- The Top 12 Tests for Heart Health and Cardiovascular Risk Factors
- Which Heart Health Tests are Right for You?
- What About Cholesterol Screening for Heart Disease?
- What About Coronary Artery Calcium?
- What to Ask Your Doctor About Heart Health Tests
Cardiovascular disease is the leading cause of death of men and women in the United States, and up to 121 million adults in the US have some form of it[*].
That means nearly half of American adults may have heart disease.
The best way to determine your risk of heart disease is by screening for risk factors. But what are the best tests for heart disease?
Although some people feel anxious about learning their personal risk level, “bad” lab results don’t mean you are bound to develop cardiovascular disease. Instead, you can use these insights to improve your heart health and reduce your risk.
In this article, you’ll learn that you can’t determine heart disease risk from a simple cholesterol screening.
Plus, you’ll learn the 12 best lab tests for heart health, how to decide which cardiovascular screening tests are right for you, and how to speak to your doctor about testing.
The Top 12 Tests for Heart Health
Overall, the number one risk factor for cardiovascular disease is age. As you get older, your risk of cardiovascular disease increases, regardless of how healthy you happen to be[*].
Whether you enjoy good health currently or have already had a diagnosis of cardiovascular disease, detecting and addressing cardiovascular issues early is the best strategy for reducing your risk.
Here are the top 12 blood tests that can help you gain a better understanding of your heart health so you can take steps to lower your chances of heart disease.
#1: The VAP Cholesterol Panel
The Vertical Auto Profile (VAP) cholesterol test can identify your risk of cardiovascular disease far more accurately than traditional cholesterol testing.
Along with the four conventional cholesterol measurements (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein), VAP provides the following numbers:
- Total number of very-low-density lipoprotein (VLDL) particles
- LDL pattern density (small-dense LDL, also called sdLDL or LDL-P)
- LDL bound to C-reactive protein (LDL-RC)
- ApoB levels
- Lipoprotein (a) or Lp(a) cholesterol levels
- Lipoprotein subclasses like HDL-2, HDL-3, and intermediate-density lipoprotein (IDL)
If this test sounds confusing, that’s because it’s so detailed.
The good news is that those details can tell you a lot about your risk level, which is why it’s the #1 choice to understand your heart health and cardiovascular risk factors better.
#2: NMR LipoProfile
The NMR LipoProfile is a more accurate way to assess your LDL particle count, size, and density than the VAP. While VAP is somewhat accurate and is good at predicting risk, it does not include a direct measurement of LDL particles[*].
Unlike the VAP panel, the NMR LipoProfile uses nuclear magnetic resonance (NMR) to measure your LDL particle size and number directly.
You don’t necessarily need to get both NMR and VAP–the decision comes down to factors like availability, cost, and your medical history. They’re both excellent choices, and light years ahead of the conventional cholesterol panel.
#3: ApoA1 and ApoB
In a nutshell, apolipoprotein A1 (ApoA1) and apolipoprotein B100 (ApoB) are similar to LDL (“bad” cholesterol) and HDL (“good” cholesterol), but they do a better job of measuring your actual heart disease risk.
Apolipoprotein A1 (ApoA1) is the primary component of high-density lipoprotein (HDL or “good” cholesterol). Low ApoA1 levels are linked with an increased risk of early heart health issues[*].
Apolipoprotein B (ApoB) is a protein found in cholesterol particles. ApoB is found mainly in VLDL, LDL, and IDL cholesterols. It is a more accurate risk marker for heart disease than LDL[*]
While ApoB is included in the VAP test (above), some people may opt for standalone ApoA1 and ApoB as a cheaper and simpler way to measure their risk.
Testing these two markers is an easy, relatively inexpensive way to get a snapshot of the good and bad of your current heart health status.
#4: High Sensitivity C-Reactive Protein (hsCRP)
C-reactive protein (CRP) is a protein produced by your liver that is linked to inflammation in your body. As you may know, inflammation plays a significant role in cardiovascular disease.
Most cardiologists and scientists aren’t ready to say inflammation causes heart disease, but there’s a strong correlation. Inflammation is involved in atherosclerosis (hardening and narrowing of the arteries) and heart attacks[*][*].
