Protect Yourself With These Heart Health Tests

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

If I’ve said it once, I’ve said it a million times: Inflammation—not cholesterol—is the true cause of heart disease!

Thanks to advancing science and books like The Great Cholesterol Myth, medicine’s vice grip on cholesterol is finally starting to loosen. But far too many doctors still remain fixated on blood lipids, and overlook much more accurate indicators of cardiovascular risk. The result? Heart attacks and strokes that seemingly come out of the blue.

To assess your true risk for heart disease, make sure your doctor is going beyond what’s “standard” and looking at the following markers. If you have a family history of early heart attack or other cardiovascular events, start getting tested at age 30. If not, it’s okay to wait until age 50 or the onset of symptoms, whichever comes first.

VAP Test Is Back for Testing Your Cholesterol Particle Size!

Essential Heart Tests: Bloodwork

  • A normal range for total levels of blood cholesterol, LDL and HDL, is 180–240 mg/dL. However, a standard total cholesterol blood test is basically meaningless for identifying risk and best treatment options. You need to ask your doctor to order one of the new generation of advanced blood lipid tests. These tests neatly fractionate cholesterol elements into percentages based on particle size (i.e. are they dense and potentially dangerous, or large and less harmless?) so your doctor can more accurately determine whether there is reason for concern or not. These tests also cover another risk factor: triglycerides (a type of blood fat). Ideally, you want a triglyceride level between 50 and 100 mg/dL.
  • Lipoprotein(a), or Lp(a), is an inflammatory, dangerous cholesterol particle when elevated, and a heart disease risk factor. Hydrogenated oils and trans fats (and potentially sugar) raise Lp(a). If you have a family history of early heart attacks or elevated Lp(a), you need to monitor this factor periodically. If you have a known Lp(a) elevation, you must avoid trans fats at all costs because trans fats will raise it and Lp(a) is the most dangerous risk factor. Normal ranges vary in different laboratories; I recommend it be less than 30 mg/dL.
  • Glycohemoglobin (HbA1c) – this test measures the amount of blood sugar (glucose) attached to hemoglobin, the red blood cell pigment that carries oxygen. As an effective indicator of the average glucose level over several months, this test is a primary tool in monitoring and managing diabetes. A normal level is below 5.7 percent; pre-diabetes below 6.4; and diabetes 6.5 and above. Routine blood glucose tests are useful for measuring glucose control on a day-to-day basis.
  • C-reactive protein is a potent indicator, not just of inflammation, but also of high blood sugar, antioxidant deficiency, thick blood, and overweight status, all important issues that contribute to arterial disease. An optimal blood level is under 0.8 mg/dL.
  • Homocysteine is an amino acid that is produced in your body by the normal breakdown of protein. However, if you’re deficient in the B vitamins folic acid, B-6, and B-12, which are needed for this breakdown, you can have a high homocysteine level. High homocysteine is dangerous because it can trigger arterial plaque and blood clot formation. Optimal level: between 7 and 10 µmol/L.
  • Fibrinogen, a coagulation-regulating protein, is intimately involved in blood clotting and blood thickness (viscosity). Having too much fibrinogen can speed up the clotting process and make you more vulnerable to a cardiovascular event. Smoking raises fibrinogen dramatically; genetics, oral contraceptives, insulin resistance, and postmenopausal status are also factors that can elevate your fibrinogen level. Optimal level: 180 to 350 mg/dl.
  • Ferritin is a protein that acts as an iron carrier in the blood. Diagnostically, it serves as an indicator of iron stored in the body. Your body needs some ferritin to make hemoglobin, the red blood cell pigment that carries oxygen. And while too little could be an indicator of anemia, too much ferritin can promote inflammation, oxidation of cholesterol, and plaque. Optimal level: under 80 mg/L (women) and 90 mg/L (men).

Heart Rate Variability

I like to tell people that heart rate variability, or HRV, is the best heart health test they’ve never heard of. In a nutshell, it measures the intervals between your heartbeats. Individuals with low HRV are more prone to develop cardiovascular disease and metabolic syndrome, and tend to have higher risk for cardiac events—which make it an essential test for assessing your true heart health.

