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Should you be screened for heart disease?

Perhaps you already know you’re at increased risk for heart disease—there’s your family history, you smoke or your blood pressure or cholesterol is higher than optimal. Or, you’re simply concerned, realizing that nearly half of all coronary events occur in people without the traditional risk factors. Many tests can assess where you stand, catch early signs of the disease and maybe even motivate you to improve unhealthy ways. Here’s the lowdown on some of the latest:

Calcium scoring

What it does: Calcium scoring uses an ultra-fast computed tomography (CT) or electron beam CT (EBCT) to scan your heart and arteries for calcium deposits, a sign of artery-clogging plaque.

What it means: A high score indicates lots of calcified plaque, which increases your risk for an artery blockage or a heart attack. However, plaque typically starts out soft and only becomes calcified over time. EBCT won’t detect soft deposits, and a negative or low score may give you false reassurance.

Should you have it? Maybe, but only after a routine workup if your doctor says you’re at intermediate risk of cardiovascular disease (a 10 percent to 20 percent chance of developing it in the next 10 years). If you’re at low risk you probably won’t benefit from this test, and if you’re at high risk you should already be using intensive risk-reduction therapies.

CRP test

What it does: A CRP test measures the level of C-reactive protein (CRP) in the blood, which the liver produces in response to injury or infection anywhere in the body. A more sensitive test, called a highly sensitive CRP (hs-CRP) assay, is sometimes used to determine heart disease risk.

What it means: An hs-CRP level of more than 3 mg/L is considered high and associated with inflammation in the body. Researchers think plaque build-up triggers inflammation in the blood vessels, leading to blood clots, blockages and heart attack or stroke. Some research suggests CRP levels are a better predictor of heart disease than cholesterol. However, other conditions, such as connective tissue diseases or infections such as gingivitis or a urinary tract infection, can cause high CRP levels.

Should you have it? Maybe. As with calcium scoring, this test is best for those at intermediate risk for developing heart disease. Your hs-CRP test results may help decide if you should be further evaluated or start medication for, say, less than ideal cholesterol.

PLAC test

What it does: The PLAC test measures your level of a blood enzyme called lipoprotein-associated phospholipase A2 (Lp-PLA2).

What it means: A high level of this enzyme may indicate vascular inflammation and increased risk for coronary heart disease, even in people whose cholesterol levels are not considered high.

Should you have it? Maybe. Talk with your doctor about adding this test to the usual assessments.

Aneurysm scan

What it does: An aneurysm scan examines your aorta, the largest artery in your body, which runs from your heart, down your chest, into your abdomen. Doctors use ultrasound, CT or magnetic resonance imaging (MRI) to detect an aortic aneurysm, a bulge in an artery wall that is highly fatal if ruptured.

What it means: Either you have one or you don’t. An aneurysm can occur when the artery wall is weakened (often due to atherosclerosis) and blood pushing against it causes it to swell. Until it ruptures, an aortic aneurysm normally has no symptoms. When identified before rupture, surgery to repair it is highly successful.

Should you have it? Possibly. Talk with your doctor to determine if you’re at risk, such as if you are older than 55, a male or a smoker or if you have high blood pressure or a family history of aneurysm.