Basically, the hsCRP test is a measure of how much inflammation is occurring in your body. Since higher levels of inflammation also predict cardiovascular problems, hsCRP is useful for assessing your heart health status and risk levels[*].
CRP levels can vary over time, so you should do the test at least two different times, two weeks apart.
#5: Glucose and Insulin Markers
Since you’re reading this article on Perfect Keto, you probably already know a thing or two about insulin sensitivity. The term refers to how efficiently your body uses the hormone insulin to store energy.
Insulin resistance, which is the same thing as reduced insulin sensitivity, correlates to heart disease risk (as well as the risk of other diseases like type 2 diabetes, cancer, and dementia)[*][*][*][*].
High blood sugar and poor insulin sensitivity raise your risk of cardiovascular issues because they damage the endothelium, a one-cell-thick tissue layer that lines your blood vessels[*]. Even in non-diabetic people, insulin resistance can predict the risk of heart disease independently of other risk factors[*].
The damage that can occur is a long-term process, but it’s a simple matter to measure (and improve) your insulin sensitivity to catch the issue early. Here’s what you need to test:
- Fasting blood glucose
- Fasting insulin levels
- Glycated hemoglobin (HbA1C)
- Oral glucose tolerance test (OGTT) (optional)
The first three may be sufficient, but the OGTT helps you measure improvements and changes over time if you do suffer from insulin resistance.
Pro tip: the keto diet paired with exercise is a fantastic way to improve your insulin sensitivity, should you discover that you’re insulin resistant.
#6: OmegaCheck
With OmegaCheck you can learn more about how your diet is affecting your risk of heart disease, and make changes (like eating more seafood to improve your ratio) if needed.
The OmegaCheck test measures the ratio between omega-6 and omega-3 fatty acids in your blood. It’s an excellent preventive choice because it is predictive of risk and gives you actionable data.
Omega-3s are healthy fats found in oily fish, shellfish, and grass-fed meats. They have anti-inflammatory effects in your body[*].
In contrast, omega-6s are found in grains, corn-fed animal products, and some plant oils. High omega-6 levels can contribute to inflammation the risk of heart disease[*].
Eating a diet with an omega-6 to omega-3 ratio of less than 4 to 1 reduces the risk from cardiovascular disease and other causes by up to 70% over two years, but the typical American diet has a ratio of about 15 to 1[*][*].
#7: Heart Rate Variability (HRV)
Chronic high-stress levels are a risk factor for heart disease[*]. Heart rate variability (HRV) is a measurement of how well your body deals with stress based on your heart’s electrical activity.
You can think of heart rate variability as measuring the connection between your mind and body. HRV even helps explain why people who suffer from depression are more likely to die of heart disease[*].
High HRV indicates good overall health, a lower mortality risk, and a calm central nervous system. If you have a high HRV score, chances are also good you have less inflammation in your body, which means a reduced risk of cardiovascular issues[*].
Conversely, low HRV indicates poor health, a higher mortality risk, and an amped-up nervous system.
If your HRV score is bad (low) you can improve it by using stress management techniques, focusing on your mental health, exercising, and getting enough sleep[*][*][*][*]. As a result, you’ll enjoy a reduced risk of heart disease[*][*][*].
You can have a doctor check your HRV, but there are also numerous mobile apps available that you can use to track your results over time.
The top-ranked Android HRV apps on Google Play are HRV4Training, Elite HRV, and Welltory. If you have iOS, the most popular HRV options in the App Store are Elite HRV, HRV +, and HRV4Training.
#8: ADMA and SDMA Biomarker Test
Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are two compounds known as toxic dimethylarginines. ADMA and SDMA harm your cardiovascular health because they inhibit nitric oxide (NO), causing elevated blood pressure[*].
They can also contribute to ill health in other ways. High levels of ADMA and SDMA suggest that the inner lining of your blood vessels is damaged[*]. They are also an early warning sign of insulin resistance, which increases inflammation and heart disease risk[*].
