5 New Heart Tests That Could Save Your Life

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When someone close to us, or a beloved public figure, dies suddenly in their 50s (or even younger) from a heart attack, it suddenly raises our awareness of the deadly danger posed by undiagnosed heart disease. And indeed, statistics show that 50 percent of men and 64 percent of women who die suddenly from coronary artery disease (CAD) had normal cholesterol readings and no prior symptoms. But how do you know if you're at risk, and how bad that risk really is? Here are five new heart tests that show impressive results in detecting heart disease early and predicting future risk of heart attack and stroke.

Coronary Artery Calcium Scan (CAC)

Calcium is one of the main components in the plaque that builds up inside coronary arteries, narrowing and stiffening them and obstructing blood flow to and through the heart. A CAC score of zero is considered ideal; a score over 400 indicates severe atherosclerosis. Although CAC scanning is still one of the lesser-known heart tests, a study in the New England Journal of Medicine a few years ago determined that the CAC test was a "strong predictor" of heart attack and fatal heart disease. The researchers followed close to 7,000 people, testing them for CAC, then followed them for more than three years, correlating the data with the number of fatal or life-threatening coronary events. Those whose scores ranged from 100 to 300 were seven times more likely to die of a heart attack or other heart ailment than those with low CAC scores, and those with scores over 300 were even more at risk.

How it's done: Scans for coronary artery calcium are done via computed tomography, otherwise known as a CT or CAT scan. Unfortunately, CAC scanning, like any other CT scan, isn't without risk. Research by the National Cancer Institute and Columbia University found that the average range of radiation exposure from having such a screening test every five years would cause 42 additional cases of cancer among 100,000 men and 62 additional cases among 100,000 women. Some doctors therefore advise holding off on CAC scanning until other tests show elevated risk.

Who should get it: The American Heart Association (AHA) now recommends a CAC test for people over age 40 with risk factors for heart disease. Recent research also shows CAC tests are particularly useful as an incentive for treatment. Two Canadian studies published in 2012 found that having a higher-than-recommended CAC score doubled peoples' likelihood of sticking to a statin regimen and motivated 40 percent of those studied to lose weight.

How it's different: CAC scores are considered the strongest predictor of future coronary events in people who are otherwise asymptomatic, according to the American Heart Association (AHA). A study published in the August 2011 issue of The Lancet found that the CAC was a better predictor of heart disease than any other measure and can be used effectively to decide who should take statins and who's less likely to benefit.

Cost: $300 to $500; sometimes covered by insurance if ordered by a doctor as indicated by heart disease symptoms or "medium risk" of heart disease based on an assessment of risk factors. Check with your doctor and insurer first.

Corus CAD Explained

A genetic test, as opposed to a physical measurement, Corus CAD looks for evidence of narrowing or blockage in the coronary arteries at the molecular level. Blood samples are screened for the activity of 23 genes that exhibit changes when there's an obstruction in the arteries. It's gender specific, taking into account differences in how men and women respond to obstructive coronary artery disease.

How it's done: A blood sample is sent to the specialized laboratory of CardioDX, the company that makes Corus CAD. Results are available within 72 hours.

Who should get it: People experiencing chest pain, tightness, or pressure that could suggest a narrowing coronary artery. (One telltale sign that chest pain might indicate arterial blockage is if symptoms increase with exercise or exertion.) Shortness of breath or unexplained fatigue are other signs. You aren't a candidate for Corus CAD if you've had a previous heart attack or artery-opening procedure. Corus CAD also isn't recommended if you're diabetic, on steroids, having chemo, or taking immunosuppressive drugs.

How it's different: Corus CAD can detect multivessel coronary artery disease in people who are having unexplained chest pain but would otherwise be considered at low risk. Corus CAD is considered an alternative to myocardial perfusion image testing (MPI), which uses a radioactive agent to test for blockages in cardiac blood flow, followed by angiogram. For example, the New England Journal of Medicine recently reported that of 400 patients who underwent invasive angiography, 62 percent turned out to have no obstructive blockage. Corus CAD potentially could be used to more effectively sort out candidates prior to performing invasive angiograms.

Cost: Approximately $1,200. Some insurers cover Corus CAD, but most don't. Check with your insurance company first. CardioDX offers a financial assistance program to help those who can't afford the test.

