Should You Undergo Testing for Heart Disease?
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Heart disease is the leading cause of death in the United States. It accounted for 1 in 5 deaths in 2020 alone.
The American Heart Association (AHA) recommends that routine screening of heart health begin at age 20, with regular follow-up based on your:
- test results
- personal health
- family history
The goal of screening is to identify risk factors for heart disease early, so you and your healthcare team can develop a plan to protect your heart health.
While you cannot prevent all forms of heart disease, you can manage your heart health with regular monitoring. This can help you make lifestyle changes or begin treatment before complications occur.
This article takes a closer look at the different kinds of testing you may undergo for heart disease, including tests that healthcare professionals may recommend if they detect any warning signs of heart disease.
As mentioned earlier, the AHA recommends regular screening starting at age 20 to monitor your heart health. This can be done at your annual physical exam by your primary care doctor.
The goal of these tests is to assess how likely you are to develop heart disease, based on various risk factors. The most common risk factors for heart disease include:
- high blood pressure
- high cholesterol
- diabetes
- overweight and obesity
- current or past smoking habits
- a diet that is high in added sugars, sodium, and saturated or trans fats
- physical inactivity
- excessive alcohol use
- a family history of heart disease at a young age
Routine screening includes several different types of tests to assess these factors and inform your healthcare team about your heart health.
Medical history
A detailed medical history can help your doctor identify certain factors that may increase your likelihood of developing heart disease.
When reviewing your medical history, a healthcare professional may ask questions about your physical activity levels, dietary patterns, past or present smoking habits, and alcohol use. Your doctor should also ask about your current lifestyle habits at each visit.
Physical exam
A physical exam can help your doctor measure and monitor other factors that may contribute to your risk of heart disease. This may include blood pressure monitoring and weight measurements.
Blood pressure monitoring
High blood pressure, also known as hypertension, is one of the leading risk factors for heart disease.
Regular blood pressure monitoring, done at least yearly, gives you and your doctor a chance to act early if your levels get too high. This can reduce the likelihood of developing potentially severe complications, according to 2020 research.
A healthcare professional monitors your blood pressure using an inflatable cuff that they wrap around your arm. They inflate and then deflate the cuff while measuring your blood pressure.
Blood pressure readings are measured in millimeters of mercury (mm Hg). The measurements are divided into categories based on your systolic (upper) and diastolic (lower) readings:
| Category | Systolic reading | Diastolic reading |
|---|---|---|
| Standard | lower than 120 mm Hg | lower than 80 mm Hg |
| Elevated | 120–129 mm Hg | less than 80 mm Hg |
| High Blood Pressure – Stage 1 | 130–130 mm Hg | 80–89 mm Hg |
| High Blood Pressure – Stage 2 | 140 mm Hg or higher | 90 mm Hg or higher |
Blood pressure readings are often expressed as the systolic number “over” the diastolic number, such as “120 over 80” for a standard blood pressure reading.
Any blood pressure reading that is 180 over 120 mm Hg is known as a hypertensive crisis and requires immediate medical attention.
BMI and waist circumference
A physical exam also typically includes an assessment of body weight. A healthcare professional will use your body weight and your height to calculate your body mass index (BMI).
While weight and BMI are not direct indicators of heart health, people with overweight or obesity tend to be more likely to develop health complications, including heart disease.
BMI readings fall into four main categories:
| Category | Measurement |
|---|---|
| Underweight | BMI less than 18.5 |
| Standard | BMI between 18.5–24.9 |
| Overweight | BMI between 25.0–29.9 |
| Obesity | BMI 30.0 or more |
In addition, or as an alternative, your doctor may measure your waist circumference. Instead of just relying on weight and BMI to assess body fat content, waist circumference accounts for where fat is located on your body.
Higher levels of body fat around the abdomen are linked to greater amounts of fat in the liver. This can cause liver disease and in turn increase the likelihood of developing heart disease.
A high waist circumference is linked to a higher likelihood of developing heart disease, even in people with a “normal” BMI. Conversely, people with a BMI classified as obese who have a lower waist circumference are less likely to have heart disease.
| Category | Measurement |
|---|---|
| Healthy waist circumference for men | less than 40 inches |
| Healthy waist circumference for non-pregnant women | less than 35 inches |
Bloodwork
Bloodwork and lab testing can help your provider monitor the levels of certain compounds in your blood that can affect how well your heart works. These include:
- cholesterol testing
- blood glucose testing
Cholesterol readings
High amounts of cholesterol in the blood can build up in the arteries, making it harder for blood to flow through. If too much cholesterol builds up in the arteries, a clot can form. This causes them to become blocked, leading to a heart attack or stroke.
