Your blood offers many clues about your heart health. For example, high levels of "bad" cholesterol in your blood can be a sign that you're at increased risk of having a heart attack. And other substances in your blood can help your doctor determine if you have heart failure or are at risk of developing plaques in your arteries (atherosclerosis).
It's important to remember that one blood test alone doesn't determine your risk of heart disease and that the most important risk factors for heart disease are smoking, high blood pressure, high cholesterol and diabetes.
A cholesterol test, also called a lipid panel or lipid profile, measures the fats (lipids) in your blood. The measurements can indicate your risk of having a heart attack or other heart disease. The test typically includes measurements of:
- Total cholesterol. This is a sum of your blood's cholesterol content. A high level can put you at increased risk of heart disease. Ideally, your total cholesterol should be below 200 milligrams per deciliter (mg/dL), or 5.2 millimoles per liter (mmol/L).
- Low-density lipoprotein (LDL) cholesterol. This is sometimes called the "bad" cholesterol. Too much of it in your blood causes the accumulation of fatty deposits (plaques) in your arteries (atherosclerosis), which reduces blood flow. These plaques sometimes rupture and lead to major heart and vascular problems. Ideally, your LDL cholesterol level should be less than 130 mg/dL (3.4 mmol/L), and under 100 mg/dL (2.6 mmol/L) is even better.
- High-density lipoprotein (HDL) cholesterol. This is sometimes called the "good" cholesterol because it helps carry away LDL cholesterol, keeping arteries open and your blood flowing more freely. Ideally, your HDL cholesterol level should be 60 mg/dL (1.6 mmol/L) or higher, though it's common that HDL cholesterol is higher in women than men.
- Triglycerides. Triglycerides are another type of fat in the blood. High triglyceride levels usually mean you regularly eat more calories than you burn. High levels increase your risk of heart disease. Ideally, your triglyceride level should be less than 150 mg/dL (1.7 mmol/L). The American Heart Association (AHA) recommends that a triglyceride level of 100 mg/dL (1.1 mmol/L) or lower is considered "optimal." The AHA says this optimal level would improve your heart health.
C-reactive protein (CRP) is a protein your liver produces as part of your body's response to injury or infection (inflammatory response).
CRP is a sign of inflammation somewhere in the body. However, CRP tests can't pinpoint where in the body this may be happening. Inflammation plays a central role in the process of atherosclerosis, in which fatty deposits clog your arteries. Measuring CRP alone won't tell your doctor your risk of heart disease. But factoring in CRP test results with other blood test results and risk factors for heart disease helps create an overall picture of your heart health.
According to the American Heart Association, your CRP test result can be interpreted as putting your heart disease risk at:
- Low risk (less than 1.0 milligrams per liter, or mg/L)
- Average risk (1.0 to 3.0 mg/L)
- High risk (above 3.0 mg/L)
The American Heart Association doesn't yet recommend CRP screening for the general public — only those at known risk of heart disease.
Cholesterol-lowering statin medications will likely reduce LDL cholesterol and CRP levels and decrease your heart disease risk, but statins aren't recommended solely to lower your CRP level. Talk to your doctor if you're concerned about your CRP level.
Fibrinogen is a protein in your blood that helps blood clot. But too much fibrinogen can cause a clot to form in an artery, leading to a heart attack or stroke.
Your doctor may check your fibrinogen level if you have an increased risk of heart disease. Certain factors, such as smoking and taking supplemental estrogen — whether from birth control pills or hormone therapy — may increase your fibrinogen level.
This test isn't always ordered because there aren't any direct treatments to lower fibrinogen levels, and the test isn't yet standardized from lab to lab.
Lipoprotein (a), or Lp(a), is a type of LDL cholesterol. Your Lp(a) level is determined by your genes and isn't generally affected by lifestyle.
High levels of Lp(a) may be a sign of increased risk of heart disease, though it's not clear how much risk.
Lp(a) is often tested if you have a family history of early-onset heart disease or sudden death in the absence of traditional risk factors. It should also be tested if your LDL cholesterol doesn't respond well to drug treatment.
Brain natriuretic peptide, also called B-type natriuretic peptide (BNP), is a protein that your heart and blood vessels produce. BNP helps your body eliminate fluids, relaxes blood vessels and funnels sodium into your urine.
When your heart is damaged, your body secretes high levels of BNP into your bloodstream to try to ease the strain on your heart. BNP levels may also rise if you have new or increasing chest pain (unstable angina) or after a heart attack.
Your BNP level can help in the diagnosis and evaluation of heart failure and other heart conditions. Normal levels vary according to age and gender. One of the most important uses of BNP is to try to sort out whether shortness of breath is due to heart failure. For people who have heart failure, establishing a baseline BNP can be helpful and future tests can be used to help gauge how well your treatment works.
A variation of BNP called N-terminal BNP also is useful in diagnosing heart failure and in some laboratories is used instead of BNP. N-terminal BNP may also be useful in evaluating your risk of heart attack and other problems if you already have heart disease.
A high level of BNP alone isn't enough to diagnose a heart problem. Your doctor will also consider your risk factors and other blood test results. This test isn't recommended for people without heart disease symptoms.
Jun. 05, 2014
- Kaptoge S, et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. New England Journal of Medicine. 2012;367:1310.
- Wilson PWF. Overview of the risk equivalents and established risk factors for cardiovascular disease. http://www.uptodate.com/home. Accessed Oct. 27, 2013.
- Wilson PWF. Overview of the possible risk factors for cardiovascular disease. http://www.uptodate.com/home. Accessed Oct. 27, 2013.
- Morrow DA. C-reactive protein in cardiovascular disease. http://www.uptodate.com/home. Accessed Oct. 27, 2013.
- Budoff BMJ, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122:e584.
- Berube C. Disorders of fibrinogen. http://www.uptodate.com/home. Accessed Oct. 27, 2013.
- Fibronogen. Lab Tests Online. http://labtestsonline.org/understanding/analytes/fibrinogen/tab/test. Accessed Oct. 28, 2013.
- Van Holten TC, et al. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses. PLoS One. 2013;8:e62080.
- Rosenson RS, et al. Overview of homocysteine. http://www.uptodate.com/home. Accessed Oct. 27, 2013.
- What is cholesterol? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hbc/. Accessed Oct. 25, 2013.
- Miller M, et al. Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2011;123:2292.
- Davidson MH, et al. Clinical utility of inflammatory markers and advanced lipoprotein testing: Advice from an expert panel of lipid specialists. Journal of Clinical Lipidology. 2011;5:338.
- Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.:The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=40. Accessed Oct. 27, 2013.
- Chen HH, et al. Natriuretic peptide measurement in non-heart failure settings. http://www.uptodate.com/home. Accessed Oct. 27, 2013.