High-Sensitivity C-Reactive Protein Assay Explained

Levels of C-reactive protein in the blood rise when there's widespread inflammation somewhere in the body. This can be due to bacterial or viral infection, but inflammation can also occur when plaque buildup irritates and inflames artery walls. Research shows that elevated levels of CRP correlate with increased risk of heart attack and fatal heart disease, possibly because inflammation damages and fragments arterial plaque, causing tiny portions of plaque to break off and be released into the bloodstream, leading to heart attack or stroke.

If your CRP level is in the upper third of that of the general population, you have double the risk of a heart attack compared with people whose C-reactive protein is within or below normal range. Some experts have also suggested that chronic inflammation may be one of the reasons heart disease is linked with gum disease.

How it's done: The hs-CRP test screens a blood sample for the level of the C-reactive protein. Fasting isn't necessary before hs-CRP testing. People with CRP values between 2.0 and 3.0 are considered at the high end of normal; a CRP score above 3.0 is considered high risk.

Who should get it: Anyone with elevated triglycerides and/or cholesterol who wants an additional measure of the likelihood of heart disease should consider this test. High blood pressure, diabetes, a family history of heart disease, or a history of smoking would also suggest that hs-CRP is a good idea. Currently the AHA recommends hs-CRP for those at "intermediate risk," but many clinics, including the Cleveland Clinic, order it for those with one or two risk factors. Women may be particularly good candidates for CRP testing; the Harvard Women's Health Study found hs-CRP a more accurate predictor than tests of cholesterol levels.

How it's different: Although a general blood panel determines the presence of fats and cholesterol in the blood, it doesn't indicate whether those increases are causing inflammation of the arteries. The standard CRP test measures a wider range of CRP levels; high-sensitivity CRP detects lower levels of the protein, making it a much more effective test for cardiovascular disease in people who are otherwise healthy.

Cost: $70 to $150 -- and hs-CRP is usually covered by insurance if you're referred by your doctor or cardiologist.

Carotid Artery IMT Ultrasound (C-IMT) Explained

One of the newest heart health tests to reach doctor's offices is a specialized, high-resolution ultrasound of the carotid artery called C-IMT. C-IMT uses sophisticated computer software to calculate the thickness of the intima and media, two layers of the lining of the carotid artery. Studies have found a strong correlation between the health of carotid arteries in the neck and the coronary arteries in the heart.

How it's done: C-IMT is performed in a doctor's office using specialized B-mode (brightness mode) ultrasound technology attached to a computer. It's considered safe and noninvasive and doesn't involve radiation.

Who should get it: Those with several risk factors for heart disease, cerebrovascular disease, and [stroke][1]. In November 2010, the American College of Cardiology Foundation/American Heart Association Task Force recommended the test for "asymptomatic adults at intermediate risk." Some heart experts think C-IMT -- along with CAC -- should gain more widespread use as a heart disease screening tool for the general population.

How it's different: C-IMT detects soft plaque as well as calcified plaque, otherwise known as coronary calcium. Studies show that while CAC is a better predictor of heart disease, C-IMT may be a better predictor of stroke, perhaps because a stroke can occur when bits of soft plaque lodge in cerebral blood vessels.

Cost: $150 to $300 or more. C-IMT is not usually covered by Medicare or other insurance, although Texas and Florida recently passed laws mandating that health insurers cover these tests when recommended by a doctor. The test is available at many walk-in heart clinics, which may offer discounted pricing.

Hemoglobin A1c Test Explained

The newest and least-known of the heart tests listed here is actually an extremely common test for diabetes, but it's only recently been used to detect heart disease. Also called glycated hemoglobin or glycosylated hemoglobin, the hemoglobin A1c test (HbA1c) is considered a measure of average blood sugar levels over time. More specifically, it measures the percentage of hemoglobin -- a protein in red blood cells that carries oxygen -- that's coated with sugar (glycated). The higher the A1c level, the poorer your blood sugar control.

How it's done: The hemoglobin A1c test is a laboratory blood test, but since it's not part of the standard lipid panel, your doctor has to order it separately. A reading between 5.0 and 5.5 is considered normal; above 5.5 to 6 percent indicates insulin resistance; 6.4 or over indicates diabetes.

