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Tests for Assessing Cardiovascular Health

By Body1 Staff
Reviewed by Dr. Mike Fuller

Having diabetes is considered a risk factor for developing cardiovascular disease. In fact, people with diabetes are twice as likely to develop heart disease or have a stroke, and also have them occur at an earlier age, than those without diabetes. Therefore, organizations such as the American Diabetes Association (ADA) recommend physicians treat all diabetic patients as if they have already had a heart attack.

Detailed Information:

Following is a list of some of the tests used to assess cardiovascular risk and health. Always remember to consult your physician with any questions.

The Basics

Body Mass Index (BMI) – BMI is a measure of weight in relation to height. Ideally, measures of BMI are performed in conjunction with an analysis of body shape and composition. Advanced BMI calculators, such as the one provided here on Diabetes1 calculate both of these measurements.

Heart rate/pulse the rate at which the heart beats. For the average adult, the heart rate should fall somewhere between 60 and 100 beats per minute (bpm).

Blood pressure (BP) – a measurement of how hard the heart is working to pump blood. It measures the pressure of the circulating blood against the walls of the blood vessels, depicted by two numbers; the systolic and diastolic pressure.

The systolic pressure measures the pressure as the heart beats, pushing blood through the vessels. It is typically measured first, and is usually the larger number of the two.

The smaller number represents the diastolic pressure which measures the pressure of the blood in the arteries when the heart is filling, or when the vessels dilate between heartbeats. The ADA and National Institutes of Health recommend a blood pressure level of about 120/80. A BP between 120/80 and 140/90 is considered to be pre-hypertension, or “early high BP”, and any measurement over 140/90 is considered to be hypertensive, or dangerously high.

Cholesterol Blood Tests

Cholesterol – Cholesterol is a waxy, fat-like substance naturally made in the liver, but can also be found in certain foods such as eggs and certain meats. Despite its negative connotations, the human body needs some cholesterol to function properly. Specifically, the body uses cholesterol to produce certain hormones, vitamin D, bile acids used to help digest fat, and build cell walls/membranes.

Too much however, can clog the coronary arteries as plaque (a think, hard deposit) builds up along artery walls, restricting blood flow. Over time, this can lead to atherosclerosis, or a permanent hardening of the arteries.

The risk of coronary heart disease rises when cholesterol levels exceed 200 milligrams per deciliter (mg/dL) of blood. Cholesterol levels can be measured in two ways; total cholesterol levels or cholesterol ratio.

Total Cholesterol – a measurement of total cholesterol count, including values of LDL, HDL, VLDL, and other lipid components.

Cholesterol Ratios – in addition to the above mentioned cholesterol recommendations, cholesterol ratios can indicate the level of cardiovascular risk. Cholesterol ratio is usually calculated by dividing the HDL level into the total cholesterol level. The optimum cholesterol ratio is thought to be 3.5:1. A reasonable goal is to keep this ratio below 5:1.

Low-density lipoprotein (LDL) cholesterolLDL-C can also be referred to as “bad” cholesterol. Increased levels of this type of cholesterol may increase the risk and incidence of plaque deposits and reduced blood flow. The ADA recommends an LDL level of less than 100 mg/dL in diabetics, and less than 70mg/dL for those who already have cardio-vascular disease or have additional risk factors.

High-density lipoprotein (HDL) cholesterolHDL-C can also be referred to as “good” cholesterol. This type of cholesterol helps carry away the “bad”, or LDL, cholesterol. For people with diabetes, the ADA recommends an HDL level of greater than 40 mg/dL in men and greater than 55 mg/dL in women.

Triglycerides – measures another type of fat in the blood stream. High levels of triglycerides may indicate excessive carbohydrate or alcohol intake. The ADA recommends triglyceride levels of less than150 mg/dL in people with diabetes.

Lipoprotein (a) – Lp(a) is a type of LDL cholesterol whose level is determined by genetics and is not generally affected by lifestyle.

