CLINICAL NUTRITION:

Group 3:
BIOCHEMICAL 1. Nguyen Hoang Ngoc Phuong

TESTS USING TO 2. Huynh Ngoc Thuy

3. Pham Thanh Truc
4. Phan Le Dan Yen
ASSESS
Instructor:
CARDIOVASCULAR
Msc. Bui Ngoc Yen Tram
DISEASE
 CONTENT
I. INTRODUCTION
II. ATHEROSCLEROSIS
III. MYOCARDIO INFARCTION
 INTRODUCTION

Cardiovascular disease: The disease of heart and blood vessels.

ATHEROSCLEROSIS

Biochemical test
• Hypertension, elevated lipids
and chronic endothelial
damage contribute.
• Caused by esterified
cholesterol, being deposited
in artery walls, resulting in
fatty streaks.
• Fatty streaks develop into
plaques that can block blood
flow.
BIOCHEMICAL TESTS OF
ATHEROSCLEROSIS
A lipoprotein profile measures the level of
cholesterol in the blood
 TRIACYLGLYCEROL
TESTof triglycerides
 Measures the amount in
your blood.
 Eat more calories  changed into
triglycerides ( stored in fat cell)
 Body needs energy  triglyceride released
into bloodstream  high triglyceride in
blood
 WHAT DO THE
RESULTS MEAN?
--------------------------
The following are the basic categories of
results for triglyceride levels in milligrams
per deciliter:
 Normal fasting: 150 mg/dL
 Borderline high: 150 to 199 mg/dL
 High: 200 to 499 mg/dL
 Very high: > 500 mg/dL
 CHOLESTEROL
Cholesterol is NOT a fat, but a “fat-like” substance present in all body cells.
It contributes to the digestion of fat and the absorption of fat soluble vitamins.
Cholesterol is manufactured by the body– mostly in the liver!
At the high concentrations it is found in our cell's plasma membranes
 CHOLESTEROL
o Total cholesterol: The total amount of cholesterol
in your blood.
o High-density lipoprotein (HDL) cholesterol:
carries cholesterol from tissues  liver.
o Low-density lipoprotein (LDL) cholesterol: carries
cholesterol too, but deposits the cholesterol in
blood vessels.
o Too much  risk of atherosclerosis
LDL vs. HDL
 APOLIPOPROTEIN
Overview
- Protein that bind lipid to form lipoprotein
- Transport the lipid through lymphatic and
circulatory systems
- Transport and redistribution of lipids to various
peripheral tissues
- Cofactor for some enzymes involved in lipid
metabolism
- Maintenance of the structure and integrity of the Structure of apolipoprotein
lipoproteins.
 APOLIPOPROTEIN
Classification (6 classes and several sub - classes)
- A ( Apo A-I, Apo A-II, Apo A-IV, Apo A-V)
- B ( Apo48, Apo 100)
- C ( Apo C-I, Apo C-II, Apo C-III, Apo C-IV)
- D
- E
- H
 Lipoprotein and
Similarities
Apolipoprotein
• The functional molecules named as lipoproteins.
• Essential in fat and cholesterol metabolism.
• Involved in the transport and distribution of triglycerides and
cholesterol.
• Act as biomarkers for various cardiovascular states and metabolic
imbalances.
 Lipoprotein and
Apolipoprotein
Differences
 APOLIPOPROTEIN A
- The primary protein associated of HDL :
high density lipoprotein
- Synthesized in liver ( 70% ) and the
intestine ( 30%)
 APOLIPOPROTEIN A
Purpose:
- Determine adequate levels of Apo A Help determine your risk of
developing coronary artery disease.
- Monitor the effectiveness of lifestyle changes and lipid treatments.
 APOLIPOPROTEIN A
Sample required:
- A blood sample drawn from a vein in arm.
- This test may be performed at the same time as a complete lipid profile,
fasting overnight may be required.
 APOLIPOPROTEIN A
Conclusion: TEST
- If the level of Apo A is low  have a low level of "good" HDL particles in
your bloodstream.
- This may mean that have a higher risk of developing heart disease
and other vascular diseases.
 APOLIPOPROTEIN A
The reference value TEST
 APOLIPOPROTEIN B
- Protein that is involved in the metabolism of lipids
- Main protein constituent of lipoproteins very low
density lipoprotein (VLDL), low- density
lipoprotein (LDL, the "bad cholesterol")
 APOLIPOPROTEIN B
Purpose: TEST
- Help determine the risk of developing cardiovascular disease.
- Help diagnose the cause of abnormal lipid levels, especially elevated
triglyceride level.
- Monitor the effectiveness of lipid treatment as an alternative to non HDL- C.
 APOLIPOPROTEIN B
TEST
Sample required:
- A blood sample is obtained by inserting a needle into a vein in the arm
- Fasting for at least 12 hours may be required.
 APOLIPOPROTEIN B
• Associated with an increased risk of CVD. Elevations may be TEST
due to a
high-fat diet and/or decreased clearing of LDL from the blood.
• If the level of Apo B is high  have a high level of “bad" LDL particles
in your bloodstream.
 APOLIPOPROTEIN B
The reference value TEST
 APOLIPOPROTEIN B/A1
RATIO
- ApoB is present in all atherogenic lipoproteins including TEST
LDL, Lp(a), intermediate-density
lipoprotein (IDL), and very low-density lipoprotein (VLDL) remnants.
- ApoA1 is the nucleating protein around which HDL forms during reverse cholesterol
transport.
 the ApoB:ApoA1 ratio represents the balance between atherogenic and antiatherogenic
lipoproteins
 APOLIPOPROTEIN B/A1
The reference value RATIO TEST
MYOCARDIAL
INFARCTION
BIOCHEMICAL TESTING
 MYOCARDIAL
• Commonly known as a heart attack,
INFARCTION
occurs when blood flow decreases or
stops to a part of the heart, causing
damage to the heart muscle.
• The most common symptom is chest
pain or discomfort which may travel
into the shoulder, arm, back, neck,
or jaw.
 MYOCARDIAL
INFARCTION
A myocardial infarction occurs when
an atherosclerotic plaque slowly builds
up in the inner lining of a coronary
artery and then suddenly ruptures,
causing catastrophic thrombus
formation, totally occluding the artery
and preventing blood flow downstream
 MYOCARDIAL INFARCTION
DIAGNOSIS
According to WHO, a patient is diagnosed with myocardial infarction if two
(probable) or three (definite) of the following criteria are satisfied:
• Clinical history of ischaemic type chest pain lasting for more than 20 minutes.
• Changes in serial ECG tracings.
• Rise and fall of serum cardiac biomarkers such as creatine kinase-MB fraction
and troponin. (biochemical test)
 CREATINE KINASE - MB
Is a form of an enzyme found primarily in heart muscle cells.

