---
title: Endothelial Dysfunction part 8 - Biomarkers
description: Endothelial Dysfunction and Blood Biomarkers | OptimalDX.com Functional Blood Chemistry Analysis
---

[The Optimal DX Research Blog ](https://www.optimaldx.com/research-blog)

# [Endothelial Dysfunction part 8 - Biomarkers](https://www.optimaldx.com/research-blog/endothelial-dysfunction-blood-biomarkers)

 Written by [ODX Research](https://www.optimaldx.com/research-blog/author/odx-research) | Jul 16, 2021 6:30:00 PM

## Endothelial Dysfunction & Blood Biomarkers

### Dicken Weatherby, N.D. and Beth Ellen DiLuglio, MS, RDN, LDN

<https://www.optimaldx.com/research-blog/endothelial-dysfunction-blood-biomarkers?hs_amp=true#_edn15>

A number of findings on a blood test can point toward an increasing likelihood of atherosclerosis, inflammation, and endothelial dysfunction:

### The Endothelial Dysfunction Series

1. [Endothelial Dysfunction part 1 - An Overview](https://www.optimaldx.com/research-blog/endothelial-dysfunction-an-overview)
2. [Endothelial Dysfunction part 2 - The Endothelium](https://www.optimaldx.com/research-blog/endothelial-dysfunction-endothelium)
3. [Endothelial Dysfunction part 3 - Nitric Oxide](https://www.optimaldx.com/research-blog/endothelial-dysfunction-nitri-oxide)
4. [Endothelial Dysfunction part 4 - Diseases and Causes](https://www.optimaldx.com/research-blog/endothelial-dysfunction-diseases-causes)
5. [Endothelial Dysfunction part 5 - Immune Response & Oxidative Stress](https://www.optimaldx.com/research-blog/endothelial-dysfunction-immune-response-oxidative-stress)
6. [Endothelial Dysfunction part 6 - Atherosclerosis](https://www.optimaldx.com/research-blog/endothelial-dysfunction-atherosclerosis)
7. [Endothelial Dysfunction part 7 - Assessment Part 1](https://www.optimaldx.com/research-blog/measuring-endothelial-dysfunction)
8. [Endothelial Dysfunction part 8 - Assessment part 2](https://www.optimaldx.com/research-blog/endothelial-dysfunction-blood-biomarkers)
9. [Endothelial Dysfunction part 9 - Functional Naturopathic Approach](https://www.optimaldx.com/research-blog/endothelial-dysfunction-functional-naturopathic-approach)
10. [Endothelial Dysfunction part 10 - Optimal Takeaways](https://www.optimaldx.com/research-blog/endothelial-dysfunction-optimal-takeaway)

- **Elevated Homocysteine**

- **Elevated Blood Glucose **
- **Elevated Fibrinogen**
- **Elevated C-Reactive Protein (CRP, hs-CRP)**
- **Insufficient Testosterone**
- **Elevated Iron**
- **Elevated Ferritin**
- **Neutrophil:Lymphocyte Ratio (NLR)** 
    - Low risk in those with neutrophil–lymphocyte ratio <1.5,
    - Intermediate risk in patients between 1.5 and 3,
    - High risk in those with neutrophil- to-lymphocyte ratio >3.
- **Oxidized LDL (OxLDL)**
- **Elevated Asymmetric Dimethylarginine (ADMA)**
- **Elevated Myeloperoxidase (MPO)** 
    - Reduces nitric oxide bioavailability
    - Increases macrophage uptake of oxidized lipids
    - It may promote atherosclerosis and has been identified in atherosclerotic plaque
    - Levels may help predict outcomes in acute coronary syndromes and in those presenting with chest pain suspected to be due to endothelial dysfunction
- **Elevated Malondialdehyde (MDA)**[18]
- **Suboptimal Omega-3 Index** 
    - Provide antioxidant and anti-inflammatory protection
    - Reduce blood pressure
    - Improve vasodilation as measured by FMD
- **Elevated Gamma-Glutamyl Transferase (GGT)**
- **Low Adiponectin**

