What is Hertta?

Hertta is a blood sample test that measures the risk of a severe heart attack more accurately than commonly used cholesterol tests. Hertta test measures also the risk of getting type 2 diabetes.

Cardiovascular diseases are the most common cause of death globally and in Europe.

Coronary artery disease is a chronic disease that narrows the vascular arteries. Arterial stenosis often begins in adolescence. The disease develops slowly, and its development does not appear outward. Coronary artery disease may be completely symptom-free and your heart attack may be the first symptom. The cholesterol levels do not reveal the hidden risk for a heart attack. The cholesterol levels may be normal and still the risk of a heart attack may be elevated.

Hertta was developed in Finland and it measures the risk of a serious heart attack more accurately than cholesterol tests. Hertta predicts the risk of cardiovascular events such as heart attack and stroke in the next few years (1-10 years). By doing the Hertta-test you will find out which risk group you belong to. The earlier the risk is detected, the better the risk can be reduced for example by life style modification.

Who should do the Hertta-test?

Hertta – heart risk test, is suitable for persons having family history of cardiovascular disease. Persons having risk factors for cardiovascular disease such as high cholesterol, diabetes, hypertension, chest pain, shortness of breath, and arrhythmias. Hertta – heart risk test can also be used to evaluate the risk of recurrent heart attacks of coronary artery disease patients. Furthermore, Hertta can detect residual risk of patients using cholesterol lowering medication. Despite cholesterol lowering medication, the risk of heart attack may still be elevated.

What if I belong to the high-risk group?

If your risk is elevated, we recommend talking to your doctor. The doctor will evaluate your situation and assess needed actions. Risk can be reduced with lifestyle changes such as smoking cessation, change in diet, increasing physical activity, and reducing stress. Treatment options also include initiation or optimization of drug therapy. On a case-by-case basis, an exercise test or coronary artery imaging may be considered.


CERT in Secondary Prevention:

Hilvo et al. 2021 Prior myocardial infarction, coronary artery disease extent, diabetes mellitus, and CERT2 score for risk stratification in stable coronary artery disease, Eur J Prev Cardiology, Published 28 August 2021

Leiherer et al. 2021 Comparison of recent ceramide-based coronary risk prediction scores in cardiovascular disease patients, Eur J Prev Cardiology, Published 21 August 2021

Gencer et al. 2020 Plasma ceramide and phospholipid-based risk score and the risk of cardiovascular death in patients after acute coronary syndrome. Eur. J. Prev. Cardiol. Published online Dec 2020

Meeusen et al. 2020 Ceramides improve atherosclerotic cardiovascular disease risk assessment beyond standard risk factors. Clinica Chimica Acta 2020. 511: 138–142

Hilvo et al. 2020 Ceramides and Ceramide Scores: Clinical Applications for Cardiometabolic Risk Stratification. Front. Endocrinol., 29 September 2020

Hilvo et al. 2020 Prediction of Residual Risk by Ceramide‐Phospholipid Score in Patients With Stable Coronary Heart Disease on Optimal Medical Therapy JAHA published online May 7, 2020.

Mantovani et al. 2020 Associations between specific plasma ceramides and severity of coronary-artery stenosis assessed by coronary angiography. Diabetes & Metabolism, 46(2): 150-157.

Hilvo et al. 2020 Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients. Eur Heart J. 2020; 41:371-380.

Laaksonen et al. 2016 Plasma ceramides predict cardiovascular death in patients with stable coronary artery disease and acute coronary syndromes beyond LDL-cholesterol, European Heart Journal, 28 April 2016

Anroedh et al. 2018 Plasma concentrations of molecular lipid species predict long-term clinical outcome in coronary artery disease patients. JLR June 2018, 59(6).

Cheng et al. 2015 Plasma concentrations of molecular lipid species in relation to coronary plaque characteristics and cardiovascular outcome: Results of the ATHEROREMO-IVUS study, Atherosclerosis 2015 Dec;243(2):560-6.


