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Disclaimer: This information is provided for the use of physicians and other licensed health care practitioners only. This information is not for use by consumers. The information and or products are not intended for use by consumers or physicians as a means to cure, treat, prevent, diagnose or mitigate any disease or other medical condition. The information contained in this document is in no way to be taken as prescriptive nor to replace the physicians duty of care and personalised care practices.

PULS Cardiac Test

An Elevated PULS Cardiac Test May Identify:

  • Coronary heart disease development
  • Presence of unstable/vulnerable arterial plaque
  • Increased near-trm risk of a heart attack

Atherosclerotic disease progression is characterized by chronic endothelial damage and an accumulation of fatty plaque within the arterial wall. Unstable plaque can rupture and lead to arterial blockage causing a heart attack. The first steps in prevention are the identification of individuals at near-term risk of a heart attack, and allowing for more aggressive therapy to potentially avoid a future event.

The PULS (Protein Unstable Lesion Signature) Cardiac Test measures key clinical risk factors including age, sex, diabetic status, family history of heart attack, and distinct protein biomarkers. These markers are associated with the biological pathways underlying cardiac lesion formation, progression and rupture. This refined methodology of cardiac risk assessment provides an improved calculation of a patient’s near-term (5 year) risk for a heart attack.

Clinical Use

The PULS Cardiac Test may be performed on individuals at intermediate risk with one or more risk factors for coronary heart disease.

Clinical Significance

  • Cardiovascular risk prediction models such as the Framingham Risk Score calculate risk of a cardiovascular event within the next 10 years. When used, these calculations rely heavily on established clinical risk factors1 which may not fully estimate the prevalence of cardiovascular disease in the general population.2,3

  • The PULS Cardiac Test measures clinically significant proteins in the blood associated with active unstable lesion formation and when combined with established clinical risk factors, predicts whether a cardiac lesion could rupture within a 5 year period.4

  • In the Multi-Ethnic Study of Atherosclerosis (MESA), the PULS Cardiac Test outperformed a common risk calculator, yielding a net reclassification index of 42.7% in individuals defined as intermediate risk by the Framingham Risk Score.4 Reclassification of those initially defined as intermediate risk to high risk may result in more appropriate therapeutic intervention.

  • In a large clinical trial, the PULS Cardiac Test identified 61% of patients who went on to have a cardiac event who otherwise would have been missed using established risk factors alone.5

Testing Frequency

The frequency of ordering The PULS Test is determined by an individual’s medical history, but may be monitored more frequently in those at moderate to high risk for cardiovascular disease.

Sample Type

The PULS Cardiac Test should be performed on a serum and EDTA whole blood sample. Patients do not need to fast for the test.



Patient Handout
Practitioner Handout
PULS Sample Report

If you have any further questions about the PULS Cardiac Test, please email our technical support team:


1. Wilson PW et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97: 1837-1847.
2. Greenland P et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003; 290: 891-897.
3. Khot UN et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003; 290: 898-904.
4. Cross DS et al. Coronary risk assessment among intermediate risk patients using a clinical and biomarker based algorithm developed and validated in two population cohorts. Curr Med Res Opin. 2012; 28: 1819-1830.
5. Simonini A and Harrington DS. Early detection of unstable cardiac lesions in asymptomatic individuals at risk of acute coronary syndrome. Cardiology. 2015; 131: 148.

Cleveland Heart Lab

Also available from Cleveland Heart Lab:

Advanced Blood Chemistry

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