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cardiovascular events is very low. It's important to have the test repeated periodically, however, since even a slight elevation could be an early warning sign of increased heart attack or stroke risk. Although it's comforting to have normal or optimal level of CRP – indicating that the arterial lining is not inflamed – a high level, as discussed above, isn't conclusive evidence of heart attack, stroke, or CAD risk. erefore, if your hs CRP results are abnormal, and there's no other apparent reason for inflammation, your healthcare provider will probably advise repeating the test a week later to confirm the results. To find our if arterial wall inflammation is causing persistently elevated CRP, it's helpful to compare hs CRP results with those of the test described below, microalbumin/creatinine urine ratio (MACR). Since the two tests measure completely different biomarkers that may signal fire in the arteries, if both are elevated, there's a very strong probability that blood vessel inflammation is the culprit. Microalbumin/Creatinine Urine Ratio (MACR) What the Test Checks for: is test detects small amounts of albumin, a blood protein, in the urine. e term "microalbumin" refers to amounts of albumin that are too small to detect in urine dipstick test used for routine urinalysis during annual physicals. Having protein in the urine is abnormal, because albumin is a large molecule that circulates in blood and shouldn't spill from capillaries in the kidney into urine. erefore, the test checks for a biomarker of endothelial dysfunction, as an indication of vascular disease. e urine ratio compares the amounts of microalbumin with those of creatinine (CR), a waste product of the muscles. Although this simple urine test cost just pennies, is covered by virtually all health plans, and provides valuable information about arterial wall health, healthcare providers rarely use it for this purpose, even though it's an extremely cost-effective way to check for evidence of arterial disease. Instead, MACR is most commonly performed to screen people with diabetes, high blood pressure, or kidney disorders for kidney damage. e Framingham study found that MACR is an independent biomarker that predicts risk for cardiovascular events, while hs CRP and fibrinogen were not independent predictors in that study. erefore, an abnormal UACR is an important warning sign of cardiovascular danger, even if your hs CRP and fibrinogen levels are normal. e researchers found that people with an elevated UACR had 20 percent higher rate of CV events, even when other risk factors were taken into account. Another insight from research is that MACR is more accurate than the conventional albumin urine test oen used in routine annual physicals because MACR takes into account how much water the patient has consumed and calculates the concentration of albumin in the urine accordingly. What the Results Mean: Very recently, new evidence from the large Framingham Offspring study shows that UACR results that have traditionally been considered "normal" can signal increased risk for cardiovascular events. Specifically, women who's MACR was above 7.5 and men with a ratio above 4 had nearly triple the risk for heart attacks, strokes, and other cardiovascular events over six years of follow-up in that study. erefore, ratios of 7.5 or lower for women and 4 or lower for men are optimal, rather than higher numbers that are still considered "normal" by standard care. Lipoprotein-Associated Phospholipase A-2 (Lp-PLA2) What the Test Checks for: is blood test measures lipoprotein-associated phospholipase A-2 (Lp-PLA2), a blood vessel specific enzyme that's mainly attached to LDL (bad) cholesterol. Levels of Lp-PLA2 rise when arterial walls become Abby's Magazine - March/April 2015 | Page 27