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 coronary event. 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, 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 other tests, non-invasive and invasive, which may be used in cardiac risk assessment. Non-invasive tests may include an EKG stress test, thallium stress test, EKG, CT scan, and echocardiogram. Invasive tests include an arteriogram and cardiac catheterization.
How is the lipid profile used?
The lipid profile measures cholesterol, triglycerides, HDL (“good” cholesterol), and LDL (“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 whether testing is being used in primary or secondary intervention
If any or all of your results are significantly outside these ranges, your risk of a cardiac event is increased. If they are only slightly outside the desirable level, diet, exercise, and/or medication may be sufficient to reduce the abnormal levels, thereby reducing your risk.
What other tests are used to assess cardiac risk?
Another test gaining importance is serum homocysteine. Homocysteine is an amino acid that comes from the normal breakdown of proteins in the body and appears to be a better test than cholesterol for predicting heart disease, stroke, and reduced blood flow to the hands and feet. Lipoprotein 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 but does not respond to typical strategies to lower LDL 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. A fairly new test, hsCRP may be measured on apparently healthy patients to determine if they are at risk for a coronary event, even if their lipid levels are normal or borderline elevated.
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?
Eating a healthy diet and exercising are important in reducing blood pressure, cholesterol and triglycerides. There are also drugs (known as statins) that have been effective in lipid management. There are some forms of elevated lipids that are hereditary and 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, have high blood pressure 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. The diagnosis is based on the results of any or all of the tests mentioned. The overall assessment requires special equipment and interpretation by a trained professional.