CERT in Primary Prevention:

Hilvo et al. 2021 Absolute and relative risk prediction in cardiovascular primary prevention with a modified SCORE chart incorporating ceramide-phospholipid risk score and diabetes mellitus, Eur Heart J. Open, Published 13 July 2021

Havulinna et al. 2016 Circulating Ceramides Predict Cardiovascular Outcomes in the Population-Based FINRISK 2002 Cohort, Arterioscler Thromb Vasc Biol. 2016; 36


CERT and Diabetes Risk:

Hilvo et al. 2018 Ceramide stearic to palmitic acid ratio predicts incident diabetes, Diabetologia 2018; 61: 1424-1434.


Publications by others:

Carrard et al. How Ceramides Orchestrate Cardiometabolic Health—An Ode to Physically Active Living. Metabolites 2021, 11(10), 67.

Choi et al. 2021 Ceramides and other sphingolipids as drivers of cardiovascular disease. Nature Reviews Cardiology. Published 26 March 2021

Öörni et al. 2020 Why and how increased plasma ceramides predict future cardiovascular events? Atherosclerosis. 2020 Dec; 314: P71-73.

Kovilakath et al. 2020 Sphingolipids in the Heart: From Cradle to Grave. Front. Endocrinol., 15 September 2020

Field et al. 2020 The Role of Ceramides in Diabetes and Cardiovascular Disease Regulation of Ceramides by Adipokines. Front. Endocrinol., 02 October 2020

Petrocelli et al. 2020 Ceramide Biomarkers Predictive of Cardiovascular Disease Risk Increase in Healthy Older Adults After Bed Rest. J Gerontol A Biol Sci Med Sci. 2020 Sep 16;75(9):1663-1670

Poss et al.2020 Risky lipids: Refining the ceramide score that measures cardiovascular health. European Heart Journal, 41(3): 381–382.

Meeusen et al. 2018 Plasma Ceramides – A Novel Predictor of Major Adverse Cardiovascular Events After Coronary Angiography. ATVB DOI:10.1161/ATVBAHA.118.311199

Carvalho et al. 2018 Plasma Ceramides as Prognostic Biomarkers and Their Arterial and Myocardial Tissue Correlates in Acute Myocardial Infarction JACC 2018, 3(2):

Mantovani et al. 2018 Association between plasma ceramides and inducible myocardial ischemia in patients with established or suspected coronary artery disease undergoing myocardial perfusion scintigraphy. Metabolism 2018. doi:10.1016/j.metabol.2018.05.006

Peterson et al. 2018 Ceramide Remodeling and Risk of Cardiovascular Events and Mortality. JAHA 2018 May 3;7(10).

Summers 2018 Could Ceramides Become the New Cholesterol, Cell Metabolism 27 (2), 276-280.

Wang DD et al. 2017 Plasma Ceramides, Mediterranean Diet, and Incident Cardiovascular Disease in the PREDIMED Trial (Prevención con Dieta Mediterránea). Circulation. 2017, 135(21):2028-2040.

Chaurasia B, Summers SA. 2015 Ceramides – Lipotoxic Inducers of Metabolic Disorders. Trends Endocrinol Metab. 2015, 26(10):538-50.

Kasumov et al. 2015 Improved insulin sensitivity after exercise training is linked to reduced plasma C14:0 ceramide in obesity and type 2 diabetes. Obesity (Silver Spring). 2015 Jul;23(7):1414-21.

Chavez JA, Summers SA. 2012 A ceramide-centric view of insulin resistance. Cell Metab, 2012, 15(5):585-94.

Bikman BT, Summers SA. 2011 Ceramides as modulators of cellular and whole-body metabolism. J Clin Invest. 2011, 121(11):4222-30.

Holland WL, Summers SA. 2008 Sphingolipids, insulin resistance, and metabolic disease: new insights from in vivo manipulation of sphingolipid metabolism. Endocr Rev. 2008, 29(4):381-402.