The bottom line: elevated ADMA and SDMA indicate a higher risk of heart attacks[*].
A large study found that ADMA levels predicted both all-cause and cardiovascular mortality in people with heart disease independently of other established and emerging risk factors[*].
That’s big news because the ability to detect heart attack risk that isn’t identified with other methods can save lives. As a bonus, this test can also predict other potentially fatal issues, allowing you the opportunity to reduce your risk of chronic disease[*].
#9: Trimethylamine-N-oxide (TMAO)
Trimethylamine-N-oxide (TMAO) is another non-traditional cardiovascular risk marker. TMAO is a gut bacteria byproduct created from the amino acid carnitine. It causes inflammation and increases the risk of heart disease[*][*].
According to published research conducted at the Cleveland Clinic, this blood test can predict future heart attacks, strokes, and early deaths in people that are not identified by traditional risk factors[*][*].
Because TMAO levels relate to your dietary patterns and gut health, high TMAO is a clue to change your diet or work on your gut microbiome to reduce your risk of heart disease.
#10: Fibrinogen
Fibrinogen is a protein found in your blood that is involved in the formation of blood clots.
This marker is associated with traditional risk markers of heart disease, but can also predict the risk of serious cardiac events independently of other markers[*][*].
While that may sound puzzling, it’s probably because fibrinogen itself causes some of the heart health issues associated with traditional risk markers, whereas many tests merely correlate to heart disease risk[*].
Not everyone needs to consider fibrinogen screening, but it can be beneficial for older people, people who already have cardiovascular disease, and people whose family history or risk markers point to a high risk of cardiovascular disease.
#11: B-type Natriuretic Peptide (BNP) and N-terminal Pro-B-type Natriuretic Peptide (NT-proBNP)
BNP and NT-proBNP are phenomenal tests for patients who have chronic diseases or elevated cardiovascular risk, or who have already been diagnosed with heart conditions[*].
If you have heart failure, your body will produce high levels of these two proteins, called natriuretic peptides. The levels increase when heart failure worsens, and decrease as you recover.
In one study of people with type 2 diabetes and heart failure, natriuretic peptide screening added as much information about mortality risk as all other conventional tests combined[*].
The takeaway about BNP and NT-proBNP is that most people don’t need to check them, but they’re incredibly useful if your risk levels are high, or if you’ve already had a cardiovascular incident.
#12: Cardiac Stress Test
The cardiac stress test is also called an exercise stress test. Most people never need a cardiac stress test.
But if you’ve had symptoms that point to cardiovascular disease (like chest pain, shortness of breath, or abnormal heart rhythms), or a history of heart disease, it’s a helpful way for your doctor to understand how well your heart works.
It’s also useful for people who have been sedentary a long time and want to begin exercising. The test allows physicians to determine how you should pace yourself during exercise, and what level of physical activity is safe.
Which Heart Health Tests Are Right for You?
If you’re feeling concerned about your heart health, it might seem like a good idea to go ahead and get all 12 tests from the previous section. However, for most people, that would be a mistake–unnecessary testing is expensive and can even muddy the waters.
Instead, the best strategy is to choose the tests that suit your age and risk level. Then you can repeat the tests and compare your results over time.
Although your current risk levels matter, the long-term trend matters more. The direction of your results over time reflects your lifestyle, habits, and health practices.
If you’re willing to experiment with these factors as you measure your risk repeatedly, you’ll gain the knowledge you need to reduce your risk of heart disease.
Here are some suggestions as a starting point for which tests to consider depending on your age and risk level. However, if you’re unsure which tests to get, your best bet is to speak to a trusted healthcare provider.
For Young, Healthy People
- ApoA1 and ApoB
- Glucose and Insulin Markers
- Optional: VAP Cholesterol Panel or NMR LipoProfile
- Optional: OmegaCheck
If you are relatively young (under the age of 40) and don’t have a family history of heart disease, you don’t need extensive testing to determine your risk profile.
ApoA1 and ApoB tell you the good and the bad about your current cardiovascular risk levels, while the glucose and insulin markers give you actionable information to ensure you’re on the right track with your diet and exercise.
