These blood tests help to determine your risk for coronary artery disease and heart attack and guide your treatment.

Lipoprotein a (Lp(a))

“Non-traditional” blood protein associated with higher risk of heart attack and stroke.

Goal values:

  • Desirable level for adults: less than 30 mg/dL

Preparation:

Blood should be collected after a 12-hour fast (no food or drink, except water). For the most accurate results, wait at least two months after a heart attack, surgery, infection, injury or pregnancy to check this blood level.

Lp(a) is LDL (low density lipoprotein) attached to a protein called apo (a). It is not fully known what Lp(a) does, but if Lp(a) is greater than 30 mg/dL, it is related to an increased risk for heart attack and stroke. It is also related to development of fatty matter in vein grafts after bypass surgery, coronary artery narrowing after angioplasty and increased risk for the development of blood clots. If Lp(a) is high, it is even more important to bring the LDL levels down to an acceptable level. Lp(a) is higher in African Americans. The causes of high Lp(a) are kidney disease and certain family (genetic) lipid disorders.

Apolipoprotein A1 (Apo A1)

Apo A1 is the major protein of HDL. Low levels of Apo A1 is associated with increased risk of early cardiovascular disease, and may be seen more often in patients with a high-fat diet, inactivity and central obesity.

Goal values:

  • Desirable level for adults: more than 123 mg/dL

Preparation:

Blood should be collected after a 12-hour fast (no food or drink, except water). For the most accurate results, wait at least two months after a heart attack, surgery, infection, injury or pregnancy to check this blood level.

Apolipoprotein B (ApoB)

A major protein found in cholesterol particles. New research suggests ApoB may be a better overall marker of risk than LDL alone.

Goal values:

  • Less than 100 mg/dL for those with low/intermediate risk
  • Less than 80 mg/dL for high-risk individuals, such as those with cardiovascular disease or diabetes

Preparation:

Blood should be collected after a 12-hour fast (no food or drink, except water). For the most accurate results, wait at least two months after a heart attack, surgery, infection, injury or pregnancy to check this blood level.

Fibrinogen

A protein found in the blood. Encourages blood clotting, but high levels are linked to an increased risk for heart attack and vascular disease.

Goal values:

  • Less than 300 mg/dL

Preparation

Blood should be collected after a 12-hour fast (no food or drink, except water). For the most accurate results, wait at least two months after a heart attack, surgery, infection, injury or pregnancy to check this blood level.

Higher blood pressure, body weight, LDL and age are related to higher levels of fibrinogen. On the other hand, alcohol use and exercise are related to lower fibrinogen levels. Higher fibrinogen levels are also seen with African Americans, and a rise is seen with menopause.

N-terminal-pro-B-type Natriuretic Peptide (NT-proBNP)

"Non-traditional" blood protein made in the heart and found in the blood. High levels are associated with increased risks of cardiovascular disease, heart attack and heart failure development. Elevated levels are associated with development of heart failure and worse prognosis.

Goal values:

  • Less than 125 pg/mL

Preparation

This test may be performed any time in the day without fasting.

LDL-associated PLA2 (PLAC)

This blood test measures the level of lipoprotein associated-phospholipase A2 (Lp-PLA2), an enzyme associated with inflammation, stroke and heart attack risk. However, elevated levels also may be due to non-arterial causes.

Goal values:

  • Less than 200 ng/mL (normal value) for low relative risk of CVD
  • Between 200-235 ng/mL for intermediate relative risk of CVD
  • More than 235 ng/mL for high relative risk of CVD

Preparation

A 12-hour fast (no food or drink, except water) is required for this blood test. Wait at least two months after a heart attack, surgery, infection, injury or pregnancy for best results.

Urine Albumin/Creatinine Ratio (Ualb/Cr)

Albumin is a protein found in urine that can be a sign of increased risk for kidney disease, diabetes complications and cardiovascular risks. If elevated levels of Ualb/CR are present, close attention to blood pressure control, including use of specific blood pressure medications that help protect the kidney, may be recommended. Aggressive global preventive risk reduction efforts, such as closer attention to lipid levels, blood pressure control and diabetes control, are suggested.

Goal values:

  • More than 30 mg/g indicates increased risk for CVD and diabetic nephropathy
  • More than 300 mg/g indicates clinical nephropathy

Preparation

A clean catch spot urine test can be performed any time in the day and does not require fasting.

Global Risk Score (GRS)

A tool that looks at a person’s risk factors, weighs them in importance and then gives a percentage risk of that patient developing heart disease or of having a heart attack within the next 10 years.

Goal values:

  • Less than 10% = low risk
  • 10 – 20% = intermediate risk
  • Greater than 20% = high risk