Heart Health Screening: Complete Assessment Guide

Normal blood pressure is below 120/80 mmHg. Elevated: 120-129/below 80. Stage 1 hypertension: 130-139/80-89. Stage 2 hypertension: 140+/90+. High blood pressure has no symptoms in most people, earning it the name silent killer. It damages arteries and increases heart attack and stroke risk by 2-4 times. Get checked at every doctor visit and at least once per year. Home blood pressure monitors (30-60 USD) provide more accurate readings than office visits due to white coat hypertension, which affects 15-30% of patients.

A fasting lipid panel measures total cholesterol, LDL (bad), HDL (good), and triglycerides. Target numbers: LDL below 100 mg/dL (below 70 for high-risk patients), HDL above 40 for men and above 50 for women, triglycerides below 150, total cholesterol below 200. Fasting for 9-12 hours before the blood draw is required for accurate triglycerides. After age 40, or if results are abnormal, test every 1-2 years. The test costs 20-50 USD and is covered annually by most insurance as preventive care.

Diabetes doubles your risk of heart disease and stroke. Fasting glucose should be below 100 mg/dL (100-125 is prediabetes, 126+ is diabetes). A1C below 5.7% is normal, 5.7-6.4% is prediabetes, and 6.5%+ is diabetes. The American Diabetes Association recommends screening every 3 years starting at age 35, or earlier if you have risk factors (BMI over 25, family history, sedentary lifestyle). Prediabetes is reversible with lifestyle changes: 150 minutes of exercise per week and 5-7% body weight loss reduce progression to diabetes by 58%.

The ACC/AHA ASCVD Risk Calculator (available free online) estimates your 10-year risk of heart attack or stroke using age, sex, race, blood pressure, cholesterol, diabetes status, and smoking status. Low risk: below 5%. Borderline: 5-7.5%. Intermediate: 7.5-20%. High: above 20%. This score determines whether your doctor recommends statin medication (generally considered above 7.5-10% risk). Share your calculated score with your doctor at your next visit to guide treatment decisions.

A CAC scan is a low-dose CT scan (no contrast, no needles) that measures calcium deposits in coronary arteries. Score of 0: very low risk (less than 5% chance of heart attack in 10 years). Score 1-100: mild plaque. Score 101-400: moderate plaque. Score above 400: extensive plaque, high risk. The scan costs 75-300 USD and is usually not covered by insurance. It is most useful for people at intermediate risk (7.5-20% ASCVD score) where results can clarify whether to start a statin. Not recommended for low-risk or already-high-risk patients.

hs-CRP measures inflammation in the body. Chronic low-grade inflammation damages blood vessel walls and accelerates atherosclerosis. Levels below 1.0 mg/L indicate low cardiovascular risk, 1.0-3.0 is average risk, and above 3.0 is high risk. Elevated hs-CRP in combination with borderline cholesterol may tip the decision toward treatment. However, hs-CRP can be elevated by infections, injuries, and other inflammatory conditions, so one elevated reading should be confirmed with a repeat test 2 weeks later.

An EKG records the electrical activity of your heart and detects arrhythmias, previous heart attacks, and structural abnormalities. The test takes 5-10 minutes, is painless (electrodes on chest and limbs), and costs 50-150 USD. The USPSTF does not recommend routine EKGs for low-risk adults, but many cardiologists obtain a baseline EKG at age 40 for future comparison. If you have symptoms (chest pain, palpitations, shortness of breath, dizziness) an EKG is essential and should be done promptly.

The Mediterranean diet reduces heart disease risk by 25-30% in clinical trials. It emphasizes fruits, vegetables, whole grains, olive oil, fish (2-3 servings per week), nuts, and legumes while limiting red meat, processed foods, and added sugars. The DASH diet (Dietary Approaches to Stop Hypertension) reduces blood pressure by 8-14 mmHg, comparable to one blood pressure medication. Both diets overlap significantly. The key changes: replace butter with olive oil, eat fish twice per week, and increase vegetable intake to 5+ servings daily.

Walking, cycling, swimming, or dancing at a pace where you can talk but not sing qualifies as moderate intensity. The American Heart Association recommends 150 minutes per week (30 minutes, 5 days) for heart disease prevention. Regular exercise lowers blood pressure by 5-8 mmHg, raises HDL cholesterol by 5-10%, reduces triglycerides by 20-30%, and improves insulin sensitivity. Even 10-minute sessions count toward the weekly total. Any amount of exercise is better than none, with the greatest benefit coming from moving from sedentary to mildly active.

Smoking doubles the risk of heart disease. Within 1 year of quitting, heart disease risk drops by 50%. Within 5 years, stroke risk equals that of a non-smoker. Nicotine replacement therapy (patches, gum, lozenges: 25-50 USD per month) doubles quit success rates. Prescription medications (Chantix/varenicline, Wellbutrin/bupropion) triple success rates. The national quitline (1-800-QUIT-NOW) provides free counseling and sometimes free nicotine replacement. Most insurance plans cover smoking cessation programs and medications with no copay under the ACA.

Statins (atorvastatin, rosuvastatin) reduce LDL cholesterol by 30-50% and lower heart attack and stroke risk by 25-35%. Statins are recommended for: anyone with clinical cardiovascular disease, LDL above 190 mg/dL, ages 40-75 with diabetes, or ASCVD risk above 7.5%. Generic statins cost 4-15 USD per month. Common side effects include muscle aches (5-10% of patients), which often resolve by switching to a different statin. The benefits of statins for qualifying patients are among the strongest in preventive medicine.

First-line blood pressure medications include ACE inhibitors (lisinopril), ARBs (losartan), calcium channel blockers (amlodipine), and thiazide diuretics (hydrochlorothiazide). Most cost 4-15 USD per month as generics. Blood pressure medication reduces stroke risk by 35-40% and heart attack risk by 20-25%. If one medication does not reach your target, combining two medications at lower doses often works better with fewer side effects than one medication at a high dose.

The USPSTF no longer recommends routine aspirin for primary prevention (people who have not had a heart attack or stroke) due to bleeding risks. Aspirin is still recommended for secondary prevention (people with a history of heart attack, stroke, or stent placement). For primary prevention, aspirin may be considered for adults 40-59 with ASCVD risk above 10% who are not at increased bleeding risk, but this is an individualized decision. Do not start aspirin on your own without discussing risks and benefits with your doctor. This guide is informational only, not medical advice.