What is your heart risk?

Lp(a) is a genetic variant of LDL cholesterol that standard lipid panels do not measure. Elevated Lp(a) — present in roughly 20% of the population — significantly increases heart attack and aortic stenosis risk independently of LDL. It does not respond to statins. A single lifetime Lp(a) measurement is now recommended by the European Atherosclerosis Society for anyone with premature cardiovascular disease, family history of early heart disease, or statin-treated patients who still have events. Ask your doctor if you have never been tested.

European Atherosclerosis Society Lp(a) consensus statement (Kronenberg F et al., Eur Heart J 2022, PMID 36036785)

Inflammation — measured by high-sensitivity C-reactive protein — is an independent predictor of cardiovascular events beyond LDL cholesterol. The JUPITER trial showed that people with normal LDL but elevated hsCRP (above 2 mg/L) who received statin therapy had significantly fewer heart attacks and strokes. hsCRP is particularly useful for reclassifying patients at 'intermediate' 10-year risk. Ask your doctor whether your overall risk warrants testing.

Ridker PM et al., NEJM 2008 (JUPITER, PMID 18997196); Arnett DK et al., ACC/AHA Prevention Guideline 2019 (PMID 30894318)

A coronary artery calcium (CAC) scan is a low-radiation CT scan that directly measures calcified plaque in coronary arteries. A score of 0 identifies people who are very unlikely to benefit from statin therapy; a score above 100 confirms elevated risk that warrants treatment even when standard risk calculators suggest otherwise. The 2019 ACC/AHA prevention guidelines explicitly recommend CAC scanning to guide treatment decisions in intermediate-risk patients who are uncertain about starting statins.

Yeboah J et al., JACC 2016 (PMID 26791059); Arnett DK et al., ACC/AHA Primary Prevention Guideline 2019 (PMID 30894318)

Both short sleep (under 6 hours) and long sleep (over 9 hours) are independently associated with increased cardiovascular disease risk. Sleeping fewer than 6 hours per night is associated with a 20% higher risk of heart attack and a 48% higher risk of developing or dying from coronary artery disease compared to 7–8 hours. Obstructive sleep apnea — which fragments sleep without obvious awareness — was found in 64% of people with hard-to-control (resistant) high blood pressure in one study.

Cappuccio FP et al., Eur Heart J 2011 (PMID 21300732); Daghlas I et al., JACC 2019 (PMID 31488267); Pedrosa RP et al., Hypertension 2011 (PMID 21968750)

The INTERHEART study of 52 countries found that psychosocial stress — work stress, financial stress, loss of control — accounted for approximately 33% of heart attack risk globally, similar in magnitude to smoking. Depression after a heart attack affects about 1 in 5 people and is associated with worse outcomes. Cardiac rehabilitation programs that include psychological support have better outcomes than exercise-only programs.

Yusuf S et al., Lancet 2004 (INTERHEART, PMID 15364185); Rosengren A et al., Lancet 2004 (INTERHEART psychosocial, PMID 15364186); Lichtman JH et al., AHA Scientific Statement, Circulation 2014 (PMID 24566200)

A resting heart rate consistently above 80–90 beats per minute — even in the normal range — is associated with increased cardiovascular mortality, independent of fitness level or known heart disease. Sustained elevated resting heart rate (above 100) warrants evaluation for thyroid disease, anemia, arrhythmia, and heart failure. Resting heart rate below 60 in trained athletes is healthy; below 50 in non-athletes warrants evaluation for conduction disease. Wearable devices now make continuous resting heart rate tracking practical.

Zhang D et al., CMAJ 2016 (PMID 26598376); AHA Scientific Statement on Cardiorespiratory Fitness 2016 (PMID 27881567)