The Truth About Heart Disease: Tests That Could Save Your Life
Heart disease remains the number one cause of death worldwide, yet half of the people who suffer a heart attack have “normal” cholesterol levels. That’s because standard cholesterol tests don’t tell the full story.
To truly assess cardiovascular risk, we need to go beyond total cholesterol and LDL and look at advanced cardiovascular tests that provide a more accurate picture of heart health.
As a naturopathic doctor, I’ve guided many patients through these tests, but it wasn’t until I did them myself that I truly understood their power and they really changed the way I treat and manage heart health.
In this article, we’ll explore the essential blood and imaging tests that can help identify hidden risks and give you the best strategy to protect your heart.
Table Of Contents
Why Standard Cholesterol Tests Aren’t Enough
When most people think of heart disease risk, they think about LDL cholesterol (the so-called “bad” cholesterol) and HDL cholesterol (the “good” cholesterol).
While these markers are important, they don’t tell us much about how atherosclerosis (plaque buildup in arteries) is actually developing.
Consider this: I’ve seen patients with LDL levels of 400 but a Coronary Artery Calcium (CAC) score of zero—meaning no plaque buildup in their arteries. Meanwhile, others with “normal” cholesterol have had heart attacks due to unseen risks.
The limitations of standard lipid panels become even more apparent when we consider the complex nature of lipoproteins and their role in cardiovascular health.
LDL cholesterol, for instance, is not a single entity but a spectrum of particles varying in size and density. Some LDL particles are large and fluffy, while others are small and dense.
The latter are more likely to penetrate arterial walls and contribute to plaque formation, yet standard tests don’t differentiate between these subtypes.
So how do we uncover the full picture? The answer lies in advanced cardiovascular testing.
Key Blood Tests for Heart Disease Risk
Before we dive into the more advanced markers, it’s important to briefly mention the basic lipid panel tests.
These include total cholesterol, LDL (low-density lipoprotein), HDL (high-density lipoprotein), and triglycerides.
While these tests provide useful information, they are not enough to fully assess cardiovascular risk. Many people with “normal” cholesterol levels still experience heart attacks, and some with high cholesterol remain heart-healthy.
This is why additional, more advanced markers are crucial for a complete assessment.
- Apolipoprotein B (ApoB) – The Best Marker for Atherosclerosis Risk
ApoB is a protein found on all atherogenic (plaque-causing) particles, including LDL, VLDL, and Lipoprotein(a).
Unlike LDL-C, which only measures cholesterol levels in LDL particles, ApoB counts the actual number of these harmful particles, making it a far better predictor of cardiovascular risk.
Why it matters: Higher ApoB levels indicate a greater number of particles that can contribute to plaque buildup. Research has shown that ApoB is a superior predictor of cardiovascular events compared to LDL-C, especially in individuals with discordant LDL-C and ApoB levels.
Who should test: Everyone, but especially those with high LDL, a family history of heart disease, or metabolic issues. ApoB testing is particularly valuable for individuals with normal LDL-C but elevated triglycerides or low HDL-C, as these conditions can mask an elevated number of atherogenic particles.
Optimal range: Below 80 mg/dL for low risk; below 60 mg/dL for optimal cardiovascular health. Some experts suggest even lower targets for individuals with established cardiovascular disease or multiple risk factors.
- Lipoprotein(a) (Lp(a)) – The Genetic Risk Factor
Lp(a) is a genetic variant of LDL that significantly increases cardiovascular risk. Unlike other cholesterol markers, lifestyle changes don’t impact Lp(a), so it’s crucial to know your levels early.
Why it matters: High Lp(a) is associated with a higher risk of heart attacks and strokes. Lp(a) is particularly dangerous because it not only contributes to plaque formation but also promotes blood clotting, further increasing the risk of cardiovascular events.
Who should test: Anyone with a family history of heart disease or unexplained cardiovascular events at a young age. Testing is especially important for individuals of African or South Asian descent, who tend to have higher Lp(a) levels.
Optimal range: Below 50 nmol/L (some experts suggest aiming for 30 nmol/L or lower). It’s important to note that Lp(a) levels are largely genetically determined and don’t change much over time, so a single test in adulthood is usually sufficient.
- High-Sensitivity C-Reactive Protein (hsCRP) – The Inflammation Marker
Inflammation plays a key role in heart disease, and hsCRP is one of the best markers for detecting low-grade systemic inflammation.
Why it matters: Elevated hsCRP levels indicate ongoing inflammation, which can accelerate arterial plaque buildup. Chronic inflammation contributes to all stages of atherosclerosis, from initial endothelial dysfunction to plaque rupture.
Who should test: Anyone with metabolic issues, high cholesterol, or an unclear cardiovascular risk. hsCRP is particularly useful for individuals at intermediate risk based on traditional risk factors, as it can help refine risk assessment and guide treatment decisions.
Optimal range: Below 1 mg/L. Levels between 1-3 mg/L indicate moderate risk, while levels above 3 mg/L suggest high risk. However, it’s important to interpret hsCRP in the context of other risk factors and to rule out acute infections or inflammatory conditions that can temporarily elevate levels.
- Homocysteine – The Blood Vessel Health Indicator
Homocysteine is an amino acid that, when elevated, can damage arterial walls and increase clotting risk. It is influenced by B-vitamin levels (B6, B12, folate) and genetic factors like MTHFR mutations.
Why it matters: High homocysteine can contribute to atherosclerosis and stroke risk. Elevated homocysteine promotes oxidative stress, endothelial dysfunction, and smooth muscle cell proliferation in the arterial wall, all of which contribute to plaque formation.
