51), blood pressure (52), diabetes (55), and tobacco use (93).Heart disease is the number-one worldwide killer of men and women, and your risk of cardiovascular problems increases as you get older. Doctors look at a constellation of health markers to help determine your likelihood of having a heart attack over the next ten years. Called the Framingham Risk Score, this tool was developed using data from thousands of people over several decades, and the results are fairly reliable. Beyond these traditional indicators, scientists have discovered new ways to pinpoint the presence of heart and vascular disease and have recently developed tests that can provide additional information about your risk.
Besides age, other unchangeable factors like gender and race play a role in your risk. Black men, for example, appear to have the highest chance of dying from cardiovascular disease. And women’s risk increases significantly after menopause. But there are several critical elements that you can control, including your cholesterol levels (51), blood pressure (52), diabetes (55), and tobacco use (93).
Cholesterol levels tend to increase as you get older, and the higher your total, the higher your risk for heart disease. According to the American Heart Association, adults should aim for less than 200 mg/dL total cholesterol. In addition, your doctor will test other blood lipids, such as triglycerides, to get a better picture of your overall risk. Doctors recommend keeping your systolic blood pressure (the top number) below 120 mm Hg and your diastolic blood pressure (the bottom number) below 80 mm Hg for the best cardiovascular health. Although diabetes is defined as having fasting blood glucose of 126 mg/dL or more, some evidence indicates that prediabetes, or fasting blood glucose between 100 to 126 mg/dL, also ages your heart. And of course you’ll want to reduce (and ideally eliminate) all exposure to tobacco smoke. To get a picture of your overall cardiovascular risk, the Cleveland Clinic offers an easy-to-use Framingham Risk Score calculator at http://my.clevelandclinic.org/ccforms/Heart_Center_Risk_Tool.aspx.
In addition to the Framingham Risk Score, a few new tests measure substances called cardiac biomarkers in your blood, which can give a clearer indication of your odds for developing cardiovascular disease. That information can help you and your doctor decide how aggressively to treat the risk factors you have, helping to ensure that your heart stays young and healthy. Talk to your doctor about whether you’re a good candidate.
A high-sensitivity C-reactive protein (CRP) test measures the concentration of a plasma protein that increases with inflammation. Since inflammation likely contributes to buildup of plaque in your arteries (atherosclerosis), a CRP test may provide an early warning for people already at risk for cardiovascular disease. Anything above 3.0 mg/L indicates high risk.
Homocysteine is an amino acid naturally found in the blood, and high levels are linked to coronary artery disease, stroke, and peripheral vascular disease. Homocysteine is normally higher in men than in women and increases with age. Your doctor may order the test if you have a family history of heart disease, or if you’ve had cardiovascular problems but don’t have traditional risk factors, such as smoking. Normal levels are 0.54 to 2.3 mg/L.
Lipoprotein(a) is a type of LDL cholesterol based more on genetics than lifestyle, and experts believe it can contribute to atherosclerosis and heart disease. If you have atherosclerosis but normal cholesterol levels, a family history of early-onset heart disease or sudden death, or if cholesterol-lowering drugs aren’t working for you, request a lipoprotein(a) test in addition to regular LDL screening. The risk of elevated lipoprotein(a) depends on your LDL cholesterol level, but a result of 80 mg/dL or higher warrants treatment.
High levels of fibrinogen, a protein that helps your blood to clot, make it more likely for clots to form in an artery, reducing blood flow to the heart and raising your risk of stroke. It’s also a marker of inflammation, which can speed up atherosclerosis. However, the test can’t identify the source of the inflammation, so doctors only perform it when you’re already at risk for heart disease. Normal levels are between 200 and 400 mg/L.
Another test is called cardiac calcium scoring, which uses a CT scan to measure the buildup of calcium in plaque in the arteries of your heart. Normally you shouldn’t have any; if you do, it’s a sign of coronary artery disease. Most doctors don’t recommend this test unless you have a 10 to 20 percent chance of having a heart attack in the next ten years (considered medium risk) based on your other risk factors.