Who should get it: According to the newest American Heart Association guidelines, hemoglobin A1c screening should be considered for people who've already had a coronary event or evidence of coronary disease. And since it's a relatively simple test, some doctors now are ordering A1c along with other standard tests to evaluate overall risk of cardiovascular disease in people with several risk factors but no symptoms. Historically, diabetics are at higher risk for cardiovascular disease, so anyone with diabetes should regularly be tested for hemoglobin A1c. Be aware, however, that if you're anemic, the A1c hemoglobin reading likely won't be accurate because of low red blood cell count.

How it's different: Unlike traditional glucose testing, which takes a reading at one point in time, hemoglobin A1c measures blood sugar levels over a period of months. The next time you have an annual screening with a standard blood panel and diabetes test, ask the doctor if HbA1c is included and if not, ask that it be added.

Cost: $60 to $100. It's usually covered by insurance for diabetes but only in rare cases for heart disease, and only for people who've already had a heart attack or other coronary event. But many experts predict this will change soon.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

over 2 years, said...

It was originally thought that cholesterol clogs the major arteries but what's been discovered is splits are developing. The cholesterol deposits are "band aid" fixes by the body to stop the leak. Too many of these fixes and the artery becomes occluded (blocked). The splits have been linked to compounds found in grasses - wheat, barley, oats. The exact substance has yet to be isolated. This certainly would suggest a reduction in consumption of grain products like bread, pizza, cereals, brewed beverages. The heart is only part of the mechanism that pumps blood. Basically it's the "primer". Arteries contain smooth muscle that also beats in a manner similar to a rail gun. You heart starts the flow but your arteries take it all the way to your toes, for example. Arteries have an interesting feature. They can increase in size and strength to accommodate loads. This feature is called vascularity , first discovered by body builders. It is possible to increase the blood flow and your general health with simple weight exercises. Check with your doctor first. Parish Health and fitness in Florida has an excellent program but and good health club will have similar. What could you expect if you start such a program ? Better breathing, clearer thinking, more pep, better digestion, in general better health.

over 3 years, said...

great explanation, especially Item 1. I will bring it to my GP's next visit. I am 71 and in good health but come from a family of heart ailments. My father died at 60 from his 3rd heart attack. Is this normal to have to ask my GP if there are further tests like a stress test I should be taking?

over 3 years, said...

Dear Melanie Haiken, Your article on CAC Scan is very informatory and humanity serving. May Creator give you knowledge and health to serve the humanity further. I'd like to copy this article and distribute it amongst my relative and friends with your name / reference if you permit.

over 3 years, said...

Great idea. I will ask my doctor since I do have symptoms.

over 3 years, said...

I use to try to get iron transfusions, because my hemoglobin always dropped, but I was allergic to IV Iron and went into anapholeptic shock. I couldn't even take baby iron. So blood transfusions I had from 1995 to 2002, every other month or sometimes I could go 3 months. Then I had a reaction to blood, and they had to take everything out of the blood except red blood cells. Finally, a new doctor did a scope and found they didn't close the loop of the stomach. I would be in so much pain and vomiting, I would pray that God would take me. My hemoglobin would get down to 7. All those blood transfusions I could of voided. I was getting diabetes shots in the stomach. I was put on a heart monitor every time I went in the hospital. They took so much of my life, now I am 62 never had a vacation and we are raising our grand-daughter. Heart attacks runs in the family as does cancer.

over 3 years, said...

My doctor just did some tests and my vitamins have almost disappeared from my body. My magnesium oxide was 5, and iron level was 9. something. I have had over half of my stomach removed. (ulcers) My triglicerides was high. I am disabled. I had forgot to tell her about my neck hurting in back.

about 4 years, said...

having a better knowledge of some of the medical terms.

about 4 years, said...

