The Heart Health Tests You Didn’t Know to Ask For—But Should

When it comes to heart health, most of us are familiar with basics like cholesterol tests and blood pressure readings. But with cardiovascular disease being a leading cause of death in the U.S., it’s time to dive deeper into diagnostic tools that go beyond the usual checkups.

Heart disease often progresses silently, and many critical signs can only be detected with advanced scans and lab tests. 

Think of your arteries like tiny highways for blood flow—but far narrower than you might expect. The average lumen1 (the open space in the artery) is smaller than a pencil dot, often less than 30 micrometers wide. That’s why even minor blockages from calcium deposits can have major health implications.

A Coronary Artery Calcium Scan is a simple, non-invasive imaging test using a CT scanner to assess the level of calcification in your coronary arteries. Calcium buildup in these arteries can be an early warning sign of heart disease.

The beauty of this test? It’s affordable, accessible, and provides a clear number (your "calcium score") that can help guide lifestyle changes and treatments.

A score of 0 means no detectable calcium—great news for your heart health. Scores above 100 suggest a higher risk of heart disease, while numbers in the 300+ range indicate severe calcification and a strong likelihood of cardiovascular events.

An echocardiogram uses ultrasound waves to create a live picture of your heart. This test helps your doctor see how well your heart muscles and valves are functioning. It's often used to diagnose conditions like heart murmurs or weakened heart muscles.

A basic lipid panel typically measures total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides.

While these metrics are useful, they don’t always capture key elements linked to cardiovascular risk, such as the size and density of LDL particles or specific inflammatory markers. That’s where advanced lipid testing can offer a more nuanced view.

One critical measurement in advanced testing is Lipoprotein (a) [Lp(a)], a marker linked to a higher risk of atherosclerosis. Elevated Lp(a) is considered a strong predictor of heart disease, independent of other cholesterol markers. 

Similarly, Apolipoprotein B (ApoB), which reflects the number of atherogenic particles in the blood, has been shown to correlate more directly with cardiovascular risk than traditional LDL measurements.

Blood sugar and insulin resistance are tightly linked to heart disease. Functional testing includes fasting glucose, fasting insulin, and hemoglobin A1c to assess long-term blood sugar control.

Trimethylamine N-oxide (TMAO) is a compound produced by gut bacteria. High levels of TMAO have been linked to an increased risk of heart disease due to its role in promoting arterial plaque formation and inflammation.

Your thyroid plays a major role in regulating metabolism, including heart rate and cholesterol levels. A dysfunctional thyroid, whether overactive (hyperthyroidism) or underactive (hypothyroidism), can contribute to arrhythmias, high cholesterol, and increased cardiovascular risk.

A coronary angiogram is a more advanced imaging test that evaluates blood flow within the coronary arteries. It involves injecting a contrast dye into the arteries and using X-ray imaging to detect blockages or narrowing that could lead to heart attacks.

Regular physical activity strengthens the cardiovascular system and improves metabolic health. 

Your heart health isn’t just about cholesterol numbers—it’s about the whole picture. The tests outlined above provide deeper insights into your cardiovascular risk, empowering you to take proactive steps.