The standard lipid profile is the most basic and widely utilized screening tool in cardiovascular medicine. While an important component of overall assessment, approximately half of all individuals faced with a cardiovascular event had normal values on their lipid panel. This common test overlooks important structural and biochemical occurrences within the arterial wall. A rapidly expanding body of clinical research has clearly demonstrated that these underlying processes are valuable indicators of heart health.^1-6

Processes within the vasculature can be identified via biomarkers, molecules that serve as quantifiable indicators of biological homeostasis. Biomarker assessments are the instruments of personalized medicine because they enable evidence-based, individualized clinical evaluations based on reliable numerical values. In addition, they enable accurate monitoring of progress following changes in diet, lifestyle and nutritional supplement strategies.*

The PureHeart™ Protocol

A collaboration between Pure Encapsulations and Cleveland HeartLab Inc. has coupled affordable biomarker tests with targeted nutritional supplement options. A CAP-accredited and CLIA-certified clinical reference laboratory, Cleveland HeartLab offers a series of cardiometabolic biomarker tests that have undergone extensive scientific validation and clinical research. These sensitive screening tools are now empowering physicians across the U.S. with the ability to determine the type of support, and a means to accurately assess progress. The PureHeart™ Protocol enables clinicians to match clinical objectives, based on test results, with the most effective products from Pure Encapsulations, simplifying and individualizing supplement approaches for maximum clinical results.*

The Screening

The Cleveland HeartLab advanced cardiometabolic biomarker profile includes six unique tests that measure biomarkers of cardiovascular health (Figure 1):*

• Myeloperoxidase (MPO) is an indicator of white blood cell activity and ensuing functional changes within the vasculature. Over the past decade, hundreds of published studies have validated MPO as a highly informative biomarker of total vascular health.¹ This test can point to key objectives such as lipid balance, glucose homeostasis, vascular relaxation and optimizing coenzyme Q₁₀ status.⁷*
• The PLAC^® Test measures the vascular-specific enzyme lipoprotein-associated phospholipase A₂ (Lp-PLA₂). Levels of this enzyme reveal the activity of macrophages, reflecting the health of the arterial wall.²* Studies suggest that maintaining lipid homeostasis and blood flow help to keep this biomarker within a healthy range.⁸*
• High-sensitivity C-Reactive Protein (hsCRP) is an extremely sensitive measurement of C-reactive protein, a biomarker produced by the liver in response to cytokine activity anywhere in the cardiovascular system. This test can expedite decisions whether to evaluate and address potential underlying processes such as glucose homeostasis, vascular endothelial function and even dental health.³*
• Urinary microalbumin quantifies the amount of the serum protein albumin in urine, providing an indication of vascular endothelial integrity.⁴ This test can help in deciding whether to address related factors such as endothelial function and glucose metabolism.*
• F₂-Isoprostanes (F₂-IsoPs) and oxidized LDL (OxLDL). Oxidative stress plays an important role in cardiovascular health, and urinary F₂-IsoPs quantify this on a systemic level.⁵ The extent to which oxidative status may be affecting functional proteins involved in lipid homeostasis can be determined through the oxidized LDL (OxLDL) test.⁶*

Figure 1. Biomarkers that can be easily measured to determine vascular health. F2-IsoPs, OxLDL and hsCRP determine systemic oxidative stress and cytokine activity. Microalbumin, MPO and Lp-PLA2 specifically address the arterial wall and can indicate the need for advanced cardiovascular support.*

The Supplements

Pure Encapsulations specializes in innovative, science-driven formulations for cardiometabolic health. This dedication integrates the most advanced bioavailability technologies with evidence-based ingredients.* Examples of supplements in The PureHeart™ Protocol include:

