​                     Professor Francisco Leyva-León

In practice, assessment of the risk of developing coronary heart disease is challenging. At a very basic level, this consists on establishing whether you have heart disease, diabetes, hypertension or a high cholesterol level. At an advanced level, additional tests such as a CT scan of the coronary arteries (cardiac CT) can provide information as to whether the you have the beginnings of heart disease, or whether you have the disease and have not yet developed the condition, such as angina and a heart attack. Unfortunately, the quality of the screening for heart disease depends on the costs of the various tests. On the NHS, blood tests are offered to selected patients, but not to the general population. Cardiac CTs are not available on the NHS for the purposes of screening. As with any test, the result is useless in isolation. It is important that this is judged by a doctor with experience in cardiology. 

 

Screening for heart disease involves ascertaining whether you have it already without knowing it (no symptoms) or whether you are at risk of developing it. ​

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The ultimate assessment of risk of coronary heart disease involves the following:

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• History and examination undertaken by experienced doctor. 

• Blood tests: electrolytes, renal function, lipids (to include cholesterol and its subtypes, triglycerides, lipoproprotein (a) and apolipoproteins) and NT pro-BNP. Useful complementary tests include a full blood count and thyroid function tests.

• ECG: interpreted by a cardiologist. Note that compiuter algorithms in ECG machines often get it wrong.

• Cardiac CT: This will reveal blockages in the coronary arteries, or whether you have the 'beggining' of heart disease.

• Echocardiogram: This will reveal valve disease or problems with contraction of the heart muscle.

• Cardiac MRI: This is required in patients who are suspected of a cardiomyopathy (heart muscle disease) or a previous heart attack. It provides excellent quality images of the heart which may add additional, valuable information on cardiovascular risk.

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Remember that a test in isolation, undertaken without the input of an experienced clinician, may be misleading. A test with institutions that do not offer the input of an experienced cardiologist is not ideal.​​​