These isoenzymes include:

• CK-MM (found in skeletal muscles and the heart)
• CK-MB (found mostly in the heart, but small amounts found in skeletal
muscles)
• CK-BB (found mostly in the brain and smooth muscle, such as the intestines
 CREATINE KINASE – MB TEST
WHY WE HAVE THIS TESTED?
To distinguish between skeletal muscle
and heart muscle damage; sometimes to
determine if you have had a heart attack;
sometimes to detect a second or
subsequent heart attack or to monitor for
additional heart damage.
 CREATINE KINASE – MB TEST
WHY WE HAVE THIS TESTED?

Because many tissues contain CK, high

levels of CK can be a sign of a variety of
problems. Higher CK-MB may point more
directly to heart damage.
 CREATINE KINASE – MB TEST
WHEN WE HAVE THIS TESTED?
When you have an increased creatine
kinase (CK) level and the healthcare
practitioner wants to determine
whether it is due to skeletal or heart
muscle damage; when it is suspected
that you have had a second heart attack
or have ongoing heart damage
 CREATINE KINASE – MB TEST
WHEN WE HAVE THIS TESTED?

Amount of CK-MB in blood : < 105 U/L

 NORMAL

If the amount of CK-MB >160 U/L, this

may have myocardial infarction.
 CREATINE KINASE – MB TEST
Measuring CK-MB used to be a common tool for diagnosing heart attacks,
but healthcare providers use it less often today. Cardiac troponin is now
the test of choice for finding a heart attack. This is because cardiac
troponin is more specific and more sensitive than CK-MB.
 TROPONIN TEST

Troponins are a family of proteins found in

skeletal and heart (cardiac) muscle fibers
that produce muscular contraction.
Troponin tests measure the level of cardiac-
specific troponin in the blood to help detect
heart injury.
 TROPONIN TEST

Normally, troponin is present in very small to

undetectable quantities in the blood. When
there is damage to heart muscle cells,
troponin is released into the blood. The more
damage there is, the greater the
concentration in the blood.
 TROPONIN TEST
WHY WE HAVE THIS TESTED?
• To determine if you have had a heart
attack or injury to heart muscle
• To determine if your angina (chest
pain related to heart trouble) is
worsening.
 TROPONIN TEST
WHEN WE HAVE THIS TESTED?
• When you are having signs and symptoms
that may be due to a heart attack, such as
pain in your chest, shoulders, neck, jaw
and/or shortness of breath;
• When your angina worsens, especially if it
does not resolve with rest
 TROPONIN TEST

• For normal individuals is <0.01 ng/mL.

• For patients who present with acute
coronary syndromes, troponin T values
>=0.01 ng/mL that are rising make the
diagnosis of cardiac injury.
 REFERENCES
– "QuocBaoNet." Một Số Xét Nghiệm Hoá Sinh Về Rối Loạn Lipid Máu & Bệnh Xơ Vữa động Mạch - Bài
Viết - Bệnh Học. Accessed April 21, 2018. http://www.benhhoc.com/bai/1409-Mot-so-xet-nghiem-
hoa-sinh-ve-roi-loan-lipid-mau-amp.html
– "Triglycerides Test: MedlinePlus Lab Test Information." MedlinePlus. October 03, 2017. Accessed April
21, 2018. https://medlineplus.gov/labtests/triglyceridestest.html.
– HaNoi Medicine University. “Hoá sinh lâm sàng: Các xét nghiệm chuẩn đoán bệnh tim mạch”. August
24, 2012. Accessed April 21, 2018.
– https://www.labtestsonline.org.au/learning/test-index/apoa
– https://labtestsonline.org/tests/apo-b