Who should test: People with a family history of heart disease, stroke, or known genetic risks. Testing is also valuable for individuals with poor dietary habits, vegans/vegetarians (who may be at risk for B12 deficiency), and those with kidney disease.
Optimal range: Below 9 μmol/L. Some experts suggest even lower levels (below 7 μmol/L) for optimal cardiovascular protection. It’s worth noting that homocysteine levels can be effectively lowered through B-vitamin supplementation in most cases.
- Blood Pressure – A Key Cardiovascular Risk Factor
Blood pressure is one of the most significant predictors of heart disease and stroke.
High blood pressure (hypertension) damages arteries over time, increasing the likelihood of plaque buildup and heart strain.
Why it matters: Uncontrolled hypertension is a leading cause of heart failure, kidney disease, and stroke. Chronic high blood pressure causes mechanical stress on the arterial walls, promoting inflammation, oxidative stress, and endothelial dysfunction.
Who should monitor: Everyone, especially those over 40 or with risk factors like obesity, high stress, or poor diet. Regular monitoring is crucial, as hypertension is often asymptomatic until significant damage has occurred.
Optimal range: Below 120/80 mmHg. The American Heart Association defines hypertension as blood pressure ≥130/80 mmHg. However, recent research suggests that even lower levels may be beneficial for cardiovascular health.
Essential Imaging Tests for Heart Health
Blood tests provide a snapshot of risk, but imaging tests can reveal actual damage or plaque buildup inside the arteries.
Coronary Artery Calcium (CAC) Score – Detecting Hardened Plaque
A CAC score measures the amount of calcium in the coronary arteries, providing a clear indication of past plaque buildup.
Why it matters: A high CAC score means more arterial plaque and a higher risk of heart attacks.
The CAC score is an excellent tool for reclassifying risk in individuals with intermediate risk based on traditional risk factors.
Who should test: People over 40, especially if they have risk factors (family history, high cholesterol, etc.).
CAC scoring is particularly valuable for individuals at intermediate risk or those with conflicting risk factors.
What it tells you: If your CAC score is zero, your risk of a heart attack is low. If it’s elevated, further testing is needed. A score of 1-99 indicates mild plaque buildup, 100-399 moderate, and ≥400 severe.
CT Angiogram – The Gold Standard for Soft and Hard Plaque
A CT Angiogram provides a detailed image of your coronary arteries, detecting both calcified and soft (more dangerous) plaque.
Why it matters: Soft plaque is more likely to rupture and cause heart attacks. CT angiography can detect non-calcified plaque and assess the degree of stenosis (narrowing) in the coronary arteries.
Who should test: Those with high ApoB, high cholesterol, or an unclear risk profile. CT angiography is particularly useful for individuals with symptoms suggestive of coronary artery disease or those with equivocal results from other tests.
- Pros: Provides the most detailed look at actual atherosclerosis. It can detect early-stage disease and help guide treatment decisions.
- Cons: Involves radiation exposure and requires the use of contrast dye, which may be contraindicated in some individuals.
Carotid Intima-Media Thickness (CIMT) – Early Detection of Artery Thickening
CIMT uses an ultrasound to measure arterial wall thickness, helping to detect early-stage plaque formation.
Why it matters: Thickened arteries indicate an increased risk of cardiovascular events. CIMT can detect early atherosclerotic changes before plaque formation occurs.
Who should test: Anyone at risk who wants a radiation-free option. CIMT is particularly useful for younger individuals or those with intermediate risk who want to assess their vascular health without radiation exposure.
- Pros: Non-invasive, no radiation, and can be repeated frequently to track changes over time.
- Cons: Results can vary based on technician skill and equipment used.
Integrating Advanced Testing into Your Heart Health Strategy
While these advanced tests provide valuable information, it’s important to interpret them in the context of your overall health profile and risk factors.
Here are some key points to consider:
- Start with a comprehensive assessment: Begin with a thorough evaluation of traditional risk factors, including family history, lifestyle habits, and basic lipid panel results.
- Consider advanced testing based on your risk profile: If you have intermediate risk or conflicting risk factors, advanced testing can help clarify your true cardiovascular risk.
- Use multiple markers for a complete picture: No single test can provide a complete assessment of cardiovascular risk. Combining blood tests with imaging studies offers the most comprehensive evaluation.
- Repeat testing as needed: While some markers (like Lp(a)) don’t change much over time, others should be monitored regularly to track progress and adjust treatment strategies.
- Work with a knowledgeable healthcare provider: Interpreting advanced cardiovascular tests requires expertise. Partner with a healthcare provider who is well-versed in these tests and can help you develop a personalized prevention or treatment plan.
Cardiovascular Testing: Knowledge is Power
Many people are walking around with a false sense of security because their standard cholesterol numbers look “fine.”
Advanced cardiovascular testing gives us a clearer, more individualized picture of heart disease risk.
If your cholesterol is high but your CAC score is zero, you might not need aggressive treatment.
On the other hand, if your ApoB and Lp(a) are high, and imaging shows soft plaque, taking action is critical.
Remember, these tests are tools for empowerment, not to have you living in fear.
By understanding your unique risk profile, you can make informed decisions about lifestyle changes, dietary interventions, and medical treatments to protect your heart health.
I hope this guide helps you take control of your heart health.
In an upcoming article, I’ll dive into the best diet, lifestyle, and supplement strategies to optimize your cardiovascular health based on these advanced markers.
Stay proactive, get tested, and protect your heart for the long run!
