When I was getting my degree in exercise science, one of the things we learned how to do is an exercise stress test with an ECG (electrocardiogram). Though we learned many different abnormalities to look for, the most prominent is what is known as ischemia.
What an ECG shows?
Ischemia is where there is a lack of oxygen that is being supplied to the heart by one of the coronary arteries. On an ECG, it is a “dip” in what is known as QRS complex (electrical waves). When this happens, this most likely means that there is an occluded artery. If you have this show up on your ECG, chances are that you would receive further testing (an angiogram or CT scan) to take a closer look. If nothing shows, chances are, no further tests will be given.
ECG is not Enough!
There is just one problem; ECG’s do not even recognize that there is a problem until 75% of the artery is occluded. Furthermore, cardiac deaths are attributed to blockages in the arteries as little as 50% occluded. This becomes a bigger problem considering that more than 25% of those who have a heart attack results in sudden death. Though I can’t give you the statistics of the number of people who have had an ECG and then had a heart attack and died, we all have heard the story of someone this has happened to.
What cholesterol test shows?
In addition to an exercise stress test, the paradigm is that you should have a cholesterol screening to determine your cardiovascular disease risks. Cholesterol levels definitely shows that there can be a risk. Especially if your LDL’s (the “bad” cholesterol) is over 100mg/dL (deciliter) of blood, you are at higher risk of cardiovascular disease. Conversely, if your HDL (the “good” cholesterol) is over 60 mg/dL, that is considered to be a negative risk factor (meaning your at less risk of heart disease). My experience is, that this is often overlooked.
Cholesterol Screenings is not Enough!
Just like an ECG, it is an applicable test. Unfortunately, it’s treated often times as the only the test you need.
For example, you can show that your cholesterol is good, but you can still have a heart attack. You can also show that your cholesterol is high, but not be at risk at all. This is frustrating, because most in the medical profession are quick to prescribe medication without really knowing if it’s necessary. At the defense of many others in the medical community, this paradigm is beginning to shift. As a matter of fact, many physicians are beginning to direct patients toward diet and exercise (though they are outnumbered). Okay, I’ll break away from this tangent as it is another discussion altogether.
What does all this mean?
For one, this does not mean that you shouldn’t have an ECG exercise stress test or cholesterol screening. Quite the opposite, you should do those tests. However, do not limit yourself to only cholesterol screenings and stress tests, especially if you have a family history of cardiovascular disease, if you have ever smoked, are obese, have Type II diabetes, etc. You own your body and you still have choices.
Here are some other tests you should also consider:
hs-CRP Test- (hs means High Sensitivity, CRP means C-Reactive Protein)
An elevation of this enzyme may mean you have damage that is sustained at the lining of your arteries. This most likely means you have a blockage as well, which increases the chances of a heart attack. If you’re at higher risk of heart disease, this test is highly recommended. All you need to do is to have your blood tested for it. When your doctor takes your cholesterol, ask him or her to check your hs-CRP.
Homocysteine Test
While you’re at it, have your homocysteine levels checked. If your homocysteine levels are elevated, this may mean you have a deficiency in B12 and/or folate. This means that you are at higher risk as well, as these vitamins vasodilate (widen) the arteries (which is what you want). Without enough B12 or folate, your arteries may be vasoconstricting (or narrowing). Just as with hs-CRP, you can have this checked just by giving your blood.
Last but not Least is a CT scan (computerized tomography)
At the heart of the matter (no pun intended), is whether you have a blockage in the artery or not. The only way to really know is to go in there and look. A CT scan can detect atherosclerosis/arteriosclerosis (hardening of the arteries) which can be caused by plaque build up of cholesterol deposits and/or calcium. Though fairly noninvasive, this test can be pricey. Often times, health insurance will not cover this test. However, if you’re at high risk, pay out of pocket. What’s your life worth to you?
“An ounce of Prevention is worth a pound of cure.” ~Benjamin Franklin
A few years ago when I was doing my radio show, I had a guest by the name of Dr. Robert Superko, author of Before the Heart Attacks. We discussed (and he shared a lot of information), that the best way to reverse heart disease is through lifestyle changes, proper nutrition, and exercise. He discussed supplements such as niacin and coenzyme Q10. He also discussed how cholesterol screenings and stress tests don’t tell the entire picture. In addition to some other preventative books out there, I highly recommend reading his book. Stay informed about heart disease!
written by
Kelly Huggins, A-CPT
Exercise Science, BS
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