Three Important Screenings for Understanding Your Cardiovascular Risk
Dr. Jean Ann Beaton, a board-certified internal medicine physician at Dupont Private Health gives guidance on heart disease prevention.
As an internist who treats many patients struggling with heart health, I know prevention simply must be a focus. Risk assessment and cholesterol (or “lipid” management) are vital pieces of any treatment and prevention strategy.
I recently attended the 2024 fall session of the National Lipid Association (NLA) in Dallas. Their meetings bring together leading physicians and researchers in lipidology to discuss the most pressing topics in cardiovascular health, both treatment and prevention. Heart disease is the leading cause of death in the U.S. But patients at risk for it notoriously go under-treated by physicians. In this post, I explain three screenings that can help you better understand your risk beyond standard LDL tests.
Prevention of Cardiovascular Disease starts with risk assessment.
Due to a variety of factors, including misconceptions about available treatments and inadequate risk assessment, patients who are at risk for cardiovascular events often don’t get the care they need. It has been estimated that by using the right tools to lower LDL cholesterol, which you may know as “bad” cholesterol, recurrent cardiovascular events could be decreased by 29%. The right tools include lifestyle modifications and the use of medications – such as commonly used statins. For an idea of lifestyle modifications, check out “Life’s Essential 8” as proposed by the American Heart Association.
The screening tests available to patients are also getting better and better at identifying cardiovascular risk in patients. Standard cholesterol measurement and hypertension management are no longer enough to get the full picture.
In a time-pressured appointment, it can be hard to cover all your bases. When consulting your physician about your cardiovascular care, I recommend asking about the following 3 screenings:
Can you check my Lpa - commonly called “Lp little a”- levels to help establish my cardiovascular risk baseline?
NLA issued a consensus statement in April of 2024 suggesting that Lipoprotein levels – known as Lp (a) – should be measured in all adults at least once in a lifetime. Lp(a) is a genetically modified form of LDL cholesterol that isn't efficiently processed by the liver, contributing to plaque buildup and heart disease. Considered the most common inherited contributor to heart disease, twenty five percent of people tested learn they have a meaningful elevated level of Lp (a.) A level above 125 nmol/L indicates high cardiovascular risk, while levels between 75 nmol/L-125 nmol/L suggest intermediate risk. Early identification of elevated Lp(a) can prompt increased monitoring, treatment targeted at cardiovascular risk factors, and recommendations for lifestyle changes. Treatments like statins, aspirin, PSK-9 inhibitors, and in severe cases, Lipoprotein apheresis, can help. New medications are also actively in development. You can learn more about Lpa and its role in your health here.
When you measure my LDL cholesterol can you also check my Apo B level?
This summer, NLA issued a consensus statement declaring Apolipoprotein B (apo B) a more accurate indicator of cardiovascular risk than the more commonly used LDL cholesterol level. Apo B screenings measure the total number of plaque-forming lipid particles in a patient’s bloodstream, including LDL, VLDL, IDL, and Lp(a), providing a fuller assessment of a patient’s risk, especially for patients with high triglycerides, obesity, or insulin resistance. NLA proposed apo B thresholds to guide more aggressive lipid-lowering treatments beyond what LDL alone would suggest. They especially recommend considering apo B reduction when determining cholesterol medication doses. Learn more about Apo B here.
Can we consider checking a Coronary Artery Calcium (CAC) Score?
In 2021, NLA issued a consensus statement that supported the use of coronary calcium scores to use as screening tools for patients to further assess cardiovascular risk. A CAC test is a quick, low-radiation CT scan that measures calcified plaque in the coronary arteries. It provides an absolute score, predicting 5-10 year cardiovascular risk, and a percentile score comparing you to an age-matched population for lifetime risk. The test can be useful to inform treatment intensification in patients who might otherwise be considered at intermediate or low risk for cardiovascular disease based on LDL levels or standard calculators. Wondering if a Coronary Artery Calcium score is right for you? Learn more through this scoring guide.
Concierge care means more comprehensive care.
As part of my care approach, I use these risk assessment tools to help my patients better understand their cardiovascular risk with the goal of tailoring more effective treatment strategies. Discussing the specifics of these tests and incorporating them into a comprehensive treatment plan takes time as does the practice of quality medicine. If you’re interested in exploring concierge medicine and the comprehensive care it entails, you can contact my office by clicking the “Contact Us” button below. I’d love to help you achieve your health goals.
If you'd like support with your health, reach out to Dr. Beaton's office today.
This article does not constitute the practice of medicine, healthcare advice, diagnosis, or treatment. You should always talk to your healthcare provider regarding your specific medical needs.