Cardiac Risk Assessment

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Formal name: Cardiac Risk Assessment
Related tests: Lipid profile; hs-CRP; Lp(a); Lp-PLA2

What is a cardiac risk assessment?

This is a group of tests and health factors that have been proven to indicate your chance of having a cardiovascular event such as heart attack or stroke. They have been refined to indicate the degree of risk: slight, moderate, or high.

What is included in a cardiac risk assessment?
Perhaps the most important indicators for cardiac risk are those of your personal health history. Age, hereditary factors, weight, cigarette smoking, blood pressure, exercise history, and diabetes are all important in determining your risk. The lipid profile is the most important blood test for risk assessment.

There are imaging tests, non-invasive and invasive, that may be used in cardiac risk assessment. Non-invasive tests may include an electrocardiogram (ECG, EKG), ECG stress test, nuclear stress test, computerized tomography (CT) scan, echocardiogram, and magnetic resonance angiogram (MRA). Invasive tests include an angiography/arteriography and cardiac catheterization. (For more on these, see the Mayo Clinic’s webpage on Coronary artery disease: Tests and Diagnosis.)

How is the lipid profile used?
The lipid profile measures cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C, "good" cholesterol), and low density lipoprotein cholesterol (LDL-C, "bad" cholesterol). Triglycerides are the major form of fat found in the body and their function is to provide energy for the cells. Below are the desirable ranges for the components of the lipid profile:

  • Cholesterol <200 mg/dL (5.18 mmol/L)
  • HDL-cholesterol > 40 mg/dL (1.04 mmol/L)
  • LDL-cholesterol <100 mg/dL* (2.59 mmol/L)
  • Triglycerides <150 mg/dL (1.70 mmol/L)
* optimal; levels will depend on the number and type of risk factors present and why testing is being done

If any or all of your results are significantly outside these ranges, your risk of a cardiac event is increased. Diet, exercise, and/or medication may reduce levels, thereby reducing your risk.

What other tests are used to assess cardiac risk?
Some other tests that may be used to assess your cardiac risk include:

  • High-sensitivity C-reactive protein (hs-CRP): Studies have shown that measuring CRP with a high sensitivity test can help identify risk of cardiovascular disease (CVD). This test is different from the regular CRP test, which detects elevated levels of CRP in people with infections and inflammatory diseases. The hs-CRP test measures CRP that is in the normal range for healthy people. It can be used to distinguish people with low normal levels from people with high normal levels. High normal levels of hs-CRP in otherwise healthy individuals have been found to be predictive of the future risk of heart attack, stroke, sudden cardiac death, and peripheral arterial disease, even when lipid levels are within acceptable ranges. Several groups have recommended that this test be used in people with moderate risk of heart attack over the next 10 years; however, there is not a consensus over how the test should be used otherwise, nor on how frequently the test should be repeated.
  • Lipoprotein A (Lp(a)): Lp(a) is a lipoprotein consisting of an LDL molecule with another protein (Apolipoprotein (a)) attached to it. Lp(a) is similar to LDL-C but does not respond to typical strategies to lower LDL-C such as diet, exercise, or most lipid-lowering drugs. Since the level of Lp(a) appears to be genetically determined and not easily altered, the presence of a high level of Lp(a) may be used to identify individuals who might benefit from more aggressive treatment of other risk factors.

How is treatment determined?
Treatment will be based on many factors, including the results of the above tests and your family and personal medical and lifestyle history.

Is there anything else I should know?
A healthy diet and exercising are important in reducing blood pressure, cholesterol, and triglycerides. Sometimes these lifestyle changes are not sufficient to reach desirable levels. There are also drugs (for example, statins) that are effective in lipid management. Some conditions involving elevated lipids levels are hereditary. High lipid levels in these conditions cannot always be lowered sufficiently by diet and exercise. This type of elevation usually requires treatment with lipid-lowering drugs.

FAQs
1. Are some people more at risk for a heart attack than others?
Yes. Those who are overweight, smoke cigarettes, have high blood pressure (hypertension) or diabetes, abnormal risk test results, and those with a family history of heart disease are at greater risk.

2. Are there home test kits for determining if I am at risk for a heart attack? No. Your overall cardiac risk is based on the results of any or all of the tests mentioned previously. The overall assessment requires special tests and interpretation by a trained health professional. However, there are home tests available to measure total cholesterol. (See the article on Home Testing).

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