new cardiovascular events in patients with manifest arterial disease without known diabetes.”
In other words: if you’ve already suffered a heart attack, you’re at risk for another if you’re insulin resistant.
You’re likely to become more insulin-resistant during periods of high metabolic dysfunction — or in other words, if you struggle with inflammation. Other conditions, such as dyslipidemia, can also contribute to inflammation and insulin resistance.
But if you’re following all best practices to recover after a heart attack, you should notice a decrease in your fasting insulin over time.
Learn more about what it means to be insulin resistant and how to solve it.
NT-proBNP
When your heart starts working harder than normal, it releases something called proBNP. It then splits into two pieces:
- NT-proBNP, which stands for N-terminal pro b-type natriuretic peptide. This is an inactive byproduct that stays in the bloodstream the longest.
- Brain Natriuretic Peptide, or BNP, which is the active hormone that affects your heart function.
BNP causes your blood vessels to dilate and your kidneys to excrete extra water and salt. This combination of factors can help lower your blood pressure. So while it’s normal to have some in your bloodstream, elevated levels can signal the onset of congestive heart failure.
The easiest solution to this is reducing sodium intake. This can help lower fluid retention and ease pressure for your heart. But your best bet is simply adjusting other lifestyle factors, which I cover later on.
hs-TnI
Damaged or dying heart tissue releases proteins into the blood, which are specifically referred to as troponins. Cardiac troponin I (called cTnI) is specific to heart muscle, and it becomes extremely detectable in the bloodstreams of those who have already suffered a heart attack.
A high-sensitivity test for this troponin, abbreviated as hs-TnI, can also help you detect damage long before a heart attack occurs. But even after the fact, you can use it to monitor recovery. There’s not much you can do necessarily to lower your cardiac troponin levels, except wait for your heart to heal. But continued or recurring highs may help you identify a secondary heart attack months before it happens.
Your best bet for seeing improvement in this biomarker is, again, relying on healthier lifestyle habits. You can also work to reduce the overall burden on the heart by giving up substances like alcohol and nicotine.
Myeloperoxidase (MPO)
Myeloperoxidase is an enzyme found primarily within specific white blood cells. Under normal circumstances, its goal is to eliminate foreign invaders. But when it becomes chronically overactivated by foreign objects like plaque — as in the case of heart disease — it can cause inflammation inside your arterial walls by oxidizing LDL particles.
High MPO levels after a cardiac event can be a major red flag that you’re at risk for a secondary event. Case in point: research published in the New England Journal of Medicine found that elevated MPO levels predicted major adverse cardiac events within 30 days, even with ‘normal-looking’ troponin levels. Plus, a separate study published in JACC found that it could predict heart attacks or even death within a matter of days — in their words, a serious “risk factor for long-term mortality.”
But seeing that MPO is primarily attributed to chronic inflammation and oxidative stress, some of the easiest solutions are cutting seed oils, ditching processed food, and reducing sugar intake. Some research also suggests eating more omega-3 fatty acids and avoiding excess omega-6, which you can take via supplements or in whole, real foods.
Where to start with improving your heart biomarkers
The biomarkers listed above are very effective at identifying potential problems, but they’re not your first line of defense against a second heart attack. Adopting healthy lifestyle habits can help you make significant headway, often within 12 weeks or less.
Cardiometabolic and resistance training
Strength and cardiometabolic training have been extensively studied and show a strong correlation to better cardiovascular health.
I recommend one of three places to start:
- Walking: Walking is associated with healthier hearts, better metabolic health, and overall longevity. Even 10 to 15 minute strolls after meals can have a positive effect on your blood sugar and insulin response.
- Zone 2 training: This refers to moderately difficult aerobic training that elevates your heart rate to approximately 60% to 70% of your max. A good way to judge it is you should still be able to hold a conversation while exercising in zone 2. Try to exercise at this level for 30 minutes per day to improve cellular health.
- Resistance training: I won’t belabor the point on this one. You can learn more about resistance training in my writeup here.
Eating whole, real foods
Ultra-processed foods, heavy carbohydrates, and refined sugars are a serious threat to heart health, whether you’re pre- or post-heart attack. One of your best protections against unwanted additives is cooking at home with whole, real foods that are minimally processed. I highly recommend a protein- and fat-rich diet from animal-based sources, with staples such as beef, eggs, butter, and more.
And keep in mind not all health foods are technically healthy. There’s plenty of protein-enriched junk food floating around in the grocery store, for example.
Learn more about following a proper human diet here.
Sleep and stress management
Many of us underestimate how vital sleep is to the heart. And yet, science shows us that a consistent lack of good sleep can profoundly affect cardiometabolic biomarkers (and therefore your overall heart health).
And while there’s no such thing as the ‘perfect’ amount of sleep, most scientists agree that somewhere between seven and nine hours is a good place to aim.
Stress is also included on this list as something that goes hand-in-hand with sleep. You can’t sleep well if you’re stressed, and lack of sleep can increase stress. Finding ways to take unnecessary stress off your heart is especially important in the years following a heart attack.
Other metabolic biomarkers for heart health and beyond
In the pursuit of protecting your heart health, knowledge is power. Requesting additional biomarkers beyond the basics is an excellent step toward determining the state of your recovery. They can also show what else you could be doing to improve your metabolic health.
But if you’re new to the world of metabolic health, all these unfamiliar biomarkers might feel overwhelming. Please don’t let them be. Standard labs are, as always, a great place to start. You’re welcome to check out more of my resources on standard bloodwork and labs below: