Heart disease is one of the leading causes of death worldwide. Early detection of heart disease risk factors and signs of heart damage is critical for preventing heart attacks and related complications. A blood test is one potential way to evaluate heart health and determine someone’s risk for cardiovascular disease.
What heart health indicators can a blood test detect?
There are several biomarkers and other substances in the blood that may provide insight into the condition of a person’s heart and their risk for heart disease:
- Cholesterol levels – High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol are associated with an increased risk of heart disease.
- Triglycerides – Elevated levels of this blood fat can also indicate higher heart disease risk.
- C-reactive protein (CRP) – High levels of this inflammatory marker are linked to plaque buildup in arteries.
- Troponin – This protein is released when heart muscle is damaged, such as during a heart attack.
- Natriuretic peptides – BNP and NT-proBNP levels increase when the heart is under stress from heart failure or other conditions.
- Fasting blood glucose – Uncontrolled high blood sugar can lead to atherosclerosis and is a risk factor for cardiovascular disease.
- Vitamin D – Low levels of this vitamin have been associated with increased cardiovascular disease risk.
In addition to established heart disease biomarkers, researchers are investigating whether new blood tests could predict heart health and future heart attack or stroke risk.
What does an ideal heart-healthy blood test look like?
A blood test indicating optimal heart health would show:
- Total cholesterol below 200 mg/dL
- LDL cholesterol below 100 mg/dL
- HDL cholesterol 60 mg/dL or higher
- Triglycerides below 150 mg/dL
- Fasting blood glucose less than 100 mg/dL
- C-reactive protein levels lower than 1.0 mg/L
- Troponin and natriuretic peptides within normal ranges
However, reference ranges can vary slightly by lab and demographic factors like age and sex. Discussing results with a doctor is important for interpreting what they mean for an individual’s cardiovascular health.
Can a blood test detect a heart problem before symptoms arise?
In some cases, yes. Blood tests that show very high cholesterol levels, triglycerides, blood sugar, CRP, or troponin/natriuretic peptides could pick up issues like atherosclerosis, diabetic heart disease, or heart damage before a person experiences any overt symptoms.
Blood tests are commonly used to screen for:
- Hyperlipidemia – High cholesterol and triglycerides can indicate atherosclerosis even when no symptoms are present.
- Diabetes – Elevated fasting blood glucose may detect diabetes or prediabetes, allowing early intervention to prevent cardiovascular complications.
- Heart failure – Increased BNP/NT-proBNP can detect heart failure in people without shortness of breath, fatigue, or edema.
Detecting these “silent” heart issues early provides an opportunity to make lifestyle changes and start medications like statins to slow disease progression before irreversible heart damage occurs.
What are the limitations of a blood test for determining heart health?
While blood tests are useful for evaluating cardiovascular disease risk factors and markers of heart damage, they have some limitations:
- Blood lipid and glucose levels fluctuate and may be affected by recent food intake, medications, exercise, and illness. A single blood test may not give the whole picture.
- Not everyone with optimal cholesterol levels is free of heart disease risk, and vice versa – some individuals maintain healthy hearts despite mildly elevated cholesterol.
- No current blood biomarker can definitively determine whether someone will have a heart attack or stroke in the future.
- Blood tests alone cannot diagnose blockages in the heart’s arteries. Additional testing like a stress test, ECG, echocardiogram or cardiac CT scan would be required.
While helpful, blood test results should always be interpreted in the context of the patient’s full clinical evaluation, risk factor assessment, and any imaging or functional cardiac tests they require.
What is the standard blood testing protocol for evaluating heart disease risk?
Medical organizations like the American Heart Association and American College of Cardiology recommend the following heart health screening blood tests for adults:
- Fasting lipid panel (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) – Start at age 20, repeat every 4-6 years
- Blood glucose – Start at age 40, repeat every 3 years
- CRP – May be useful to refine risk assessment in those with borderline elevated cardiovascular risk
More frequent testing may be appropriate for people at higher risk due to family history, obesity, smoking, hypertension, or other heart disease risk factors.
