Must-Have Tests for Heart Risk Factors

Filed Under: Diagnostic Tools, Heart Health

As part of my Heart Health Awareness Campaign in celebration of American Heart Month, I’d likemust-have tests for heart risk factors to focus for a moment on those critical tests you need to evaluate your personal risk for heart disease.

Roughly 90 percent of all cardiovascular disease has no symptoms at all. High cholesterol doesn’t make you feel ill, and high blood pressure seldom does. And for about half the people who have coronary artery disease, their first symptom is death.

If you have a personal or family heart disease, you must know your risk factors for heart disease—and that means getting tested. I can’t stress highly enough the importance of regular cardiovascular evaluation. If you’re at high risk of heart disease because of your personal or family medical history, you should get tested beginning at age 30. Even if you’re at low risk, you should get regular testing beginning at age 50. And if you have any heart-related symptoms, you should get tested immediately, regardless of your age.

Certainly, everyone should have these standard tests, which assess the function of your heart:

  • An electrocardiogram (EKG) establishes baseline information about the way electrical messages flow to the heart muscle and possible arrhythmias.
  • An echocardiogram will assess you’re the health and function of your heart overall—individual chamber size, possible enlargement, valve status, wall motion abnormalities, and the presence of any fluid around the heart.
  • A nuclear stress test (treadmill) is essential for anyone who is symptomatic, to reveal if any area of the heart is particularly vulnerable to a lack of oxygen.

In addition to the standard tests, I recommend these newer tests, which can give you a more precise reading of your risks.

C-Reactive Protein (CRP) is a marker for inflammation that is directly associated with overall heart and cardiovascular health. In multiple studies, CRP has been identified as a potent predictor of future cardiovascular health—and, in my opinion, one that is far more reliable than elevated cholesterol levels. Biological characteristics that are associated with high CRP levels include infections, high blood sugar, excess weight, and hypercoagulability of blood (sticky blood).

Fortunately, there is a simple test that your doctor can conduct to find out how much CRP is in your blood. Just make sure they use the high sensitivity test (hs-CRP). This test doesn’t take much time; typically, blood is drawn from a vein located either on the forearm or from inside your elbow. The blood is then analyzed in several tests to determine the level of CRP present.

My Sinatra Smart Zone recommendation for an optimal CRP level is less than 0.8 mg/dL.

Serum Ferritin (iron) is necessary throughout life for stimulating the production of hemoglobin, the red blood cell pigment that carries oxygen to our cells. However, newer research indicates that iron overload can actually contribute to heart disease risk.

A Finnish study examined the role of iron in coronary artery disease. After studying 1,900 men ages 42 to 60 for five years, researchers found that those with excessive levels of ferritin were more than twice as likely to have heart attacks, and that every one percent increase in ferritin translated into a four percent increase in heart attack risk. To find out if your iron levels are healthy, ask your doctor to perform a special iron test called serum ferritin.

My Sinatra Smart Zone recommendation for an optimal serum ferritin level is less than 80 mg/L (for women); less than 90 mg/L (for men).

Fibrinogen is a protein that determines the stickiness of your blood by enabling your platelets to stick together. You need adequate fibrinogen levels to stop bleeding when you’ve been injured, but you also want to balance your fibrinogen levels to support optimal blood circulation.

If you have a family history of heart concerns, you must check your serum fibrinogen level.
Women who smoke, take oral contraceptives, or are postmenopausal usually have higher fibrinogen levels and should also get this simple test done.

My Sinatra Smart Zone recommendation for an optimal fibrinogen level is 180 to 350 mg/dL.

Homocysteine is an amino acid that causes your body to lay down sticky platelets in blood vessels. Having some homocysteine is normal, but an excess may affect your cardiovascular health.

If you’ve had a heart attack or other cardiovascular event, you have a family history of early heart disease, you have hypothyroidism, or have lupus or kidney disease, you should consider asking your doctor to test your homocysteine levels. Finally, if you take drugs that tend to elevate homocysteine—theophylline (for asthma), methotrexate (for cancer or arthritis), or L-dopa (for Parkinson’s)—you should be tested.

My Sinatra Smart Zone recommendation for an optimal homocysteine level is less than 9 umol/L.

Interleukin-6 is important because it stimulates the liver to produce CRP. And in addition to heart disease, we are learning that this cytokine has a strong association with asthma (asthma is the result of airways swelling and constricting, so it makes sense that an inflammatory agent is behind the curtains here as well). The Iowa 65+ Rural Health Study demonstrated that elevations of interleukin-6 and CRP were associated with increased risk of both cardiovascular disease and general mortality in healthy older people.

I’m convinced that interleukin-6 may be an even better marker for inflammation than CRP because these “precursor” levels rise earlier. Therefore you should ask your doctor to conduct an interleukin-6 test if you are concerned about inflammation and its impact on your heart.

My Sinatra Smart Zone recommendation for an optimal interleukin-6 level is 0.0 to 12.0 pg/mL.

DISCLAIMER: The content of is offered on an informational basis only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified health provider before making any adjustment to a medication or treatment you are currently using, and/or starting any new medication or treatment. All recommendations are "generally informational" and not specifically applicable to any individual's medical problems, concerns and/or needs.

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