Cholesterol is produced by the body in the liver, but we get extra cholesterol from the food we eat. If your cholesterol levels are too high, your doctor may suggest a change to your diet or prescribe medication to lower them.
A simple blood test can measure your:
- HDL (good) cholesterol
- LDL (bad) cholesterol
- triglycerides
Work with your doctor to discuss your readings and whether or not they’re in a standard range.
Fasting cholesterol levels should be taken every 4 to 6 years. Your doctor may suggest more frequent testing if you are considered at higher risk for heart disease.
Blood sugar readings
High levels of glucose in the blood can increase the likelihood of developing insulin resistance, which can lead to prediabetes or type 2 diabetes.
Both of these conditions can cause heart health concerns. High levels of glucose in the blood can also damage the blood vessels, which can cause clots and clogged blood vessels.
A simple blood test can determine your glucose readings. These readings are measured in milligrams per deciliter (mg/dL).
| Category | Measurement |
|---|---|
| Normal A1C Results | less than 5.7% |
| Normal Fasting Blood Sugar Results | less than or equal to 99 mg/dL |
| Normal Glucose Tolerance Results | less than or equal to 140 mg/dL |
Numbers above these readings may be a sign of prediabetes or diabetes.
Blood glucose testing is recommended every 3 years starting at age 45, but your healthcare professional may want to test sooner or more often if you have certain risk factors for heart disease.
If regular testing shows that you have early signs of heart disease or may be more likely to develop heart disease, your doctor may suggest additional testing to evaluate your heart health.
Some of these may be done by your primary care doctor, whereas others may be performed by a heart specialist known as a cardiologist.
Heart monitoring
An electrocardiogram, also known as an ECG or EKG, is used to detect any atypical rhythms in the way your heart beats.
In this test, a healthcare professional will attach patches with electrode sensors to your chest, arms, and legs. These sensors will monitor the electrical activity of your heart.
A Holter monitor is a wearable ECG device that allows for continuous monitoring of the electric activity of the heart. It can be worn for 24 to 48 hours or up to several weeks if needed. This type of monitor allows your doctor to monitor your heart rate over time and in different settings.
Your doctor may also use an ECG to perform a stress test. The goal of stress testing is to determine how well your heart works under stress. If you are unable to exercise, your doctor may prescribe a medication to make your heart beat faster.
Work with your healthcare professional to discuss the results of any heart monitoring and what they mean for your health.
Heart imaging
An echocardiogram is a type of ultrasound scan that healthcare professionals use to see the structure of your heart. By capturing a video of your heart, your doctor can check its size and shape, as well as how all of the different chambers and valves are working.
Your doctor may use a variety of other noninvasive imaging techniques to look at your heart in different ways, including a chest X-ray or a CT or MRI scan of the heart.
If results from other tests indicate you have heart disease, a cardiologist may recommend a coronary angiogram to study how blood is flowing through your heart.
In this procedure, a healthcare professional will insert a catheter through a blood vessel in your arm or groin and thread it to the heart. Once in the heart, a dye is injected and a special X-ray is used to visualize blood flow.
Healthcare professionals can also use an angiogram to take tissue samples of the heart and perform minor surgical procedures if needed.
Your doctor will go over the results from any heart imaging that’s performed and what they mean.
Genetic testing
Genetic testing isn’t typically part of a heart workup. However, some people who may be more likely to develop heart disease may benefit from genetic testing.
Genetic testing may be recommended for people who are more likely to develop certain types of heart disease that are known to be inherited, such as hypertrophic cardiomyopathy (HCM). People with a first-degree relative who has been diagnosed with HCM should discuss genetic testing with their healthcare professional.
Talk with your doctor about your family history of heart disease and whether you would benefit from genetic testing. If you do undergo genetic testing, your doctor can also discuss the results and what they may mean for your health.
Heart disease comes in many forms and can have serious effects on your health. Regular testing can help you identify any potential issues early, allowing you to get a diagnosis and take the necessary steps to protect your health.