## Advanced biomarkers in endothelial dysfunction[26] [27]

- Elevated cellular adhesion molecules (released from damaged endothelial cells)
- Vascular cell adhesion molecule-1 – VCAM-1, endothelial leukocyte adhesion molecule-1 E-selectin, intercellular adhesion molecule-1-ICAM-1
- Elevated von Willebrand factor indicative of endothelial damage
- Elevated Endothelin-1 peptide
- Soluble NOX2-derived peptide (sNOX2-dp) and 8-iso-prostaglandin F2α (8-isoPGF2α) reflect oxidative stress.
- Endothelial progenitor cells (EPCs) and microvesicles (MVs) are biomarkers for inflammation and endothelial dysfunction. 
    - Elevated endothelial progenitor cells from bone marrow assist in endothelial repair

[NEXT UP - Endothelial Dysfunction part 9 - Functional Naturopathic Approach](https://www.optimaldx.com/research-blog/endothelial-dysfunction-functional-naturopathic-approach)

## References

[1] Bendall, Jennifer K et al. “Tetrahydrobiopterin in cardiovascular health and disease.” Antioxidants & redox signaling vol. 20,18 (2014): 3040-77. 

[2] University of Michigan. Pathology Handbook. Accessed October 25, 2020 

[3] Whisner, Corrie M et al. “Effects of Low-Fat and High-Fat Meals, with and without Dietary Fiber, on Postprandial Endothelial Function, Triglyceridemia, and Glycemia in Adolescents.” Nutrients vol. 11,11 2626. 2 Nov. 2019.

[4] Ellins, Elizabeth A et al. “Increased fibrinogen responses to psychophysiological stress predict future endothelial dysfunction implications for cardiovascular disease?.” Brain, behavior, and immunity vol. 60 (2017): 233-239. 

[5] Anderson, Todd J. “Nitric oxide, atherosclerosis and the clinical relevance of endothelial dysfunction.” Heart failure reviews vol. 8,1 (2003): 71-86.

[6] Ilinčić, Branislava et al. “Vitamin D status and circulating biomarkers of endothelial dysfunction and inflammation in non-diabetic obese individuals: a pilot study.” Archives of medical science : AMS vol. 13,1 (2017): 53-60. 

[7] Akishita, Masahiro et al. “Low testosterone level is an independent determinant of endothelial dysfunction in men.” Hypertension research : official journal of the Japanese Society of Hypertension vol. 30,11 (2007): 1029-34. 

[8] Duffy, S J et al. “Iron chelation improves endothelial function in patients with coronary artery disease.” Circulation vol. 103,23 (2001): 2799-804. 

[9] Sciacqua, Angela, et al. "Effect modification by ferritin on the relationship between inflammation and arterial stiffness in hypertensive patients with different glucose tolerance." (2020). [R]

[10] Martínez-Urbistondo, Diego et al. “The neutrophil-to-lymphocyte ratio as a marker of systemic endothelial dysfunction in asymptomatic subjects.” “El índice neutrófilo/linfocito como marcador de disfunción sistémica endotelial en sujetos asintomáticos.” Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia vol. 36,4 (2016): 397-403. doi:10.1016/j.nefro.2015.10.018 [R]

[11] Chen C, Khismatullin DB. Oxidized low-density lipoprotein contributes to atherogenesis via co-activation of macrophages and mast cells. PLoS One. 2015 Mar 26;10(3):e0123088. doi: 10.1371/journal.pone.0123088. PMID: 25811595; PMCID: PMC4374860. [R]

[12] Gao, Shen et al. “Circulating Oxidized Low-Density Lipoprotein Levels Independently Predict 10-Year Progression of Subclinical Carotid Atherosclerosis: A Community-Based Cohort Study.” Journal of atherosclerosis and thrombosis vol. 25,10 (2018): 1032-1043. doi:10.5551/jat.43299 [R]

[13] Chen C, Khismatullin DB. Oxidized low-density lipoprotein contributes to atherogenesis via co-activation of macrophages and mast cells. PLoS One. 2015 Mar 26;10(3):e0123088. doi: 10.1371/journal.pone.0123088. PMID: 25811595; PMCID: PMC4374860. [R]

[14] Widmer, R Jay, and Amir Lerman. “Endothelial dysfunction and cardiovascular disease.” Global cardiology science & practice vol. 2014,3 291-308. 16 Oct. 2014, doi:10.5339/gcsp.2014.43 [R] This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.

