I used to tell my patients that the #1 killer in America was heart disease (specifically, coronary artery disease).  This was the case until the past year, when heart disease was overtaken by cancer as the #1 killer.  I say "overtaken" but that is somewhat misleading.  The fact is that both are going down as causes of death, it is just that heart disease is going down at a faster rate than cancer.  Still, if you don't use cancer as a group but single each type out individually, they are far out-distanced by heart disease.

So how do you know if you are at risk for Coronary disease?  First you need to know your risk factors.  There are 5 clear independent risk factors for heart disease:

1. Diabetes - especially Type 2 (Adult onset) diabetes
2. High blood pressure
3. Family history of heart disease (Father under age 55, mother under age 65 or siblings with heart disease are considered strong risk factors)
4. Smoking - the more the merrier - smoking a single cigarette per day is not the same as 2 packs per day, but both are a bad idea.
5. High Cholesterol.

With these risk factors, we can calculate a 10-year risk of having a heart attack using the Framingham Risk Assessment.  Using my EMR, I do this for all of my patients with high blood pressure, diabetes, or high cholesterol.  If you have any of these risk factors, or are over age 60, you should have your risk calculated.

So how do we know if you have coronary heart disease (and are at risk for a heart attack)?  There are several tests we can do to see if there are problems with the heart:

1. An EKG - This test looks at the electrical pattern of the heart at rest.  Hearts that are damaged by heart attacks, have electrical problems, or have other specific problems will show up with different patterns from normal hearts.  Cardiologists and most general practice physicians are trained to recognize these abnormalities.  The problem is that an EKG looks for either past or present problems, but does not really look to the future.  It is kind of like looking at your bank statement to see if you overdrew your account last month.  It may not be a bad idea, but you want to know sooner than that.
2. A stress test - there are several types of stress tests, but they all have the same premise:  stress the heart by getting it to beat faster, and see if there are changes that suggest narrowing of the blood vessels to the heart.  This generally looks for narrowing of the coronary blood vessels (that supply blood to the heart) of more than 80%.  A positive stress test may indicate significant heart problems.  The problem is that significant heart disease may exist even with a normal stress test.
3. Cardiac CT scan - this is a fairly new test that looks for calcium buildup in the blood vessels to the heart.  This finding is strongly correlated with atherosclerosis (or plaques form cholesterol).  A negative calcium score is a very good sign that a person is low-risk of having heart problems.  A high calcium score indicates other testing may need to be done.

The most important thing a person can do is to know his/her risk.  I tell patients that people living in California don't have to worry about hurricanes, while people in Florida don't need to worry about earthquakes.  You need to know what you are at risk for and prepare for it.  If you are at high risk for heart disease, then getting a Cardiac CT scan may be the best test to do to give you an idea of your risk.  This test is getting more common, although it is often not covered by insurance, since it is a new test.