Although many of the basic tests already discussed can give a fairly good idea of cardiovascular risk contemporary Preventative Cardiology has more advanced tools at its disposal.
Apolipoprotein B (apoB) serum concentration has been shown in multiple studies to be a more accurate marker of atherosclerotic risk than either non-HDL cholesterol or LDL cholesterol.
Lp(a) level is genetically inherited so this only needs to be tested once in each patient. A high Lp(a) level indicates a much higher coronary disease and heart attack risk, so once identified these patients need aggressive preventive strategies — their blood-relatives should probably get screened too.
hsCRP is a general marker of inflammation. In patients without any obvious trauma or infection a high hsCRP suggests “hidden” inflammation. Systemic inflammation can impair endothelial health (the inside lining of the arteries), promote coronary atherosclerosis and increase heart attack risk.
Carotid IMT is an ultrasound assessment of the main arteries in the neck. These arteries are close to the coronary arteries and tend to undergo the same changes early in atherosclerosis. Because we cannot easily ultrasound the coronaries the next best thing is to ultrasound their neighbour, the carotids.
The APO E gene controls the packaging of cholesterol. There are three main gene variants and each of us has any two of these three types. Certain combinations indicate a decreased risk of coronary disease while other indicate a higher risk and the need for more aggressive intervention. They also help predict Alzheimer’s disease risk.
DEXA scanning is a quick and easy way to assess body composition. It can estimate total muscle mass (muscle is now known to be essential for good glycemic control, cognitive function and physical independence in old age) and fat mass. Most importantly it can estimate visceral fat mass — this directly correlates with metabolic health, cardiovascular risk and even risk of many forms of cancer.
You can check out some other medical conditions known to increase cardiovascular risk.