This is a group of tests and health factors that have been proven to indicate your chance of having a cardiovascular event such as a heart attack or stroke. They have been refined to indicate the degree of risk: borderline, intermediate, or high risk.
Perhaps the most important indicators for cardiac risk are your personal health history. These include:
There are some imaging tests that may be used in cardiac risk assessment. Non-invasive tests may include, for example, an electrocardiogram (ECG, EKG) or a stress test, also called ECG stress test or metabolic stress test. Invasive tests may also be used to evaluate for the presence of cardiovascular disease (CVD), but they are usually used for diagnostic purposes in people with signs and symptoms and not for risk assessment. Examples include an angiography/arteriography and cardiac catheterization. (For more on these, see the Mayo Clinic webpage on Coronary artery disease: Diagnosis.)
The lipid panel is the most important blood test for cardiac risk assessment.
The lipid panel is used to help determine your risk of heart disease and to help make decisions about what treatment may be best if there is borderline or high risk. The results of the lipid panel are considered along with other known risk factors for heart disease to develop a plan for treatment and follow-up. Depending on the results and other risk factors, treatment options may involve lifestyle changes such as diet and exercise or lipid-lowering medications such as statins.
The lipid panel measures cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C, "good" cholesterol) as well as calculates low density lipoprotein cholesterol (LDL-C, "bad" cholesterol). Triglycerides are a form of fat and a major source of energy for the body.
According to 2002 guidelines from the NCEP Adult Treatment Panel III, the desirable ranges for the components of the lipid panel are:
Some other information may be reported as part of the lipid panel. These parameters are calculated from the results of the tests identified above.
Some other tests that may be used to assess cardiac risk include:
Several other tests are being studied for their usefulness in determining cardiac risk. Currently, there is no consensus or formal recommendations for them. A healthcare practitioner may order one or more of these tests to help assess cardiac risk.
Some of these include:
Health organizations have different recommendations for treatment based on your predicted CVD risk.
Guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that a risk calculator be used to determine your 10-year risk of CVD if you are age 40 to 75 and do not have heart disease. Many factors are considered in the calculation, including total cholesterol, LDL-C, HDL-C, age, gender, race, blood pressure, presence of diabetes, and smoking habit. An initial (baseline) risk should be calculated and then your risk can be tracked over time with each subsequent risk calculation. Ten-year risk is categorized below:
|Calculated 10-Year Risk||Risk Category|
|Less than 5%||Low|
|5% to 7.4%||Borderline|
|7.5% to 19.9%||Intermediate|
|Greater than 20%||High|
ACC and AHA recommend treatment with statins if you:
The U.S. Preventive Services Task Force (USPSTF) makes recommendations on the use of statins for treatment in adults ages 40 to 75 with no history of heart disease (i.e., no symptoms of coronary artery disease or stroke), based on risk factors (i.e., LDL-C greater than 130 mg/dL(3.37 mmol/L), HDL-C level less than 40 mg/dL(1.0 mmol/L), diabetes, high blood pressure, smoking) and the use of the risk calculator.
Use of the risk calculator and ACC/AHA guidelines remains controversial and is evolving as more data become available. Some say that the current risk calculator can overestimate risk. Many still use older guidelines (2002) from the NCEP Adult Treatment Panel III to evaluate lipid levels and CVD risk. (See above for the target values listed in "How is the lipid panel used?") According to NCEP Adult Treatment Panel III guidelines, if you have LDL-C above the target values and risk factors (e.g., family history, cigarette smoking, diabetes, high blood pressure), you require treatment.
Yes. The following factors can increase your risk of heart attack:
No. Your overall cardiac risk is based on a number of factors, including your personal health history as well as the results of any or all of the tests mentioned previously. An assessment requires interpretation by a trained medical professional. However, there are resources available to help you better understand your risk. For example, you can read the American Heart Association article Understand Your Risks to Prevent a Heart Attack. Using results of the lipid panel and a physical exam, you can calculate your 10-year risk of heart disease or stroke using the Heart Risk calculator from AHA and American College of Cardiology if you are age 40 to 75 and do not have heart disease. And there are home tests available to measure your cholesterol. (For more on home cholesterol testing, see the Mayo Clinic article Are home cholesterol test kits accurate?)
