Atherosclerosis Diagnosis

---

Beginning at age 20, your provider will regularly check to see if you have risk factors for  plaque  buildup in the  arteries . Your provider may:

• Check your blood pressure.
• Calculate your body mass index by measuring your waist.
• Order blood tests to see whether you have unhealthy blood cholesterol or triglycerides.

Very high blood pressure is a medical emergency. If the top number of your blood pressure is higher than 180 mm Hg or if the bottom number is higher than 120 mm Hg, call your healthcare provider right away.

Talk with your provider about risk factors related to:

• Your lifestyle habits such as smoking or vaping, low physical activity, and unhealthy eating behaviors
• Your personal health history of medical conditions that may affect your risk, including diabetes and  inflammatory  conditions such as rheumatoid arthritis and psoriasis
• Your family history if you have blood relatives who had heart attacks or died suddenly before they were 55 years old

A risk estimator can help determine your risk for a major complication, such as a heart attack, from atherosclerosis.

• For people between ages 20 and 59, the risk estimator can help you understand the risk of having a stroke or heart attack over your lifetime.
• If you are between ages 40 and 79, the risk estimator can help you understand the risk of having a stroke or heart attack in the next 10 years.

The risk estimator considers your  cholesterol  levels, blood pressure, and other factors to calculate your 10-year or lifetime risk of a serious complication from atherosclerosis. If you have all the information, you can use the app yourself. The app shows risk levels as low, borderline, intermediate, or high.

Discussing risk with your provider

Keep in mind that your cholesterol numbers and your risk score are only part of the story. Talk to your provider to learn what the numbers mean for you. Other risk estimators are available, such as the ASCVD Risk Estimator Plus. It's good to have the options, because no single risk calculator is right for everyone. Studies show that some calculators overestimate risk for certain groups, while others may underestimate risk.

When diagnosing your condition, your provider may order tests even if you don't show symptoms. The type of test depends on which  arteries  are affected by plaque buildup.

Blood tests

Providers use blood tests to check cholesterol, triglycerides, blood sugar, and lipoprotein levels, along with proteins that show signs of  inflammation , such as C-reactive protein.

Electrocardiogram

An electrocardiogram, also called an ECG or EKG, is a simple, painless test that detects and records your heart's electrical activity. An ECG can show how fast your heart is beating, check your heart's rhythm, and assess the electrical impulses passing through each part of your heart.

For an ECG, you will lie on a table. A provider will attach up to 12 electrodes to the skin on your chest, arms, and legs. The electrodes are connected by wires to a machine that records your heart's electrical activity. The test takes a few minutes. An ECG has no serious risks.

Imaging tests

Your provider may order a heart imaging test to take pictures of your heart and check the blood flow in your heart and coronary arteries.

Different heart imaging tests can be used to diagnose atherosclerosis:

• Angiography is a special type of X-ray using a dye. This procedure can check the arteries in the heart, neck, brain, or other areas of the body.
• Cardiac MRI (magnetic resonance imaging) detects tissue damage or problems with blood flow in the heart or coronary arteries. Cardiac MRI can help explain results from other imaging tests such as chest X-rays and CT scans.
• Cardiac positron emission tomography (PET) scanning assesses blood flow through the small blood vessels of the heart. This type of heart scan can diagnose coronary microvascular disease.
• Coronary computed tomographic (CT) angiography shows the inside of your coronary arteries without invasive cardiac catheterization. It uses radiation to create a picture of your heart's arteries. Because CT scans use radiation, talk to your provider before the test if you are or could possibly be pregnant.
• Cardiac intravascular ultrasonography uses a tiny  ultrasound  device on the tip of a cardiac catheter to look inside the arteries of the heart. Learn more about this procedure.
• Coronary calcium scans measure the amount of calcium in the walls of your coronary arteries using a CT scanner. Buildup of calcium is a sign of atherosclerosis. The results are given as a score based on the amount of calcium in your coronary arteries. A score of zero is normal. The higher your score, the more likely you are to have coronary heart disease. If your score is high, talk with your provider about more testing and ways that heart-healthy living can lower your risk of complications.

Stress tests

A stress test checks how your heart responds to physical stress. Some heart problems are easier to detect when your heart is pumping blood to your body at a high rate.

You may do a stress test in a clinic, a provider's office, or a hospital. The test usually involves exercise such as walking on a treadmill or riding a stationary bike. If you are not able to exercise, your provider will give you medicine to make your heart work hard and beat faster, as if you were exercising.

Ankle-brachial index (ABI) test

An ABI test can help diagnose peripheral artery disease. This painless test compares the blood pressures in your ankle and your arm using a blood pressure cuff and an ultrasound device.

Healthcare providers sometimes recommend  genetic  testing for people who have very high cholesterol levels or if they have a family history of heart disease or unexplained, sudden death at young ages. For example,  familial hypercholesterolemia  can be passed from parent to child and raises the risk for severe complications of atherosclerosis at a young age.

If results of genetic testing show you have a high risk of disease linked to atherosclerosis, you and your provider can discuss plans for monitoring your heart health, heart-healthy living, and starting treatment with medicines. Your provider may also recommend genetic counseling to help you understand your results.

Learn more about familial hypercholesterolemia.