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Cardiac Risk Assessment

Overview | Related Pages

What is a cardiac risk assessment?

This is a group of tests and health factors that are used to find out your chance of having a heart attack or stroke. They have been improved to show whether the risk is slight, moderate, or high.

What is included in a cardiac risk assessment?
Perhaps the most important indicators for cardiac risk are those of your personal health history. Age, family history of heart disease, weight, cigarette smoking, blood pressure, exercise, and diabetes are all important in findout out your risk. The lipid profile is the most important blood test for risk assessment.

Imaging tests where pictures are taken of your heart and blood vessels may be used in cardiac risk assessment. Non-invasive imaging tests which just take a picture may include an electrocardiogram (ECG), ECG stress test, nuclear stress test, computerised tomography (CT), echocardiogram and magnetic resonance angiogram (MRA). Invasive tests include cardiac catheterization - where dye is injected into the arteries so that blood flow can be observed and any obstructions in the blood vessels identified. In terms of blood tests, the lipid profile is the most important blood test for risk assessment.

How is the lipid profile used?
The lipid profile measures cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C, “good” cholesterol), and low density lipoprotein cholesterol (LDL-C, “bad” cholesterol). Triglycerides are the major form of fat found in the body and they provide energy for the cells. Below are the desirable ranges for the components of the lipid profile:

  • Cholesterol <5.0 mmol/L)
  • HDL-cholesterol > 1.00 mmol/L in men and > 1.20 for women
  • LDL-cholesterol <3.0 mmol/L*
  • Triglycerides <1.70 mmol/L

* the best levels for you will depend on the number and type of risk factors you have and why the tests are being done

If any or all of your results are outside these ranges, your risk of a cardiac event is increased. Diet, exercise, and/or medication may reduce levels, thereby reducing your risk.

What other tests are used to assess cardiac risk?
Some other tests that may be used to assess your cardiac risk include:

  • High sensitivity C-reactive protein (hsCRP): Studies have shown that measuring CRP using a high sensitivity test can also help measure the risk of cardiovascular disease (CVD). This test is different from the regular CRP test which is used to detects elevated levels of CRP in people with infections and inflammatory diseases.    The hs-CRP test measures CRP within the range which is seen in otherwise healthy people.  It can be used to distinguish people with low normal levels from people with high normal levels.   High normal levels of hs-CRP in otherwise healthy individuals have been found to predict the future risk of a heart attack, stroke, sudden cardiac death, and peripheral arterial disease (disease of arteries not in the heart), even when lipid levels are within acceptable ranges.
  • Lipoprotein A (Lp(a)):  Lp(a) is a lipoprotein consisting of an LDL molecule with another protein (Apolipoprotein (a)) attached to it. Lp(a) is similar to LDL-C but does not respond to lowering LDL-C by diet, exercise, or most lipid lowering drugs. Since the level of Lp(a) is not easily altered, the presence of a high level of Lp(a) may be used to identify people who might benefit from more ‘aggressive’ treatment of other risk factors.

    • How is treatment decided?
    Treatment depends on many factors including the results of the tests described above and your family and personal medical and lifestyle history.

    Is there anything else I should know?
    A healthy diet and exercising are important in reducing blood pressure, cholesterol and triglycerides. Sometimes these lifestyle changes are not sufficient to reach desirable levels.  There are also drugs (for example, statins) that are effective in lipid management. Some conditions involving elevated lipids levels are inherited.  High lipid levels in these conditions cannot always be lowered sufficiently by diet and exercise. This type of risk usually requires treatment with lipid-lowering drugs.

    Frequently Asked Questions (FAQs)

    1. Are some people more at risk for a heart attack than others? Yes. Those who are overweight, smoke cigarettes have high blood pressure (hypertension) or diabetes, abnormal risk test results, and those with a family history of heart disease are at greater risk.

    2. Are there home test kits for me to find out if I am at risk for a heart attack? No. Your cardiac risk depends on the results of any or all of the tests described above. The overall assessment requires special tests and interpretation by your doctor.

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