C-Reactive Protein (CRP) – a type of protein produced by the liver as an inflammatory response to infection or injury. According to the American Heart Association, CRP test results can be interpreted as putting the risk of developing heart disease at:

·Low risk (less than 1.0 milligrams per liter, or mg/L)

· Average risk (1.0 to 3.0 mg/L)

·High risk (above 3.0 mg/L)

Lowering CRP levels is thought to be at least as important as lowering cholesterol levels in terms of preventing heart disease.

Fibrinogen – a type of protein in the blood to aid blood clotting. Too much however, and it can cause a clot to form in an artery, possibly leading to a heart attack or stroke. A normal fibrinogen level is considered to be between 200 and 400 mg/L. Smoking, inactivity, excessive alcohol consumption and supplemental estrogen from birth control or hormone replacement therapy may increase fibrinogen levels.

Homocysteine– a substance used to make protein and to build and maintain tissue. Too much homocysteine may increase the risk of stroke, certain types of heart disease and peripheral artery disease (PAD). Though it is still uncertain whether reducing homocysteine levels actually reduces the risk of death from heart disease, taking in plenty of folic acid and B vitamins through foods such as green, leafy vegetables and fortified grain products can help to lower it.

Non-Invasive Tests

Exercise Stress Testa test using exercise in order to measure stress to the heart under controlled conditions. This test is used to determine amongst other things, whether or not there is adequate blood flow to the heart during increased levels of activity, as well as the likelihood of developing heart disease. During the test, the patient's electrocardiogram (EKG), heart rate, heart rhythm and blood pressure are continuously monitored.

If taking medication to control blood sugar levels, be sure to ask your physician to advise about taking medications the day of the test. If taking insulin, it is usually recommended that only half of the morning dose is taken and a light meal is consumed 4 hours prior to the test. If taking pills, it is recommended that they be taken after the test. Be sure to also bring a handheld blood glucose monitor to check blood sugar levels before and after the test.

Physiological Stress Test – also known as a dobutamine or adenosine stress test, it is used in people who are unable to exercise. The test is conducted using chemical stimulation similar to adrenalin instead of exercise in order to measure stress to the heart under controlled conditions.

Stress Echocardiogram a test using thesound waves of an ultrasound used to produce images of the heart at rest and at the peak of exercise.

Nuclear Stress Test – also known as radionuclide, this type of stress test involves the injection of a harmless amount of radioactive isotope into the bloodstream to determine which parts of the heart are healthy and functioning normally. Images of the patient's heart are taken in the resting condition and again following exercise. The two sets of images are then compared.

Electrocardiogram (EKG or ECG)measures the electrical activity of a heart over time using small electrode patches attached to the skin of the chest, arms and legs.

Computed Tomography (CT) scanin assessing cardiovascular health, CT scans help to provide a cross-sectional view of the heart anatomy and coronary circulation, not to mention the aorta, pulmonary veins and arteries. There are three types of CT scans used to diagnose heart disease: coronary calcium scan, coronary CT angiography (CTA), and total body CT scan. The coronary calcium scan is a test thatmeasures calcium deposits in the coronary arteries. Coronary CT angiography is a non-invasive heart imaging test wherein high-resolution, three-dimensional pictures of the heart and main vessels are taken after an iodine-containing contrast dye is injected into an IV in the patient’s arm.

Cardiac magnetic resonance imaging (MRI)MRIs use large magnets and radio-frequency waves to produce pictures of the body’s internal structures. In evaluating cardiovascular health, an MRI scan helps to evaluate the anatomy and function of the heart, major vessels and pericardium.

Invasive Testing

Coronary Angiographyusually done along with a cardiac catheterization, this test involves taking accurate angiographic images of the heart to reveal the extent and severity of coronary arterial blockages. The procedure is performed with the use of a mild sedative and local anesthesia. A small catheter is inserted through the skin into an artery in either the groin or the arm. The catheter is then carefully moved to the heart and, once in place, a dye is injected into the catheter. Then x-ray images are taken of the dye moving through the arteries, locating any blockages.

For more information on heart health, please visit: Heart1.com or Veins1.com

Last updated: 01-Jan-00

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