Until recently, it has been difficult for doctors to determine which patients may develop heart disease years from now, and prevent it from occurring. But now cardiologists are using tests that can help them pinpoint patients who already are developing atherosclerosis—hardening and narrowing of the arteries—years before they display symptoms. This means they can be treated before they become ill, says David Southren, MD, FACC, Cardiologist at Advanced Cardiovascular Care and Chief of Cardiology at Nyack Hospital.

“The problem with finding people with early atherosclerosis is that it is clinically silent—it doesn’t cause obvious health problems we can see,” he says.

Today, doctors are taking a much more sophisticated approach to assessing a person’s risk factors for heart disease—such as diabetes, high blood pressure, and high cholesterol—and more aggressively treating them, Dr. Southren says. “We aren’t waiting until a person’s blood pressure or lipid levels become very high before we start treatment,” he notes. “We now have more exact ways to evaluate a person’s individual risk for heart disease.”

When a person has risk factors, their doctor can refer them to a cardiologist for further testing. These tests include a coronary calcium scan—a CT scan that takes pictures of the arteries to check for calcified plaque in the arteries, and a CT angiogram, which uses X-rays to provide detailed pictures of the heart and the blood vessels to look for disease.

“We can take a person with mildly elevated cholesterol or blood sugar or a family history of premature heart disease and do a calcium scan to find out if they have atherosclerosis decades before they might have a heart attack or stroke,” Dr. Southren says. “We can lower their blood pressure and cholesterol and get their diabetes under control, which can help prevent them from going into the hospital with heart disease. In many cases, use of these tests will have a significant impact on how we decide to treat patients.”

The American Heart Association recommends the following heart-health screening tests:

• Blood pressure: High blood pressure greatly increases your risk of heart disease and stroke. Your blood pressure should be checked at each regular healthcare visit or at least once every two years if your blood pressure is less than 120/80 mm Hg. If your blood pressure is higher, your doctor may want to check it more often.
• Cholesterol: A fasting lipoprotein profile should be taken every four to six years, starting at age 20. This is a blood test that measures total cholesterol, LDL (bad) cholesterol and HDL (good) cholesterol. Your doctor may recommend more frequent testing if you have elevated risk for heart disease and stroke.
• Weight/Body Mass Index (BMI): Your weight should be checked during your regular healthcare visit. Being obese puts you at higher risk for health problems such as heart disease, stroke, atrial fibrillation and congestive heart failure. 
• Blood sugar: High blood sugar levels put you at greater risk of developing type 2 diabetes. Untreated diabetes can lead to many serious medical problems including heart disease and stroke. Your blood sugar (glucose) should be tested at least every three years. The American Diabetes Association recommends testing for prediabetes and risk for future diabetes for all people beginning at age 45 years. If tests are normal, the doctor may repeat testing at a minimum of three-year intervals.
• Discuss smoking, physical activity, diet: You should talk with your doctor about these at each regular healthcare visit. If you smoke, ask for help in quitting.

“Talk to your doctor about your risk factors for heart disease,” Dr. Southren advises. “The earlier you treat them with lifestyle changes and/or medications, the greater the chance you’ll be able to live a longer, healthier life.”