Five Tests To Assess Your Heart Health In The New Year.
Getting these core tests right will make a major difference to your heart health.
I am a little odd.
At least, according to my wife, anyway.
I love Mondays and January.
Everyone else seems to dislike these calendar milestones, but for me, they represent a fresh start and the opportunity to reassess the work that needs to be done.
As we approach the end of the year and prepare to set out into the next one, the most common New Year resolutions are often health-related.
It is around this time of the year that my friends, often previously uninterested in heart health, ask me:
“What tests do I need to get done to check my heart health?”
Here are five simple tests I recommend.
This list is not exhaustive, but it captures some of the core metrics you need to get right to set yourself on track for the new year and excellent heart health.
Daily Step Count
The figure of 10,000 steps per day as a requirement for good health was initially decided by a Japanese engineer looking for a nice round number to aim for when designing the first pedometer to track steps.
Ironically, this number is a valuable metric to aim for, and it comes with a LOT of benefits.
Not just for the prevention of heart disease but also to reduce your risk of dying from all conditions.
Walking at least 7000 steps per day is associated with half the risk of dying from any cause over a ten-year time frame1.
This is a huge deal.
There are very few if any, things in medicine that are associated with that magnitude of benefit.
Your daily step count is easily accessible on your phone or smartwatch to give you a very accurate picture of where you stand.
Exercising to get your V02 max to very high levels is something many people will struggle to do.
But walking.
Walking is something pretty much everyone can do.
Maybe it’s time to get more movement into your day.
Blood Pressure
High blood pressure is the risk factor responsible for the greatest number of deaths worldwide2.
For every 20mmHg increase in systolic (Top Number) blood pressure, the risk of dying from a heart attack or stroke doubles3.
High blood pressure is defined as a systolic blood pressure above 140mmHg, but we know that even levels above 90mmHg risk starts to increase.
Blood pressure is easy to check.
What’s yours?
Because with good nutrition and exercise, it is possible to reduce your blood pressure if needed.
Non-HDL Cholesterol
There is no ‘Good’ cholesterol on a standard cholesterol blood test.
There really is only bad cholesterol.
The relationship is simple—higher cholesterol for longer increases your risk of coronary artery disease4.
The best cholesterol value in the standard cholesterol panel to evaluate the risk of coronary artery disease is your Non-HDL. This value is obtained by subtracting your HDL cholesterol from your Total Cholesterol.
A 40-year-old male with a Non-HDL cholesterol of 5.0 mmol/L (193 mg/dl )and NO other risk factors has a 23% chance of a major cardiovascular event by age 75.
This figure can be reduced to a risk of less than 4% by lowering that person’s Non-HDL cholesterol by 50%5.
What is your Non-HDL cholesterol?
Lp(a) - Lipoprotein (a)
Lp(a) is a genetic cholesterol particle disorder present in 10-20% of the population associated with early heart disease6.
It is super common.
Yet rarely tested for and only needs to be done once.
Guidelines recommend that everyone have their levels checked at least once over their lifetime.
Although specific therapies to lower Lp(a) have yet to be approved, that does not mean we cannot reduce overall cardiovascular risk even if you have an elevated Lp(a).
If you have a family history of heart disease, this is a must-do test.
Cardiac CT
In simple terms, you cannot die from a condition you do not have.
If you do not have coronary artery disease, the probability of you dying from it then is very low.
The factors that we have discussed so far are all important risk factors for developing coronary artery disease.
They influence the probability of you getting coronary artery disease, but they do not tell you whether or not you HAVE coronary artery disease.
A cardiac CT is a low-dose CT scan of your heart that assesses whether or not you have plaque in your coronary arteries and, if so, how much.
In general, the more plaque you have, the higher your risk of a heart attack over the next 10 years. This is commonly done as a CT Coronary Artery Calcium (CAC) score with a figure of more than 0 indicating the presence of advanced plaque7.
A score of greater than 100 typically reflects a high risk of a heart attack over the next 10 years.
A CAC score of 0 is a powerful predictor of being in a low-risk category over the near term, but for longer-term risk assessments, you should focus more on risk factors.
Remember, the whole point is to DELAY the onset of the disease as long as possible.
Understanding where you stand on these five tests will give you an excellent understanding of your cardiovascular risk.
Of course, there are other tests that can be done, but these five are a great place to start.
As the New Year approaches, it is always good to take stock of where things are in terms of your risk of heart disease.
It is an even better time to start putting in the work towards reducing that risk.
2025 is a New Year.
It is a fresh start.
Time to hit reset and start again.
Happy Christmas and New Year.
Did You Know That 90% Of Early Heart Disease Is Preventable?
You just need to know the formula.
The Heart Health Formula is the step by step solution to preventing heart disease.
It is a lifestyle-first approach to:
Understanding the best tests to assess your risk of heart disease - Many of which are commonly not done.
Reduce your future risk of heart disease using primarly lifestyle measures.
Lower high cholesterol.
Lower high blood pressure.
Reverse insulin resistance.
And lots more.
The Heart Health Formula is everything you need for the New Year to significantly reduce your future risk of heart disease.
Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study. JAMA Netw Open. 2021 Sep 1;4(9):e2124516.
https://ourworldindata.org/causes-of-death
Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903-13
Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series. J Am Coll Cardiol. 2018 Sep 4;72(10):1141-1156.
Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium.
A Test in Context: Lipoprotein(a). JACC VOL. 69, NO. 6, 2017
JACC: Cardiovascular Imaging May 2015, 8 (5) 579-596;
What's the conversion from mg/dl to mmol/l that you use? I read: 'divide by 18' so one of your examples appears off, or where did I go wrong?
Is there a chart for LDL-C direct test cholestrol?