If you crave more detailed information, the VAP Panel or NMR LipoProfile can satisfy your desire for quantification, while OmegaCheck will provide you with additional insight to adjust your diet and reduce your risk.
If You’re Young and At Risk
- VAP Cholesterol Panel or NMR LipoProfile
- High-Sensitivity C-Reactive Protein (hsCRP)
- Glucose and Insulin Markers
- Optional: ADMA and SDMA Biomarker Test
- Optional: OmegaCheck
- Optional: Heart Rate Variability (HRV)
If you’re young but have a family history of heart disease, or other reasons to be concerned, these tests can tell you a lot about your current risk levels.
The VAP Panel or NMR LipoProfile is the most direct and comprehensive window into your heart health, but hsCRP adds useful insight into your inflammation levels, which can also influence your overall risk.
Finally, the glucose and insulin markers (and optionally OmegaCheck) give you a roadmap to determining your optimal eating pattern to reduce your risk. (Hint: keto is an excellent choice to improve these markers.)
If you want more markers to track, ADMA and SDMA are potent predictors of multiple cardiovascular conditions, while heart rate variability (HRV) sheds light on your ability to deal with stress–and your risk of sudden cardiac death[*]. By raising your HRV score, you can increase your resilience and reduce your risk of heart problems.
For Healthy Older People
- VAP Cholesterol Panel or NMR LipoProfile
- Glucose and Insulin Markers
- OmegaCheck
- Optional: High Sensitivity C-Reactive Protein (hsCRP)
Recall that even if you’re healthy, age is still a risk factor for heart problems.
That doesn’t mean you need to go all-out with testing, but a detailed test like the VAP Panel or NMR LipoProfile can uncover issues you wouldn’t otherwise detect.
Meanwhile, it’s also a good idea to fine-tune your lifestyle and diet to maintain high insulin sensitivity and low levels of inflammation. For those purposes, measuring your glucose and insulin markers and your omega-6 to omega-3 ratios (OmegaCheck) is invaluable.
If You’re Older and At Risk
- VAP Cholesterol Panel or NMR LipoProfile
- High-Sensitivity C-Reactive Protein (hsCRP)
- Glucose and Insulin Markers
- OmegaCheck
- Heart Rate Variability (HRV)
- Optional: ADMA and SDMA Biomarker Test
- Optional: Trimethylamine-N-oxide (TMAO)
For older people with familial risk or other risk factors for heart disease, it’s time to pay a lot of attention to screening. After all, heart disease is the leading cause of death.
The VAP Panel (or the NMR LipoProfile), hsCRP, glucose and insulin markers, OmegaCheck, and HRV together will provide a tremendous amount of information to assess your heart health from multiple angles and take appropriate action to manage your risk.
If ADMA/SDMA and TMAO are available to you, and you can afford to get them annually, you may gain additional insight from these tests because they can pick up on problems that other tests miss.
For Cardiovascular Patients
As with most other risk groups, the following tests offer the most bang for your buck:
- VAP Panel or NMR LipoProfile
- High Sensitivity C-reactive Protein (hsCRP)
- Glucose and Insulin Markers
You can dig deep into those markers and use them to gauge your improvement if you’ve already experienced a cardiovascular event.
Depending on your history and risk levels, the following tests may be useful along with the basics:
- Fibrinogen
- BNP and NTpro-BNP
- Cardiac Stress Test
You can also consider other tests like the ADMA/SDMA biomarker test, trimethylamine-N-oxide (TMAO), OmegaCheck, and HRV to gain more understanding of your current health status.
If you’ve already had a serious run-in with cardiovascular issues, it’s imperative that you maintain regular contact with a trusted physician. He or she can help you decide which tests are appropriate and assist with treatment decisions.
Cholesterol Screening for Heart Disease
Most people think of high cholesterol when they think of heart disease, but recent data suggests the traditional lipid profile is not the best way to detect cardiovascular disease.
For nearly 50 years, most physicians have considered high total cholesterol and LDL (so-called “bad cholesterol”) due to diet to be the primary cause of atherosclerosis and poor cardiovascular health.