Flash back to 2001. The entire medical community strongly opposed this sort of upper-body CAT scan -- except for those mavericks, rebels, and charlatans charging you $700-$900 out of pocket for one. I tried to persuade my wife to go with me to get one anyway. My risk factors: father and brother had died of coronary artery disease at 40; I was then 54 (and extremely athletic for 54). Her risk factors: her father had died of his third different cancer. Her mother (a highly opinionated member of the mainstream medical community) talked her out of it. My scan showed the beginning of a calcium plaque buildup, despite cholesterol levels within the supposedly safe range. I went on Lipitor right away and took other steps to lower my LDL a bit more. Her scan, if she'd had one, might or might not have showed the tumor growing in her right lung. Seven months later, it manifested itself as a seizure from a large metastatic brain tumor. She passed away three and a half years later -- a virtual certainty when non-small-cell lung cancer reaches Stage IV. At Stage I, it is very, very treatable. Me...the scan proved to be both prophetic and useful. I just had open-heart surgery in November as I approached 67 years old. Knew it was coming because of family history. But my father had his first heart attack at 35, and died at 40. Lifestyle, the scan and resultant statins and daily aspirins helped me reach nearly 67 before trouble showed up in the form of mild angina. What is so interesting about the judgment of the mainstream medical community is that they were so firmly against getting this sort of scan as a preventative, but in 2002, when I had a pneumothorax and major hospital-caused complications, they thought nothing of MORE THAN TWENTY chest X-rays in a two-week period.

over 4 years, said...

A short checklist type of each and minor explaination to cut and keep for doctor apts rather like a note to bring with to doctors office.

over 4 years, said...

Why are all these tests so expensive? What are the costs in doing them?

almost 5 years, said...

Amazing! Thank you for those who did the research and put this information together to help educate the world. For once I feel that I learned and read something constructive and which is critical and very important for everyone to learn. So much junk, bad news and falls info. on line and this health info. gives it a different perspective. This information should be in every home, school, clinic/hospital for everyone to see and learn from. Make it mandatory to be part of everyones annual/physical exams. I love to see this test covered on everyone health insurance. Wouldn't that be something?

almost 5 years, said...

Foods that cause and food to avoid to prevent strokes. I cannot believe everything one must do before buying or eating a meal. Label reading is something I will increase doing after this informative article. Thank you very much for your information. Very helpful for sure. Hats off to you at the very least.

almost 5 years, said...

Not to be dumb, but do people with this problem have high lvls of calcium in their blood tests? my blood calcium tests are always at the top of the"normal" levels or slightly above it. Also I was told that I have multiple calcium lumps throughout my intestines... which doctors have never done anything about.. so we ignore them I guess. My sister has these lumps in her lungs as does my brother who also has calcified lumps in his kidneys.. as does his daughter. my c reactive protien test was 1.4 in 2010.. normal, according to my hmo's website is .5 or less. So what should I do? Is there any thing I can do to help the problem get better? can an inability to process calcium normally be some genetic disorder? Anyone have any ideas?? thank you for your help.

about 5 years, said...

Very informative! Thanks.

about 5 years, said...

Thank you for this important information. A patient must be their own advocate today, and especially with the new health coverage cuts -thanks Obama!- Information is essential to be an intelligent advocate. Thanks again!

about 5 years, said...

Thank you. I just wanted to add that everyone should have a home blood pressure monitor. Aortic "compliance" (i.e. the flexibility of the aorta) is important to cardiovascular health. The pulse pressure (the difference between the high number -systolic- and the low number - diastolic), when above 50, can mean a stiff aorta and heart problems (the bigger the number, the stiffer the aorta). You can do this at home cheaply. Also knowing your blood pressure is in a normal range or out of it is important.

about 5 years, said...

I have conditions pertaining to what this article is about; many doctors do not explain to their patients the need nor what patients scores really mean. It is shameful many doctors do not inform patients thoroughly about the meaning of test and the results.

over 5 years, said...

Thank you!

over 5 years, said...

My 88 year old mother just suffered a stroke on our last day of vacation in Mexico. What a heart breaking experience. I wish my mom had had some of these preventative tests over the last decade to indicate that her heart was not functioning properly. Her stroke was severe, but if she finds the strength she can revovery most of her mobility, speech, and swallow reflex. I am wondering if my doctor will agree to some of these preventative tests, given the fact that my father died of a third heart attack at 67, my mother and aunt have both suffered strokes, and on my father's side of the family every single person in his genetic family has succombed to heart disease.

almost 6 years, said...

Gentlemen: I am diabetic, insulin dependent for the last 26 years, I have 2 stents and one pace maker. What kind of blood exams I can takem since after exercising I feel lack of breath. Thank you for your answer