If you are at increased or uncertain cardiovascular risk, there are many additional tests beyond the basic cholesterol levels and stress EKGs that can predict the likelihood of a heart attack or stroke.
Post-challenge insulin, high sensitivity C-reactive protein (hs-CRP), Lp(a), iron levels, additional lipid fractions, homocysteine, fibrinogen and others can be done to provide a clearer picture of your risk. A thorough evaluation can involve as many as 20 to 30 different conditions and lab tests. Establishing your risk through laboratory testing and taking steps to reduce any abnormalities gives you more control over whether or not you experience a sudden heart attack or stroke.
Although current guidelines for the management of high blood pressure rest almost completely on the measurement of the systolic (top) and diastolic (bottom) values, a new study has found that something known as the "pulse pressure" may actually be a better predictor of heart disease risk. The pulse pressure is the difference between the systolic and diastolic pressures. For example someone with a blood pressure of 120/80 has a pulse pressure of 40, which is considered normal.
Elevated levels of serum uric acid increase the risk of heart attack. In evaluating 5,926 subjects who were between 25 and 74 years of age, after 16.4 years of follow-up, there were 1,593 deaths, of which 45.9% were attributed to cardiovascular disease. It was found that increased serum uric acid levels were independently and significantly associated with the risk of cardiovascular mortality [JAMA, May 10, 2000;283(18): pp.2404-10].
As an example of the value of additional testing, it is now known that persons with the greatest absolute risk of dying from a heart attack tend to have the highest ratios of apoB to apoA-I. In fact, these two cholesterol particles have turned out to be more powerful predictive markers for a future fatal heart attack than levels of "good" (HDL) cholesterol, "bad" (LDL) cholesterol, total cholesterol, or triglycerides. [Lancet 2001;358: pp.2026-33]
S-Adenosylhomocysteine, which is the precursor of homocysteme, appears to be a more sensitive marker for differentiating cardiovascular patients from control subjects than homocysteine [Am J Clin Nutr, 2001;74: pp.723-9].
A simple and inexpensive blood test for hs-CRP has proven more accurate than cholesterol screening in predicting a person's risk for a heart attack according to researchers at the Brigham and Women's Hospital in Boston [NEJM, May 23rd, 2000]. Current data suggest that the addition of hs-CRP to standard lipid screening can improve the ability to detect absolute coronary risk. This is a critical issue because one-half of all myocardial infarctions and strokes occur among individuals without overt hyperlipidemia.
Recent support has been given to the concept of a bacterial infection component of heart disease. The organisms Chlamydia pneumonia and CMV (cytomegalovirus) both increase CRP and are associated with increased heart disease risk. There are treatments for these organisms.
Some laboratories are offering complete profiles of your actual risk. For example, AAL Reference Laboratories offers an "Atherosclerosis Activity Evaluation" and Great Smokies Diagnostic Labs offers a "Comprehensive Cardiovascular Risk Profile".
The authors of one study concluded that a high level of lipoprotein is an independent risk factor for thoracic aortic atherosclerosis and should be controlled in order to prevent aortic disease including aortic aneurysm. [American Journal of Cardiology, July 15, 1993;72: pp.227-30 ]
An electrocardiogram is recommended every three to five years after the age of 50, or after 30 if at high risk for heart attacks.