Doctors now have the diagnostic tools to detect cardiovascular disease in its earliest stages, years if not decades before a heart attack or stroke occurs. Unfortunately, too few people are taking advantage of these tools. For this reason, I encourage you to read this part of the program and discuss what you learn with your doctor. It describes the most up-to-date tests for predicting whether you're a candidate for a heart attack or stroke, as well as the appropriate follow-up tests.

Although sophisticated tests are becoming more and more widely used, there are still some places in the United States where they may not be available. If so, I recommend contacting the nearest major medical center affiliated with a university to seek a referral to a prevention-oriented physician or a prevention clinic. Because the quality of testing, particularly of the imaging tests, can vary widely from facility to facility, it's important to seek out the best center near you. A well-respected department of radiology will usually have a specialist in the area of cardiac CT. An experienced radiologist or cardiologist is essential for an accurate scan and its proper interpretation.

Why These Tests Are Needed

It's critical to remember that a healthy percentage of all heart attacks occur in people who have none or one of the obvious risk factors for heart disease. These men and women don't smoke, they don't have a bad family history, and even their total cholesterol and LDL and HDL cholesterol levels may be fine by conventional laboratory standards. Some cardiac risk factors can only be detected through the more sophisticated diagnostic tests.

For example, getting advanced blood testing is the only way to find out the size and density of your LDL particles, whether your HDL is the right size, or if you have high levels of lipoprotein (a). Many individuals whose numbers look normal on a Standard Lipid Profile may nevertheless be building up plaque and harboring these potentially dangerous cholesterol particles. Without advanced blood testing, these people would never know they are at risk for a heart attack.

I realize that this involves getting diagnostic tests that may not be covered by your health insurance plan. But to really assess your level of risk for heart disease, you must go beyond conventional testing, even if it means investing some of your own money. While a noninvasive angiogram (heart scan) that includes dye injection, performed with the state-of-the-art 64-slice scanner, can cost about $1,000, you can get your Calcium Score alone for about $400. Advanced blood tests are more likely to be covered but can cost an additional several hundred dollars. I realize that some of you who are already paying hefty insurance premiums may be dismayed by the prospect of having to pay more. However, I believe that getting these tests is one of the best investments you will ever make.