But recent evidence has shown that the root causes of heart disease are more complicated. The dietary cholesterol hypothesis is on shaky ground when it comes to evidence because it requires researchers to ignore contradictions in the data[*].
If that sounds far fetched, check out these recent findings about food, cholesterol, and the risk of heart disease:
- About 50% of heart attacks and strokes happen to people with normal cholesterol levels[*].
- Eating saturated fat and dietary cholesterol doesn’t raise cholesterol levels for most people[*].
- Higher total cholesterol (TC) is linked to a lower risk of death from all causes[*].
- High LDL cholesterol (so-called “bad” cholesterol) is linked to longer life in people over the age of 60[*]
- Low LDL cholesterol levels predict an elevated risk of cancer[*].
- Statin treatment is not an effective primary treatment to prevent heart disease[*].
Essentially, recent research contradicts the old ideas that saturated fat is unhealthy, dietary cholesterol is harmful, and statins are required for people with high total cholesterol levels.
Another shortcoming of conventional cholesterol testing is that total cholesterol and HDL are measured, but LDL cholesterol is estimated, and you don’t get a breakdown of particle count, size, or density.
That’s why newer, more advanced cholesterol screenings like the VAP Panel or especially NMR LipoProfile are better choices to determine your actual risk.
Coronary Artery Calcium
Coronary artery calcium (CAC) scores are another option to shed light on your risk of a severe cardiac event. One study shows that a single CAC test has an accurate predictive value for heart problems for up to 15 years[*].
The CAC test is a CT scan (computed tomography) scan done “dry,” without a contrast agent. This scan focuses on your heart and generates an image. Then, total calcification is estimated based on the amount of bright white in the picture.
You get to learn the total calcification score, as well as a percentile based on your age, sex, and ethnic group.
Unlike biomarkers, your CAC score is based on a measurement of what’s already been occurring in your heart. Calcification occurs when your heart has to remodel itself after a cardiovascular lesion has formed.
However, there are some shortcomings:
- A score of zero doesn’t mean you have a risk level of zero–based on your family history or biomarkers, you could still be in a high-risk group.
- Up to half of heart attacks occur in non-calcified areas of the heart[*].
- The CAC doesn’t measure calcification in other arteries.
Statistics can be tricky; even though CAC is accurate for predicting trends in large groups of people on average, you don’t want to bet everything on it.
For people with no symptoms who are in low-risk groups, or for people who already have a diagnosed cardiovascular disease, the test isn’t likely to change anything. If you’re somewhere in the middle, it might help you understand your risk better.
As with other tests, CAC can be valuable sometimes, but it’s not a one-stop solution. Most importantly, remember that a CAC score of zero doesn’t mean “zero risk.”
What to Ask Your Doctor About Heart Health Tests
If you have a family history of heart disease, or if you’ve already been diagnosed with heart disease, a competent doctor is an ally you need.
And if you’re lucky, your doctor already understands or will be receptive to, modern methods for heart health screening.
But if not, you have to make a decision: do you want to try to persuade him or her, or is it time to look for a new doctor that has up-to-date information?
The goal is to identify your risk group (based on age, family history, and any symptoms), then get the appropriate tests regularly to learn how your lifestyle is affecting your risk level. An informed doctor can help with those decisions.
Remember that very few people (if anyone) will need all 12 tests. If you ask your doctor for all the tests, you’re more likely to get the cold shoulder.
Depending on your health background and risk factors, you might choose to get screened annually, biannually, or even quarterly. Testing gives you a better understanding of how your habits and lifestyle affect your risk factors, which empowers you to follow through with positive changes that work.
Particularly if your doctor isn’t on board with your getting tested, you may end up paying out of pocket for screening, which can be expensive through your doctor’s office. Make sure to check whether your insurance covers the tests you want before you go through with them.
As an alternative, you can consider going through a reputable website that allows you to purchase tests online inexpensively, get blood drawn at a local lab, and review your results online. Then you can present them to your doctor.
Consider making an appointment soon with your doctor or healthcare professional to discuss which diagnostic tests are right for you, how to interpret your results, and how to lower your risk level.