This section is a brief review of the imaging, labs and assessments we can do to find out your current health status. Take some time and go gathering to get your entire health picture. Numbers don’t mean everything. It’s important to look at the entire picture. Your numbers could look great but you could have risks like being in a high stress field that can increase your chances of having heart disease. I recommend treating the numbers and imaging as part of an overall picture.
How to assessment your current heart status
- Labs
- Imaging
- Genetics, age, sex
- Risk Factors
- Lifestyle
I highly recommend organizing a personal health folder or “chart” – just like we use to have in medical offices. Take this with you to all appointments and keep it updated.
It’s not uncommon for medical offices to change EMR’s. Getting information that is over 7 years old or from an office that has closed down can be very difficult.
Include:
- Labs
- Specialists information
- Medications (include what has worked and what hasn’t)
- Allergies
- Vaccines
- Procedures
- Diagnostic
- And visit notes if you can
- You can also include a section for research, books that you read and a vision board for the outcome you desire
Labs
Lipids
The big lab screening that is used most often is a simple cholesterol panel. Traditionally lipid screenings were done fasting but more recent guidelines take out the fasting component.
The overall total does not mean much
Look first at the LDL “bad” “lousy” “low”
- You want this to be low and usually the lower the better. We generally will start medications on most people if over 190, If you have other risk factors that goes to 160, high risk factors like diabetes we may start medications if over 70.
Triglycerides
- This is the second “bad” cholesterol and can change quickly with foods. Ice cream is notorious for increasing even a couple of days after eating ice cream. Goal is 150 but we don’t generally treat until over 350.
HDL “happy” “High”
- This is your good cholesterol or draino. We use to say, take away a risk factor if this number is over 60. Less than 40 can be a problem. Sometimes super high levels (over 100) may not be as protective or even cause problems.
The Fancy Lipids
There are much more involved lipid panels that go into particle sizes and several other analyses. These panels were very popular about 10 years ago but are not routinely ordered by primary care due to lack of coverage and many providers don’t know what to do with them.
The other Standard Labs:
CBC, CMP, A1C – these labs are done to look for other conditions, however if you have diabetes, lipid or kidney problems, then your heart risk goes up
The Fancy Labs (for a little bit more information):
This group of labs can give us more information about heart health status as well as alternatives for prevention
Fasting Insulin: this lab is not routinely collected but can be an early indicator of glucose intolerance. I recommend aiming to keep this under 10. This can be done with diet, supplements like berberine, and medications like metformin of GLP’s.
Homocysteine: This can be elevated when B12 and Folate are not functioning well. If elevated – consider taking methylated B12 and Folate (sublingual if over age 50 or you have absorption concerns)
Lp(a): Measures lipoprotein(a), we describe this as measuring the stickiness of clotting. High levels increase the risk of heart attack and stroke.
CRP: This is an inflammatory marker that is used in many different assessments especially when looking for infection. Higher CRP levels can mean that you are at increased risk of heart disease … but there is not a lot of great research about how to lower CRP levels. Some blood pressure medications, cholesterol medication and certain diabetic medications can lower this lab. Lifestyle changes and supplements can also help. Getting fasting insulin controlled, increasing vitamin D and getting a good omega ratio can help
Vitamin D: Raising vitamin D to over 50 can help the immune system and improve cardiac health.
Highly sensitive troponin T: Lab panels including this test can be very expensive but it can catch early stressors on the heart in people that do not have symptoms. Sometimes this test can be associated with sleep apnea (which puts pressure on the heart). If elevated, consider getting sleep apnea testing.
Apolipoprotein B (ApoB): Some studies report ApoB testing can be more predictive of heart attack vs lipids. If elevated there is not a specific treatment, we work harder to lower entire risk.
Omega Ratio: Current American diets have a much different ratio of omegas vs traditional diets. Some clinicians feel the imbalance in this ratio is a large contributing factor to many of today’s chronic conditions. There are lab companies that can test and make recommendations. Because many omega supplements are not purified and have some inflammatory omega’s mixed in, it can make a big difference to get a good brand.
Genetic Tests
There are a few companies that offer genetic testing as well to help guide treatments They likely will not be covered by insurance and most primary care providers may not know what to order.
So I have my labs … now what?
Calculators
Generally a medical provider will look at your labs and additional risk factors to come up with your estimated risk and then make recommendations.
