Key Tests to Know
Coronary Artery Calcium (CAC) Scan: A non-invasive CT scan that detects hardened plaque (calcified plaque) in the arteries of your heart. A CAC score of 0 generally means no visible calcified plaque and low short-term risk (~5-10 years) of a heart attack or stroke (with a few important exceptions). A score above 0 suggests plaque is present and risk may be higher (particularly when >100).
- Why it matters: CAC scoring is one of the most reliable tools for assessing short- to intermediate-term cardiovascular risk. It provides a direct look at whether atherosclerosis is present.
- Access: Often available without a referral. Out-of-pocket cost typically ranges from $50–$150.
- Other notes: Low radiation, no pre-medications required, quick procedure (~5 minutes), more predictive of heart disease risk in older adults because plaque becomes calcified with age; in younger people plaque is often still soft, so a CAC score of zero may miss early disease.
CT Angiogram (CTA): A more detailed imaging test that shows both calcified and soft (non-calcified) plaque — including early-stage plaque that may not be visible on a CAC scan.
- Why it matters: CTA offers a deeper look at artery health and can detect soft plaque, which may be more likely to rupture.
- Access: Requires a referral and may need insurance approval. Out-of-pocket costs without insurance may be >$1000.
- Other notes: Higher radiation, longer procedure time (up to ~1-2 hours), and requires contrast dye and may require pre-medications (beta-blockers to slow the heart or nitroglycerin to open up the blood vessels).
Fasting Insulin: A simple blood test that measures how much insulin your body produces in a fasting state.
- Why it matters: High insulin levels can be an early sign of insulin resistance — a major risk factor for heart disease, diabetes, and fatty liver — even when glucose, cholesterol, or triglyceride levels appear normal. Low fasting insulin (with few exceptions) generally reflects efficient metabolism.
How to Ask for These Tests
Approaching your provider about additional testing can feel intimidating, but framing your questions with curiosity and collaboration can make all the difference. Rather than making demands, aim to open a conversation. Here are some tips:
- Lead with curiosity: Share that you’ve been learning more about certain tests and are wondering whether they could be helpful in your case.
- Use collaborative language: Phrases like “Would it make sense…” or “Could it be worth exploring…” invite shared decision-making.
- Express your goals: Emphasize that you’re trying to be proactive about your health and want to better understand your personal risk.
- Stay open-minded: Let your provider know you’re looking for guidance and are open to their clinical judgment.
- Keep the conversation respectful and centered on partnership — most providers will appreciate your interest in better understanding your health.
Insurance Tips
- CAC scans are often not covered by insurance but are relatively low-cost out of pocket.
- CTA is more involved and may require documentation of symptoms or risk factors to get coverage.
- Fasting insulin is usually inexpensive and available through most commercial labs.
Why LDL-C May Not Be Enough on Its Own
LDL-C is one piece of the cardiovascular risk puzzle, but it may not tell the full story. Context matters.
What else matters
- Whether you already have plaque buildup (CAC or CTA can detect this)
- Markers of metabolic health e.g., fasting insulin, triglyceride-to-HDL ratio
Questions to Ask Your Doctor
- Are my triglycerides and HDL in a good range?
- Could we measure fasting insulin to assess my metabolic health?
- Could we consider getting a CAC scan to better understand my risk of heart disease?
- What are the next steps if my CAC score is 0? What if it’s above 0?
You are your best advocate. Try to be curious, ask questions, and most of all, understand what the numbers actually mean — for you.
Final Takeaway
The more you understand your health — and the context behind your numbers — the better positioned you are to make informed decisions with your care team.