As someone whose grandparents died from heart disease, and who has a genetic redisposition to it, I’m keen to know more about cardiovascular disease risk tests and the lifestyle changes that prevent it. I went to see Dr Jason Kaplan from the Sydney Interventional Cardiology Centre and Macquarie University for a full assessment and advice.
Here’s the first of a 2 part interview and set of tests Jason did at the Macquarie University clinic. I can highly recommend going through this process. Jason was a delight as he not only preaches good health but practices it himself!
First steps in your cardiovascular risk assessment
Doctors can get a very good idea about your level of cardiovascular risk by taking a comprehensive family history (you’ll need to trawl back as far as your grandparents’ health/cause of death). If your doctor doesnt take this step, then get very worried and look for another doctor!
We obviously can’t change our genes, but we have some control over our environment. One thing doctors will ask you when taking your history is whether you smoke or have smoked in the past. If you smoke you should consider giving up then you should give up immediately, as this is a big risk when it comes to cardiovascular disease. The good thing to note is that if you smoked when you were younger (but not currently), then this doesn’t necessarily increase your risk of developing cardiovascular disease.
Interestingly, atherosclerosis – the disease that causes the most coronary disease/blocks blood supply to the heart – can show up very early. Studies have shown it may actually start in the teenage years.
Another important thing to examine is your diet. A large study, called the PREDIMED study, published in the New England Journal, shows that if we follow a Mediterranean-style diet, which involves consuming lots of nuts and olive oil, we can reduce our risk of cardiovascular events by 40%.
If you are anything like me and travel a lot, then also beware of what is known as the ‘social business style of eating’. Research has shown that many social-business eaters have a significantly worse cardiovascular risk profile, with evidence of early atherosclerosis.
Cardiovascular disease risk tests
One of the key cardiovascular disease risk tests is to determine your cholesterol levels. Luckily, I turned out to have very good cholesterol, with a total of 4.6 – my bad cholesterol (LDL) was 2.6 and my good cholesterol (HDL) was 1.8. A good line to draw is at 5.
Bad cholesterol takes cholesterol from the liver to your blood vessels while the good cholesterol takes cholesterol from your blood vessels outside and excretes it from the body. Therefore the higher your good cholesterol is, the better, and for the bad cholesterol, lower is better.
Blood pressure tests
It’s vital to know your blood pressure when determining your risk of cardiovascular disease.
Doctors will use a SphygmoCor device to test your blood pressure. It not only measures blood pressure in your arm, from your brachial artery, but it also measures your blood pressure as it’s coming out of the heart. This is a true reflection of your actual blood pressure, how stiff your arteries are and ‘arterial age’.
When someone has very diseased arteries, their blood vessels become very stiff, while someone who is healthy will have elastic arteries. The stiffer your arteries are, the greater the risk of developing high blood pressure down the track and the greater the risk of stroke.
When I got my blood pressure taken, I was happy to discover my arteries are really elastic for a woman of my age (54).
Pulse Wave Analysis
Another of the key cardiovascuar disease risk tests is Pulse Wave Analysis. This test, which was developed based on research by a doctor at St Vincent’s Hospital in Australia, is the gold standard on measuring how elastic or stiff your arteries are.
It’s important to know that there are a range of other metrics doctors will review when determining your risk for cardiovascular disease. These include blood tests for a variety of things such as the ones mentioned above, and also blood sugar levels.
Coronary Artery Calcium Score test
The Coronary Artery Calcium Score is probably the most useful test doctors have in predicting cardiovascular risk.
This test provides a snapshot of your artery and looks for the presence of plaque in the artery wall.
Sometimes people may have perfect numbers on their tests but still have hidden plaque lying in the walls of arteries, which puts them at risk of cardiovascular disease. This is why a lot of people present with heart attacks without having there being any signs before.
So a test such as the Coronary Artery Calcium Score can pick up very early signs of heart disease.
My calcium score came back at 0, meaning there’s no long term calcific plaque or long term plaque in my arteries. This also correlates to a very low risk of a major cardiovascular event over the next 7 years.
Your calcium score can be between 0 to more than 1,000. The higher a calcium score, the larger the amount of atherosclerosis that you have.
Having all of the information from the above tests allows doctors to come to a conclusion about your overall cardiovascular risk.
They will then put that into a risk score calculator, which will provide an accurate number regarding your risk of a major event over the next 10 years.
One calculator doctors will use is the Multi-Ethnic Study of Atherosclerosis. But there are many others such as an Australia New Zealand Cardiac Risk Calculator or the Framingham, and it just depends on preferences.
Each risk score calculator has its own limitations. Some don’t include family history, which is actually very important, and others don’t include ethnic origin.
The MESA calculator will take your age, your calcium score in Augustine units, which was the invention of Arthur Augustine, a cardiologist in Florida who invented the South Beach diet and worked on calcium score.
After putting in all the relevant information, I got a score of 1.2%, which is classified as very-low risk.
Stress echo test
Doctors may also decide to test your functional capacity, because while all the numbers might come back positive, if you’re unfit, you’re not going to live as long.
One way to do this is using a stress echo, which shows the heart and its valves in real time.
Experts prefer to conduct stress echos in women, as the stress ECG has historically shown false positive readings in women and the jury is out as to whether this is because many of the past research was done in cohorts dominated by men or whether there is some other reason at play.
See the second video where I go through a stress test to check my cardiovascular risk.