Identifying Personal Risk for Cardiovascular Disease: What Test is Right for Me?

If you spend time on social media, watch TV, or read magazines, you’ve probably seen information about Coronary Calcium Scoring or Lipoprotein(a) and wondered, “Is that something I should do?” Both tests help identify your personal risk for cardiovascular disease, which can lead to a heart attack or stroke.

Understanding your risk factors is an important first step in prevention. Some risks—like family history or race—cannot be changed. But many everyday habits can increase your chances of developing heart disease. These modifiable risk factors include smoking or using tobacco, lack of physical activity, and eating a diet high in saturated fats or processed foods.

Below, two cardiologists from Saint Alphonsus Heart Care explain what Coronary Calcium Scoring and Lipoprotein(a) testing are, and who may benefit from them. Talk with your primary care provider if you think one of these tests might be right for you.

Christine Shirazi, MS, APRN

Understanding Coronary Calcium Score: A Individualize Risk Assessment for a Heart Attack or Stroke

A coronary calcium score is the least expensive and most accessible test to determine a person’s risk of a heart attack or stroke. It is one of the best tools we have to individualize heart attack risk.

A famous bank robber named Willie Sutton was once asked why he robbed banks. His answer was simple: “That’s where the money is.”

A calcium score test looks “where the money is” — directly at the blood vessels around the heart. The test measures the amount of calcium in plaque, and this is used to create a calcium score.

Like golf, the higher the score, the worse the outcome.

• A score of 0 = very low risk of a heart attack.
• A score over 100 = higher risk, and the person may benefit from lifestyle changes and possibly medications.
• A score over 400 = very high risk, and often means a stress test is needed to look for severe blockages.

Not everyone needs this test. It is most helpful for people ages 40–65 who have higher risk factors, such as smoking, high blood pressure, obesity, or a stressful lifestyle. It is also useful for those with a strong family history of heart disease.

If your result is abnormal, talk to a cardiologist who specializes in prevention. They can help you make effective lifestyle changes and discuss medications that lower heart attack risk.

— Matthew Nelson, MD FACC FASE

Understanding Lipoprotein(a): A Genetic Risk Factor for Heart Disease

Lipoprotein(a), often written as Lp(a), is a type of cholesterol particle that you inherit from your parents. High levels of Lp(a) can raise the risk of developing heart disease at an early age. In fact, people with elevated Lp(a) may have 2–3 times higher risk of heart attacks compared to the general population—even if their regular cholesterol levels are normal.

Your Lp(a) level is usually set by around age 5, because it is determined by your genes. However, certain conditions—such as diabetes, kidney disease, and menopause—can raise levels over time. Lp(a) levels also tend to be naturally higher among African American and South Asian individuals.

Because Lp(a) is genetic, most people only need the test once in their lifetime, typically after age 20. Men generally do not need repeat testing; women may benefit from checking again after menopause.

At the moment, there are no widely available treatments proven to lower Lp(a) effectively. The good news is that several medications are in advanced clinical trials, and early results show they may reduce Lp(a) levels by 65–98%, offering hope for future treatment options.

Until those treatments become available, anyone with high Lp(a) should be considered at increased risk for early heart disease. Your healthcare provider may recommend a more aggressive approach to managing other risk factors—such as adopting a heart healthy diet, controlling blood pressure and diabetes, and lowering LDL (“bad”) cholesterol to below 55 mg/dL.

— Alex C. Johnson, MD FACC