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 (statins) that are effective in lipid management. Some conditions involving elevated lipids levels are hereditary. High lipid levels in these conditions cannot always be lowered sufficiently by diet and exercise. This type of elevation usually requires treatment with lipid-lowering drugs.
Sources Used in Current Review
(9/30/2019) Blood Tests to Determine Risk of Coronary Artery Disease. Cleveland Clinic. Available online at https://my.clevelandclinic.org/health/diagnostics/16792-blood-tests-to-determine-risk-of-coronary-artery-disease. Accessed November 2020.
Baer, J. (2017 August 11). AACE and EAS Lipid Guidelines. American College of Cardiology. Available online at https://www.acc.org/latest-in-cardiology/articles/2017/08/11/08/35/aace-and-eas-lipid-guidelines. Accessed March 2019.
(2016 November 13). Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. US Preventive Services Task Force Recommendation Statement. Available online at https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/statin-use-in-adults-preventive-medication. Accessed November 2020.
Genzen, J. (2018 August, Updated). Atherosclerotic Cardiovascular Disease (ASCVD) Traditional Risk Markers – Cardiovascular Disease Risk Markers (Traditional). ARUP Consult. Available online at https://arupconsult.com/content/cardiovascular-disease-traditional-risk-markers. Accessed March 2019.
Lloyd-Jones, D. et. al. (2017 October). 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk, A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. JACC v 70 (14) October 2017. Available online at http://www.onlinejacc.org/content/70/14/1785. Accessed March 2019.
Jackson, E. (2017 September 5). 2017 ACC Recommendations for Non-Statin Therapy. American College of Cardiology. Available online at https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/09/05/10/03/2017-focused-update-of-the-2016-acc-expert-consensus-nonstatin. Accessed March 2019.
Sources Used in Previous Reviews
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA (2001) 285: 2486-2497.
Clinical Chemistry: Theory, Analysis, Correlation. 3rd Edition. Lawrence A. Kaplan and Amadeo J. Pesce, St. Louis, MO. Mosby, 1996.
Clinical Chemistry: Principles, Procedures, Correlations. Michael L. Bishop, Janet L. Duben-Engelkirk, Edward P. Fody. Lipincott Williams & Wilkins, 4th Edition.
American Heart Association. Heart Attack/Coronary Heart Disease Risk Assessment. Available online at http://www.heart.org/presenter.jhtml?identifier=3003499. Accessed October 2008.
(July 3, 2008) MayoClinic.com. Coronary artery disease: Tests and Diagnosis. Available online at http://www.mayoclinic.com/health/coronary-artery-disease/DS00064/DSECTION=tests-and-diagnosis. Accessed October 2008.
(March 30, 2007) MedlinePlus Medical Encyclopedia. Coronary Heart Disease. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm. Accessed October 2008.
(May 2001) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). PDF available for download at http://www.nhlbi.nih.gov. Accessed October 2008.
American Heart Association. 2013 Prevention Guidelines Tools: CV Risk Calculator. Available online at http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp. Accessed June 2014.
2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. Published online November 12, 2013. Available online at http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437741.48606.98.full.pdf+html. Accessed June 2014.
Cleveland Clinic. Blood Tests to Determine Risk of Coronary Artery Disease. Available online at http://my.clevelandclinic.org/heart/diagnostics-testing/laboratory-tests/blood-tests-to-determine-risk-of-coronary-artery-disease.aspx. Accessed June 2014.
Cleveland Clinic. Electrocardiograph Tests. Available online at http://my.clevelandclinic.org/heart/diagnostics-testing/electrocardiograph-tests/default.aspx. Accessed June 2014.
National Heart, Lung, and Blood Institute. What Are Coronary Heart Disease Risk Factors? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/hd/. Accessed June 2014.
Mayo Clinic. How important is cholesterol ratio? Available online at http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol-ratio/FAQ-20058006. Accessed July 2014.