Understanding the numerical outcomes of health assessments is a great way to deepen your relationship with your heart health, says Pooja Swamy, MD, an interventional cardiologist at Loma Linda University International Heart Institute. For February’s American Heart Month, Swamy discusses how to use five metrics to safeguard your heart health.
Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score
If you are between 40 and 75 years old, Swamy recommends undergoing an ASCVD risk assessment, which calculates your 10-year risk of developing heart disease or stroke using an algorithm from the American College of Cardiology and the American Heart Association guidelines. You or your care provider can complete the test online by entering information about your age, gender, race, cholesterol, blood pressure, and whether you have diabetes or smoke.
Swamy says a score of below 7 percent may not require any therapeutic interventions, while scoring between 7 and 7.5 percent represents a "grey zone," especially if you have risk factors, in which she recommends receiving a calcium score or coronary CT to refine ASCVD risk estimation and determine whether intervention is needed. If you have had a calcium scoring or coronary CT, Swamy recommends using this online test to estimate your ASCVD risk score.
If your ASCVD risk score is above 7.5 percent, Swamy recommends partnering with your health care provider to develop a preventive life style and therapeutic strategy including medications to control heart disease risk factors and safeguard your heart health.
Cholesterol is an essential substance your body creates to build cells, vitamins, and other hormones. But Swamy says excess cholesterol circulating in your blood can pose serious health risks due to genetic, metabolic, or nutritional reasons. Cholesterol can create deposits and subsequently blockages in vessels of the heart, the extremities, and other vital organs like the brain, eyes, and kidneys.
Swamy says three essential sub-components make up cholesterol. Understanding the significance of these individual measurements and how they work together is the first step to ensure your cardiovascular system stays as healthy as possible.
- Low-density lipoprotein (LDL): With LDL numbers, Swamy says, "the lower, the better.” An LDL of 160 mg/dl or less may not necessarily require medications if you do not have any risk factors for heart disease. But LDLs closer to 70 are best. Moreover, maintaining LDL under 70 is essential if you know you have had a heart attack, a cardiac disease, pre-diabetes, diabetes, or chronic kidney disease.
- High-density lipoprotein (HDL): Swamy says, "the higher [the number], the better.” An HDL of around 60mg/dl represents healthy levels.
- Triglyceride is another component of cholesterol closely related to lifestyle and intertwined with blood sugar. A normal triglyceride reading will fall under 150 mg/dL. Persistently elevated triglyceride (above 175 mg/dl) often signals elevated blood sugar, and can be a risk factor for heart disease. Swamy says providers will focus on reducing heart disease risk by controlling blood sugar first.
- Those with a family history of cholesterol issues, heart attack, or stroke at a young age should consider checking levels of another component called Lipoprotein A , Lp (a) levels, The acceptable range of Lp(a) is specific to ethnicity and may refine ASCVD risk estimation. This may also help healthcare providers decide on the best therapeutic or preventive strategy.
Bloodwork measures cholesterol levels. Swamy recommends that people between 20 and 40 years old without risk factors be tested every 4 to 6 years. Those 40 years old and above should get a lipid profile during annual health visits and blood work, or more frequently if they possess heart disease risk factors like diabetes, hypertension, peripheral arterial disease, or chronic kidney disease.
Blood glucose molecules give us the energy to maintain bodily function from the cellular level, Swamy says. In excess, however, she says blood sugar becomes problematic. High blood sugar is tied to pre-diabetes and diabetes — conditions that affect how the body turns food into energy: major risk factors for coronary heart disease.
To keep a pulse on your blood sugar levels, Swamy says you can receive a glycosylated hemoglobin A (HbA1c) test through bloodwork at a clinic or lab; the test provides a three-month average of your blood sugar level. A score of 5.6–6.4% on the HbA1c signals pre-diabetes, while 6.5% and above signals diabetes.
You and your care provider will strategize how to best control your levels based on your outcomes.
Swamy says blood pressure is the pressure needed for blood to optimally reach every organ and cell in your body. Blood pressure is comprised of two components:
- Systolic blood pressure is exerted by the heart itself and presented as the "top number" in a blood pressure reading.
- Diastolic blood pressure is exerted by blood vessels to keep the blood moving and is presented as the "bottom number" in a blood pressure reading.
Current guidelines show that an ideal blood pressure reading is 120mm Hg/80mm Hg. Any results too far from this result could signal abnormal blood pressure. Chronically high blood pressure, called hypertension, can damage the heart and other major organs, Swamy says. Hypertension is a top risk factor for coronary artery disease and also causes the heart muscle to thicken over time, eventually leading to heart failure. Hypertension also increases the risk of developing atrial fibrillation, chronic kidney disease, retinopathy, stroke, and aortic aneurysm. If your blood pressure remains persistently elevated above 140/90 mmHg, Swamy urges you to discuss ways to manage blood pressure with your health care provider.
What is “normal” in blood pressure numbers can look different for everyone, Swamy says, so keeping regular tabs on your blood pressure with a cuff at home or throughout medical visits and discussing results with your care provider is essential.
Body Mass Index (BMI)
BMI is an estimate of body fat and is easily calculated online; the higher your BMI, the higher your risk for hypertension, diabetes, and heart conditions. Reaching and maintaining a BMI of 25 or below can help control blood pressure. If your BMI is above 40, Swamy recommends undergoing evaluation for metabolic syndrome and obstructive sleep apnea, which is a disorder that causes hypertension and heart disease.
“All of these metrics intertwine and affect each other, so no one metric is more important than another," Swamy says. "Understanding and keeping track of the numbers is a crucial way to engage with your heart’s health.”