lipid.siteTests to ask for
A standard cholesterol panel misses some things. A few extra tests can show whether plaque is already there, whether your genes raise your risk, and who else in your family should be checked.
What's really in the wall: soft plaque, with calcium in some of it.
Only calcium shows. Soft plaque is invisible, so a score of 0 lowers risk but doesn't rule out plaque.
Pick a score to see the scan
Score 1 to 99: Some calcified plaque. Plaque is present, which often tips the balance toward treatment to lower LDL.
Coronary artery calcium (CAC) scan
A quick CT scan of the heart, with no needles and a low dose of radiation, looks for calcium in the heart's arteries. Calcium only forms in plaque, so it shows plaque you already have. The score adds up the amount and density of the calcium. It helps most when you and your clinician can't decide whether to start a medicine. A CT angiogram is a different test: dye given through an IV lets it show soft plaque and narrowing too.
Key takeaways
- 1
A coronary calcium (CAC) scan shows calcified plaque in your heart's arteries. It can help you and your clinician decide about treatment when the choice isn't clear.
- 2
Lp(a) is mostly set by your genes and barely changes, so testing it once as an adult is widely recommended. ApoB counts the particles that cause plaque.
- 3
Genetic testing can confirm familial hypercholesterolemia (FH), which helps your relatives find out early. Some gene tests also show how you may handle certain statins.
Go deeper
▸Reading a calcium score
Scores are often grouped as 0, 1 to 99, 100 to 399, and 400 or more. Reports may also give a percentile, comparing you with people of the same age and sex.
A score of 0 means no calcium was seen. It doesn't rule out soft plaque, and it counts for less in people who smoke, have diabetes, or have FH. A CAC scan isn't usually needed for people who already have heart disease or very high LDL; they qualify for treatment anyway.
Insurance often doesn't cover it, but many centers offer it at a modest cash price. Ask what it costs before booking.
▸Lp(a) and ApoB in practice
Lp(a) results come in nmol/L or mg/dL. About 125 nmol/L (or 50 mg/dL) or more is a common threshold for higher risk. A high result is a reason to work harder on LDL and other risks, and to tell close relatives.
ApoB is especially useful when triglycerides are high, or with diabetes or extra weight, when LDL-C can underestimate the number of particles.
▸Genetic tests in plain language
FH testing looks for changes in genes such as LDLR, APOB and PCSK9. Clinicians often consider it when LDL-C is 190 mg/dL or more, or when the family has a history of very high cholesterol or early heart disease.
Pharmacogenomic tests look at genes that affect how your body handles a medicine. For example, a common SLCO1B1 variant raises blood levels of some statins, especially simvastatin, and the chance of muscle side effects.
In the US, a law called GINA protects you from genetic discrimination in health insurance and most employment, but not in life, disability or long-term care insurance. A genetic counselor can explain what a result means for you and your family.
What people experienced
One person's experience isn't a prediction of yours.
Sources
- Coronary calcium scan, NHLBI (NIH)
- Familial hypercholesterolemia and Lp(a), Family Heart Foundation
- Familial hypercholesterolemia, MedlinePlus Genetics (NIH)
- Genetic testing, MedlinePlus (NIH)
- Cholesterol levels (lab test), MedlinePlus (NIH)
- National Lipid Association, National Lipid Association
- CardioSmart, the ACC's patient education site, American College of Cardiology
Not medical advice. This exhibit is general education to help you understand your condition and talk with your clinician. It doesn't tell you what to take or change. If you have chest pain or other signs of a heart attack or stroke, call 911.
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