[15] Bendall, Jennifer K et al. “Tetrahydrobiopterin in cardiovascular health and disease.” Antioxidants & redox signaling vol. 20,18 (2014): 3040-77. doi:10.1089/ars.2013.5566 [R]

[16] Quest Diagnostics. [R] [R]

[17] Upadhyay, Ravi Kant. “Emerging risk biomarkers in cardiovascular diseases and disorders.” Journal of lipids vol. 2015 (2015): 971453. doi:10.1155/2015/971453 [R] This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[18] Yang, Rui-Li et al. “Increasing Oxidative Stress with Progressive Hyperlipidemia in Human: Relation between Malondialdehyde and Atherogenic Index.” Journal of clinical biochemistry and nutrition vol. 43,3 (2008): 154-8. doi:10.3164/jcbn.2008044 [R]

[19] Zehr, Kayla R, and Mary K Walker. “Omega-3 polyunsaturated fatty acids improve endothelial function in humans at risk for atherosclerosis: A review.” Prostaglandins & other lipid mediators vol. 134 (2018): 131-140. doi:10.1016/j.prostaglandins.2017.07.005 [R]

[20] Harris, William S. “The omega-3 index as a risk factor for coronary heart disease.” The American journal of clinical nutrition vol. 87,6 (2008): 1997S-2002S. doi:10.1093/ajcn/87.6.1997S [R]

[21] Bradley, Ryan D et al. “Associations between γ-glutamyltransferase (GGT) and biomarkers of atherosclerosis: the Multi-ethnic Study of Atherosclerosis (MESA).” Atherosclerosis vol. 233,2 (2014): 387-393. doi:10.1016/j.atherosclerosis.2014.01.010 [R]

[22] Bradley, Ryan et al. “Associations between total serum GGT activity and metabolic risk: MESA.” Biomarkers in medicine vol. 7,5 (2013): 709-21. doi:10.2217/bmm.13.71 [R]

[23] Meisinger, C et al. “Serum gamma-glutamyltransferase is a predictor of incident coronary events in apparently healthy men from the general population.” Atherosclerosis vol. 189,2 (2006): 297-302. doi:10.1016/j.atherosclerosis.2006.01.010 [R]

[24] Mancuso, Peter. “The role of adipokines in chronic inflammation.” ImmunoTargets and therapy vol. 5 47-56. 23 May. 2016, doi:10.2147/ITT.S73223 [R]

[25] Hui, Xiaoyan et al. “Adiponectin and cardiovascular health: an update.” British journal of pharmacology vol. 165,3 (2012): 574-90. doi:10.1111/j.1476-5381.2011.01395.x [R]

[26] Roberto Carnevale, Vittoria Cammisotto, Francesca Pagano and Cristina Nocella (November 5th 2018). Effects of Smoking on Oxidative Stress and Vascular Function, Smoking Prevention and Cessation, Mirjana Rajer, IntechOpen, DOI: 10.5772/intechopen.78319. Available from: [R] This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[27] Jezovnik, Mateja K. "How to assess endothelial function for detection of pre-clinical atherosclerosis." E-journal Cardiology Practice 10.22 (2011): 10. [R]

[28] Roberto Carnevale, Vittoria Cammisotto, Francesca Pagano and Cristina Nocella (November 5th 2018). Effects of Smoking on Oxidative Stress and Vascular Function, Smoking Prevention and Cessation, Mirjana Rajer, IntechOpen, DOI: 10.5772/intechopen.78319. Available from: [R] This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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