Brinda Chokshi, MD

Cardiovascular disease, including heart attacks and strokes, remains a high-level threat in the US, accounting for one death every 34 seconds. Since heart disease develops slowly over time, there has been an increased focus on assessing and treating cardiovascular risk earlier in life.

Getting screened earlier can help decrease your risk as you age. Since each person has their own unique health considerations, think of a cardiovascular screening as a health puzzle to piece together with your health care provider. Analyzing risk factors, any current medical conditions, and different test options can help you make informed decisions with your provider for optimizing cardiovascular health at any age.

Risk Factors

Research indicates that over 90% of men and 80% of women who had a fatal or non-fatal event related to cardiovascular disease, such as a heart attack or stroke, had at least one elevated risk factor. Risk factors that can be controlled include high blood pressure, high levels of blood fats or lipids in the blood, tobacco use, chronic kidney disease, obesity, or diabetes. The risk factors we can’t control include genetics and family history, gender, and getting older.

A healthy lifestyle is recommended as a strong first approach to preventing cardiovascular disease and to help manage any cardiovascular-related conditions. Lifestyle factors, including healthy eating, regular physical activity, adequate sleep, managing stress, and having meaningful connections, are cornerstones of good health. Improvements in any of these areas can help decrease your risk. Keeping blood pressure and lipids in healthier ranges, working with your provider to keep diabetes in control, maintaining a healthy body weight, and treating chronic kidney disease all help decrease cardiovascular disease risk.

In 2024, it was estimated that around 48% of Americans have high blood pressure, 11% have diabetes, 38% have prediabetes, and about 73% are at an unhealthy weight. This means many people have risk factors for cardiovascular disease that they may not be aware of.

Assessing cardiovascular risk is easily completed during an annual health checkup. Start scheduling yearly exams with annual labs and screenings in your early 30s at the latest. Find a health care provider you can trust and speak with openly about your health.

Here are a few of the basic tests used to establish your risk profile:

Blood Pressure

Blood pressure is a simple baseline test measuring pressure in the arteries as the heart beats. Uncontrolled high blood pressure is directly linked to heart disease, strokes, kidney disease, and dementia. Having high blood pressure causes the heart to work harder, which can lead to it becoming thicker and stiffer over time. High blood pressure also damages blood vessels in the body, especially in the heart, brain, and kidneys. There are many medications available to control high blood pressure. Maintaining a blood pressure reading of under 130/80 is crucial for keeping the vessels and organs throughout the body healthy.

Lipid Profile

This fasting blood test checks your total cholesterol, LDL, HDL, and triglycerides, which are different types of fats in the body. Research indicates that the total amount of cholesterol is not as significant as the levels of different types of fat particles in the blood. 

• LDL, or low-density lipoprotein, known as the “bad” cholesterol, causes sticky cells to build up in arteries, forming plaque. An increased focus on maintaining lower LDL levels for longer is emphasized to prevent and treat heart disease. The more risk factors a person has, the more important it is to keep LDL levels lower. An LDL level of 100 or lower is recommended. However, depending on risk factors such as diabetes or family history, lowering LDL to below 70 significantly reduces the long-term risk of developing and treating heart disease. Statin medications, of varying intensity depending on risk factors, are the first line of defense in treating higher LDL and other lipid levels and have been used safely for decades. The Mediterranean diet can also help decrease LDL levels.
• HDL or high-density lipoprotein, known as the “good” cholesterol, helps protect the lining of blood vessels, prevents clots, and decreases blood vessel inflammation. Aim for HDL levels of 45-60 or higher. Regular exercise helps increase HDL, along with taking niacin and omega fatty acids. Talk with your provider about strategies to increase HDL.
• Triglycerides are another type of fat in the blood that increases the risk of heart disease. A high triglyceride level doesn’t directly impact arterial walls, but it causes more inflammation to promote plaque buildup. Aim for a triglyceride level of less than 150.

Other fat particles in the blood can also be measured, including ApoB and LP(a).

• ApoB or Apolipoprotein B is a specific protein that transports LDL cholesterol in the blood and is linked to heart disease risk. This test is more specific than LDL alone. It can be helpful for a person who may have a normal LDL level but also has a strong family history of heart disease, obesity, diabetes, or high triglyceride levels.
• LP(a) or Lipoprotein A is another type of LDL particle linked to heart disease risk. Primarily genetic, this particle is also linked to inflammation in the arteries and creates an environment for plaque buildup.

PREVENT Risk Calculator

Providers may also use an online cardiovascular risk calculator. The American Heart Association developed the PREVENT calculator as a preventive measure for people with no known heart disease, found at professional.heart.org/en/guidelines-and-statements/prevent-calculator.

In 2023, the PREVENT calculator introduced a 30-year risk indicator, allowing younger people to assess their risk and make lifestyle changes earlier. Using PREVENT includes answering risk factor questions and inputting lab results to assess a 10- or 30-year risk of developing cardiovascular disease, depending on your age. These types of assessment tools are general and can be used to discuss risks with your provider, review any lifestyle changes or appropriate medications, or determine if further testing is needed.

CT Calcium Score

This is a one-time specialized scan of the heart used to detect heart disease before any symptoms develop. It measures the amount of calcium in the four main coronary arteries. Calcium buildup can narrow the arteries and reduce blood flow to the heart. This test is indicated with a higher LDL level and two other risk factors. You are given a risk score that can help your provider make recommendations for further testing, treatment, or referral to a cardiologist. Your insurance may cover a CT calcium score, and if not, it usually costs around $150, making it a very reasonable way to assess your risk of heart disease.

To help prevent cardiovascular disease events, become aware of risk factors starting in your 20s or early 30s, complete annual check-ups, and discuss prevention or treatment options with your health care provider to reduce your risk. Putting the pieces of the cardiovascular risk puzzle together earlier means taking care of yourself now and for the future!