• Ultra-pure omega-3 fatty acids such as EPA/DHA essentials address multiple objectives pertaining to arterial health, lipid balance and metabolic homeostasis. Specialty formulas such as UltraKrill+D deliver EPA and DHA in the form of phospholipids in krill oil, with vitamin D₃ and astaxanthin for added vascular support.⁹*
• Sustained-release and enhanced absorption coenzyme Q₁₀ provides powerful support for endothelial function, oxygen utilization and bioenergetics of the heart and vasculature. Ubiquinol VESIsorb^® contains the active form, ubiquinol, in a colloidal delivery system for enhanced absorption. SR-CoQ₁₀ with PQQ provides 24-hour sustained-release CoQ₁₀ in combination with PQQ, a B-vitamin-like antioxidant with a range of cardioprotective benefits.¹⁰*
• Resveratrol is a polyphenol that supports systemic antioxidant defenses, vascular endothelial relaxation and metabolic health. Resveratrol VESIsorb^® and ResCu-SR™ deliver colloidal and sustained-release resveratrol, respectively, to enhance bioavailability and maximize clinical results. Metabolic Xtra combines pure, clinically researched resVida^® resveratrol with alpha lipoic acid, berberine hydrochloride and chromium to support and maintain insulin receptor function and glucose homeostasis.¹¹*
• Proprietary polyphenol blends have been developed as part of a long-term research collaboration between Pure Encapsulations and the Institute of Nutraceuticals and Functional Foods (INAF) based at Université Laval, Quebec, Canada.¹² The cardiometabolic polyphenol platform emerging from this program includes Alpha Lipoic Acid w/GlucoPhenol™, which delivers alpha lipoic acid with strawberry and cranberry polyphenols that support glucose uptake in skeletal muscle. CranLoad™, a clinically researched blend of grape seed and cranberry extracts, supports nitric oxide synthesis and healthy flow-mediated dilation.¹³ Vascular Relax BP features CranLoad™ as part of a formula of polyphenols and magnesium to maximally support healthy endothelial function.*

Screening + Supplements = Success™

With an ongoing dedication to heart health, Pure Encapsulations provides evidence-based formulations, advanced delivery technologies and unparalleled quality assurance. Based on objectives determined by screening, supplement support options can be selected using The PureHeart™ Protocol Guide. The Cleveland HeartLab tests are changing the way practitioners assess patients, select supportive avenues and monitor progress. By aligning reliable assessment tools and science-based product options, The PureHeart™ Protocol offers a simple solution to cardiometabolic care. For more information on the screening, visit visit www.clevelandheartlab.com.*

References

1. Brennan ML, Penn MS, Van Lente F, et al.  Prognostic value of myeloperoxidase in patients with chest pain. N Engl J Med (2003) 349(17):1595-1604.
2. Kolodgie FD, Burke AP, Skorija KS, et al. Lipoprotein-associated phospholipase A2 protein expression in the natural progression of human coronary atherosclerosis.  Arterioscler Thromb Vasc Biol (2006) 26(11):2523-2529. 
3. Devaraj S, Singh U, Jialal I. Human C-reactive protein and the metabolic syndrome. Curr Opin Lipidol (2009) 20(3):182-189.
4. Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA (2001) 286(4):421-426.
5. Schwedhelm E, Bartling A, Lenzen H, et al. Urinary 8-iso-prostaglandin F2 alpha as a risk marker in patients with coronary heart disease: a matched case-control study.  Circulation (2004) 109(7):843-848.
6. Holvoet P, Lee DH, Steffes M, et al. Association between circulating oxidized low-density lipoprotein and incidence of the metabolic syndrome. JAMA (2008) 299:2287-2293.
7. Andreou I, Tousoulis D, Miliou A, et al. Effects of rosuvastatin on myeloperoxidase levels in patients with chronic heart failure: a randomized placebo-controlled study. Atherosclerosis (2010) 210(1):194-198. 
8. Lee SH, Kang SM, Park S, et al. The effects of statin monotherapy and low-dose statin/ezetimibe on lipoprotein-associated phospholipase A. Clin Cardiol (2011) 34(2):108-112. 
9. Fassett RG, Coombes JS. Astaxanthin in cardiovascular health and disease.  Molecules (2012) 17(2):2030-2048.
10. Zhu BQ, Zhou HZ, Teerlink JR, Karliner JS. Pyrroloquinoline quinone (PQQ) decreases myocardial infarct size and improves cardiac function in rat models of ischemia and ischemia/reperfusion. Cardiovasc Drugs Ther (2004) 18(6):421-431.
11. Zhang H, Wei J, Xue R, et al. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression.  Metabolism (2010) 59(2):285-292.
12. Heim KC, Angers P, Léonhart S, Ritz BW. Anti-inflammatory and neuroactive properties of selected fruit extracts. J Med Food (2012) 15(9):851-854.