There are a few standard calculators that you can use online to get an idea of risk and if you should consider medications. They are:
American College of Cardiology (the one healthcare providers use most)
Mayo Clinic
Always, always, always discuss these numbers with your medical provider along with your risk tolerance
- Generally if your risk is less than 7.5% in 10 years, it is recommended to work on lifestyle changes and contributing factors
- If you are 7.5-10% that is an in depth discussion with your medical provider and consider additional imaging.
- Over 10% consider being aggressive in lifestyle changes as well as medications
If you have additional information (the fancy tests) there are not generally calculators that add those numbers.
Imaging & Diagnostic Studies
Imaging to detect heart disease earlier has come a long way.
Cardiac Calcium Scores:
This is a relatively new test. Generally the price is around $150 and is a CT scan that looks for calcium build-up in the arteries of the heart. This test can give us a lot of information about people at medium risk. A zero calcium score significantly decreases your risk of heart disease.
Here are proposed recommendation on how to consider calcium scoring screening:
- Proposed guideline using 10-year ASCVD risk estimate plus CAC scoring to guide statin therapy (1):
- <5%: statin is not recommended regardless of CACS.
- 5-7.5%: consider statin; CACS = 0 statin not recommended; CACS >1 consider statin.
- >7.5-20%: recommend statin; CACS = 0 statin not recommended; CACS >0 recommend statin.
- >20%: recommend statin regardless of CACS.
- <5% and >20%: CACS not effective for this population.
Here’s a calculator that also uses calcium score to access risk
More information on calcium scores can be found here.
Carotid Ultrasounds (CIMT):
Carotid Ultrasounds, specifically CIMT scans that measure the thickness of the carotid artery can show if other arteries in the body are developing thickening. The assumption is that if other arteries are getting thicker than your heart likely is too. This is a low risk test that is done by ultrasound but is currently not as popular as the Ca Score test. It does not use radiation.
Here’s more information about this test:
Aorta Ultrasounds:
These aren’t specifically testing the heart but can be important screening tests. Aorta ultrasounds are recommended for men ages 65-75 who have ever smoked. Groups with other risk factors like family history may also benefit from screening.
Stress Tests:
Stress tests are when a patient is generally placed on a treadmill (or given medication) to see how the heart acts when stressed. They can be combined with EKG’s, nuclear imaging, or heart ultrasound. Recently they have been used less for asymptomatic screenings and more often for people with some symptoms. They can still be used in higher stress careers as screenings.
Other Cardiac Tests (more for diagnostic than screenings)
EKG: Can be done in the office and checks the electrical rhythm of the heart. It is a good idea to have a “baseline” EKG if you are over age 65 or have other conditions. Usually not used for screenings but frequently done prior to surgery or high risk activities. Keep this in your medical folder.
Echocardiogram: This is an Ultrasound that looks at the physical function of the heart. Used to detect heart failure, valve problems, and other structural problems.
Heart Cath: This surgical procedure that uses dye to access the blood vessels around the heart.
All of these imaging tests are ordered by a medical provider for different situations. Results should be discussed with your medical team.
Genetics, Race, Sex & Age
These are the things you can’t change. Genetics is one of the biggest factors contributing to heart disease. If you have healthy family members that have heart disease then you will likely want to be more proactive evaluating and treating your risk.
Different races have an increased risk of heart disease. Black adults and American Indians have a higher risk than white adults. Asian adults generally have a lower risk. It’s difficult to tell how much of this difference is due to genetics or differences in diet and economics.
Males are at higher risk than females
The older you are, the higher the risk of heart disease.
Even with all other risk factors being negative, a 65 year old male is going to have a relatively high baseline cardiac risk over 10% with all other risk contributors being normal
Risk Factors for Heart Disease
We’re going to go into risk factors in much more detail in the rest of this course – the list is long.
The big ones are:
- High Blood Pressure
- Diabetes
- Smoking
- Obesity
- Movemen
- Diet
- Stress
- Sleep (including sleep apnea)
Lifestyle
Lifestyle is the biggest modifiable risk factor for heart disease. Consider looking at your current diet, how much you move, how much you sleep, and your stress level. Find some small manageable and sustainable changes and keep finding ways to improve.
Here is an assessment for the overall picture
Once you know where you are, then you can get a pretty good idea of where you need to start with your changes. If you’re overall pretty healthy and just need small adjustments, then start there. If you have questions about your overall risk and current health status – then the first step to heart health may be a doctor’s appointment to discuss your risk.
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/07/23/13/39/Coronary-Calcium-Score-and-Cardiovascular-Risk