Blood testing protocols to diagnose acute heart damage or monitor known heart conditions may include any of the following:
- Serial troponin levels – To detect and monitor a heart attack
- BNP/NT-proBNP – To diagnose or monitor heart failure
- Complete blood count (CBC) – To evaluate for anemia and its contribution to heart disease
- Electrolytes – Imbalances can affect heart rhythm
- Thyroid function tests – Both hyper and hypothyroidism affect cardiovascular health
Should everyone get yearly blood work to screen for heart disease?
Annual heart health blood screening is likely excessive for most healthy adults with minimal cardiac risk factors.
However, yearly testing may be appropriate for:
- Adults with a family history of premature cardiovascular disease or familial hyperlipidemia
- Smokers
- People with diabetes, hypertension, or known heart conditions
- Middle-aged and older adults
- Anyone experiencing potential heart attack symptoms like chest pain
Rather than blanket yearly screening, the optimal blood testing interval for heart disease risk assessment depends on an individual’s risk profile – those at higher risk likely need more frequent monitoring.
Discussing screening schedule, results, and their implications with a doctor is key for determining appropriate heart health evaluation through bloodwork.
How accurately can blood tests identify unstable plaque and predict heart attacks?
No current blood test can reliably and accurately identify unstable or ruptured atherosclerotic plaque and predict imminent heart attack risk.
Researchers have investigated a variety of novel biomarkers that may indicate vulnerable plaque and heightened risk, including:
- Myeloperoxidase (MPO)
- Pregnancy-associated plasma protein A (PAPP-A)
- Osteopontin
- Choline
- Visfatin
- Lipoprotein-associated phospholipase A2 (Lp-PLA2)
However, more research is needed to determine if testing for these emerging biomarkers can provide actionable information beyond traditional risk predictors like cholesterol levels.
Currently, plaque buildup is best visualized directly through coronary angiography, though other imaging modalities like carotid ultrasound and cardiac CT scanning can also detect atherosclerosis.
While blood tests can identify some indirect markers and general cardiovascular risks, they cannot yet reliably substitute for direct plaque imaging to detect unstable lesions and predict heart attack likelihood.
What blood tests should doctors use to best predict heart health?
Based on current evidence and guidelines, the blood tests doctors should prioritize for assessing heart health include:
- Fasting lipid profile – LDL, HDL, total cholesterol, triglycerides
- Blood glucose – Particularly for those over 40 or with diabetes risk factors
- CRP – For refining risk assessment in intermediate-risk patients
- Troponin and BNP/NT-proBNP – When evaluating for acute myocardial damage or heart failure
These standard blood biomarkers provide a snapshot of known cardiovascular risk factors like hyperlipidemia, diabetes, inflammation, and heart damage.
While emerging blood tests assessing novel proteins linked to cardiovascular disease show promise, most require further research before they are ready for routine clinical use in predicting heart health.
Select patients may also benefit from additional specialized testing like:
- Lp(a) – For refining risk in those with strong family histories of CVD
- Homocysteine – When evaluating for genetic causes of atherosclerosis
- hsCRP – A more sensitive CRP assay
Overall, standard assessment of cholesterol, blood glucose, and basic CRP remain the blood testing staples for determining heart disease likelihood in most adults.
Conclusion
While blood testing for biomarkers like cholesterol, blood sugar, and inflammatory proteins can provide useful information about a person’s cardiovascular health status and heart disease risk, they have limitations.
Blood tests only measure indirect signals in the circulation and cannot visualize what is happening directly in the heart arteries.
However, used appropriately alongside a complete clinical evaluation, standard bloodwork for lipids, diabetes, and acute heart damage can aid cardiovascular risk stratification and guide preventive treatment in many patients.
Emerging novel blood biomarkers show promise for refining assessment further, though more research is needed on newer tests before they are ready for routine clinical practice.
Ultimately, a blood test is one helpful tool but not a definitive test of whether someone’s heart is truly healthy. Comprehensive assessment and optimal prevention take a multidimensional approach.
