 Lifelong heart health depends on making smart lifestyle choices, such as not smoking, getting regular exercise, eating a nutritious, balanced diet and working with your doctor to identify developing cardiovascular problems. But it is not easy to know which tests you should be taking or how to decipher what their results mean for you.
Generally, heart-health tests are used for either screening or diagnosis.
What’s best for you will depend on your age, symptoms, family history and other personal factors.
“There is no single test to diagnose heart disease—and the testing one person undergoes may be significantly different from what is best for someone else,” says Nieca Goldberg, M.D., associate professor of medicine at NYU Langone Medical Center in New York and author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health.
To reduce your heart disease risks, you need to know your personal risk factors—and that’s where screening tests come in. And if you are making lifestyle changes, screening tests can help you gauge whether they are reducing your risks enough. Here are the screening tests adults should have:
Blood pressure
Your blood pressure should be checked annually at your doctor’s office. If it’s high (140/90 mmHg or higher), it should be monitored more often, and you should take steps to lower it by losing excess weight, exercising regularly, sticking with a low-sodium, heart-healthy diet and, perhaps, taking hypertension medication. The goal is to get it under 120/80 mmHg.
Fasting lipid profile
Starting at age 20, you should have a fasting blood lipid test, which measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglyceride levels. (Triglycerides, a type of fat in the blood, are an important measure of your heart health.) This test should be repeated every five years if results are in the normal range, more often if they are not.
Normal results
The recommendations are:
- Total cholesterol under 200 mg/dL
- LDL under 100 mg/dL
- HDL of at least 50 mg/dL for women and at least 40 mg/dl for men. HDL levels of 60 mg/dl and higher are protective.
- Triglycerides under 150 mg/dL
Abnormal results
If the results are abnormal, following a low-fat, heart-healthy diet, exercising regularly and losing excess weight can help; in addition to lifestyle modifications, you may be prescribed a cholesterol-lowering medication. If you’re taking a cholesterol-lowering medication, your lipid levels should be monitored at least every six months, says Kansas City, MO, cardiologist Tracy Stevens, M.D.
Fasting blood glucose test
This will indicate if your blood sugar levels are normal (under 100 mg/dl when fasting or in the morning) or if you have diabetes (126 mg/dl or higher). “If you’re lean and fit, and you don’t have a family history of diabetes, you can wait to have this until your forties,” says Robert O. Bonow, M.D., chief of cardiology at Chicago’s Northwestern Memorial Hospital. “If you’re overweight or have a family history of diabetes, you should have your blood sugar tested in your twenties.”
If your blood sugar is borderline high (in the prediabetes range), shedding excess pounds, exercising regularly and consuming a diet rich in fruits, vegetables, fiber, whole grains and low-fat dairy products can help you control your blood sugar. If you have type 1 diabetes, daily injections of insulin are mandated. For type 2 diabetes, oral medication or insulin may be warranted. In both cases, you’ll be advised to have regular hemoglobin A1C tests, which measure your average blood sugar levels over a period of three months.
Specialized screenings
If you have a family history of heart disease, even without other significant risk factors, your doctor may probe a bit deeper into the lesser-known blood factors that have been implicated in heart disease. These include C-reactive protein (CRP), a marker of inflammation; Lp(a), a harmful type of cholesterol that’s similar in chemical structure to LDL; and the amino acid homocysteine. Knowing that one of these factors is elevated can help physicians decide how aggressively to treat a person for other borderline-high risk factors.
“If we’re on the fence about whether to put a person with borderline-high cholesterol on a statin or to stick with dietary and exercise changes, knowing his CRP is high might lead us to put him on a statin sooner,” says Dr. Bonow.
If you have worrisome symptoms with normal activity, have problems such as chest pain or tightness, or are at elevated risk for heart disease because of family or personal health history, it may be time for diagnostic tests such as:
Electrocardiogram (EKG)
Providing a graphic picture of the electrical impulses in the heart, an EKG, or ECG, can detect abnormal heart rhythms, decreased blood flow to the heart or heart attack.
Abnormal results or persistent chest discomfort may warrant further testing. A caveat: False negatives—a normal result even though there are underlying problems—may occur.
Echocardiogram
This test, in which sound waves create visual images of how the heart muscle and valves are functioning, may be done if a baseline EKG is abnormal or a heart murmur or hypertension is present. “It’s an excellent, noninvasive way to assess valve problems and structural abnormalities in those with heart arrhythmias,” notes Dr. Goldberg. “Accuracy depends on the skill of the technician and the physician.”
Stress test
In an exercise stress test, a person walks on a treadmill or pedals a stationary bike while an EKG or echocardiogram evaluates the heart’s response. With a nuclear stress test, a radioactive isotope travels into the heart and, with a scanning camera, provides a picture of how blood flows through the heart during exercise. A chemical stress test uses synthetic medications that mimic the effects of exercise. If reduced blood flow to the heart is revealed during the test, an angiogram may be next.
Coronary angiography
With this invasive test, done in a hospital, a catheter (tube) is inserted into an artery in the groin, and dye is injected into the coronary arteries to highlight blockages in the heart’s blood vessels. (This information can also be gathered in an outpatient setting via a computerized tomography [CT] scan angiogram, which uses X-rays and shows a cross-section view of the insides of the body.) An angiogram may be recommended if your doctor suspects unstable angina (chest discomfort) or if you’ve had an abnormal EKG or stress test or are having heart attack symptoms. It can also help pinpoint the location and amount of obstruction in a blood vessel.
Ankle-brachial index (ABI) test
In an ABI test, your doctor uses a special blood pressure cuff to compare the blood pressure ratio in your legs versus your arms. This screens for peripheral artery disease (PAD), a condition caused by plaque buildup in arteries outside the heart, especially those in the legs.
Coronary artery calcium scoring
This test uses a CT scan to find and quantify calcium deposits in the heart’s arteries, a sign of accumulated plaque, which raises heart attack risk. The presence of deposits can help doctors decide how aggressively to use medication to try to lower cholesterol or other risk factors.
Tracy Stevens, M.D., a cardiologist and medical
director for the Saint Luke’s Muriel I. Kauffman Women’s Heart Center
in Kansas City, MO recommends that you ask your health-care provider the following six questions:
1. Why are you ordering this test for me?
2. What will it tell us?
3. How likely is it to be accurate in my case?
4. Are my results in the normal range?
5. If not, what do we need to do next?
6. Are there options for managing this with lifestyle changes and/or medication, or do we need to do something invasive? |
In the pipeline are a variety of tests that may improve the detection of heart disease, often with fewer side effects. These include:
• New genetic tests for heart disease that will be especially helpful for those who have a family history of sudden cardiac death
• CT angiograms that use lower doses of radiation
• Positron emission tomography (PET) scans, which can be used as part of the chemical stress test. These will provide a clearer image of the heart, eliminating shadows cast by the breasts or diaphragm.
• Minimally invasive magnetic resonance angiograms (MRA) that can detect blood vessel problems that are reducing blood flow
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