2 Bengaluru hospital executives die of heart attack: Why your reports may look normal but your risk remains hidden

Other than comparative analysis of routine markers like blood sugar, lipid profile to understand the extent of low-density lipoprotein (LDL) or bad cholesterol and triglycerides, kidney function and blood pressure, there are other tests that can be more indicative.

Calcium score test

This test involves a simple CT scan and does not need an invasive procedure with dyes. It measures the amount of calcified plaque in your arteries, which in turn leads to heart attacks and strokes. A high score puts you in the at-risk category but it doesn’t mean you will get a heart attack the next moment. It indicates a probability so that medical intervention with drugs and lifestyle modification can be started early. And it is relatively cheaper compared to other tests.

For South Asians, any coronary artery calcium (CAC) score higher than 0, or a score over 100 in individuals under 55, is a crucial indicator for aggressive lifestyle modification and medical intervention. South Asians often experience faster plaque progression, so making early detection is critical. Generally, scores are interpreted as zero (low risk), 1–99 (mild), 100–300 (moderate) and more than 300 (high).

This test picks up 90 per cent of calcium deposits which form plaque in blood vessels. It can even pick up which of these are more obstructive. Then the doctor can go for aggressive treatment with cholesterol lowering drugs alongside stricter lifestyle protocols.

What tests to do for tracking your LDL?

For Indians, LDL must be ideally below 70 mg/dL though the normal range is often considered as 100 mg/dL. Also, the kind of LDL matters. Somebody with an LDL of 117 mg/dL may not develop a blockage but somebody with an LDL of 100 mg/dL may have a clot sitting in the arteries. Some of the LDL is small, dense and sticky.

Lipoprotein (a) [Lp(a)] and Apolipoprotein B (ApoB) tests assess cardiovascular risk by measuring specific protein components of cholesterol, often revealing risks undetected by standard lipid panels. Lp(a) is a genetic, high-risk factor for plaque buildup, while ApoB indicates the total number of harmful, plaque-producing particles.

If you are specifically monitoring high triglycerides previously diagnosed by a doctor, or if you need to check on the impact of recent diet, lifestyle and medication on fat levels, then go for a triglycerides (a type of fat) serum test. This is a standalone blood test used to measure the specific level of triglycerides in your blood. While often part of a routine lipid profile, it can be ordered alone to assess heart disease risk, typically requiring 9-12 hours of fasting for accuracy.

We also insist on an exercise stress test to assess how the heart functions under physical exertion to uncover blockages.

The importance of follow-ups

I would advise tracking BP, cholesterol and blood sugar every year from your 20s. If there is an aberration and a discernible tendency of these counts rising, then the tests can be done every six months. Given that hypertension is a potent indicator of the stress on the heart, I would recommend a BP monitoring every one to three months. This involves maintaining a chart of morning and evening readings for a week. Done at regular intervals of a few months, you get a sense of how your BP curve is behaving and where it could do. Weight-monitoring is an easy tracker too.

(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)