Heart Rate Variability

Imaging and Other Heart Tests

  • The electrocardiogram (EKG) is a routine heart test, usually performed at the first visit to a cardiologist. The EKG shows the electrical activity of the heart and provides vital information about cardiac rhythm and rate, coronary blood flow, and pump action.
  • The echocardiogram is an ultrasound exam that doctors employ to check for blood flow patterns and abnormalities in the heart muscle, and the performance of the cardiac valves.
  • For individuals who are symptomatic, a cardiologist will order a routine or a nuclear stress test. This procedure combines the treadmill with images recorded by a computerized camera to pinpoint arterial blood flow restriction to parts of the heart.

Of course, knowing your blood pressure numbers is also of crucial importance, as high blood pressure is a serious cardiac risk factor.

The heart tests I have listed here can make a big difference in whether you need treatment or not, and what kind. You can find more information about tests for strokes and where I like the numbers to be at

© Stephen Sinatra, M.D. All rights reserved.

Leave a Reply


  1. Lisa M.

    on February 15, 2017 at 6:18 pm

    Can triglycerides be too low? I read in another of your articles that triglycerides should be between 50 and 100. Mine has hovered around 45 for years (used to be as low as the mid-30s). My HDL is 83 so my triglycerides to HDL ratio is 0.54. I am a 56 year old woman. Thanks Dr. Sinatra for all your fantastic articles; I read most of them!

  2. Beth W.

    on November 27, 2018 at 4:30 pm

    I’ve suffered 3 Takotsubo syndrome ‘ heart attacks’ ( broken heart syndrome) in the past 4 years. Now my heart tests show severe damage to parts of the midsection and twisting motion of my poor heart.
    I believe my heart was probably already damaged before this – from many years of being Hypothyroid – which was ignored due to the pedantic interpretation of the TSH blood test, despite numerous signs and symptoms suggesting a problem.
    I’ve also had low iron stores pretty consistently – also ignored, and not interpreted as a problem by Allopathic GP’s.
    Are there any relationships between thyroid function and heart disease that you have identified and taken a special interest in during your long and varied career in Heart Medicine, Dr Sinatra?

  3. HeartMD Editor

    on December 10, 2018 at 2:54 pm

    Hi Beth,
    It is true that thyroid relationships can affect the heart, especially if they are undiagnosed for a considerable period of time. The good news about being hypothyroid is that it can be corrected. And as long as you’re taking thyroid and you’re lipid biochemistry is appropriate, it is unlikely there would be a relationship with heart disease. Dr. Sinatra has had patients with low thyroid function for years who never developed heart disease while taking thyroid medication. However, the Broken Heart Syndrome is a valid concern. In some of his patients with this disorder he used the Awesome Foursome.

  4. Glenn Ladue

    on August 23, 2019 at 4:00 pm

    Hi Dr. Sinatra,
    My wife has some wild numbers so the Doctors are really pushing her to get on statins. I first saw you on Dr. Becker’s “To Your Health” show, and learned about the necessity of treating the whole person, not just Cholesterol numbers. I watched a 2013 video of you today where you showed the Lipid tests to ask for and you said that prescribing statins based on old science Cholesterol (Total, HDL, LDL) was bad medicine. Our HMO Doctors refuse to discuss other factors and keep repeating they use the Guideline. They refuted looking at TG/HDL, Lp(a), OxLDL, Fibrinogen, & Homocysteine. They do let us get the us-CRP and Vitamin D tests, but do not include those results in risk assessment. Of course the TG comes with the Lipids panel, but they ignore that number if asked about the relationship. About 8 doctors so are sticking to the party line, so I assume they are sworn not to deviate. The current tests of my wife (turning 60) have TG=105, HDL=79!! Ratio 1.33 seems quite impressive, but LDL calculated was 222, and Total 322, not so good it would appear. Her Ultra-Sens CRP was 2.7 mg/L, and Vitamin D=91. We pushed for more tests and got her the echocardiogram. She said the Cardiologist was so happy and told her her heart is so beautiful, and he doesn’t get to see hearts like hers in his work. The doctors don’t care about that and insist she needs statins. So I pressured to find out if she has plaque or not–they agreed to give her the Calcium Score scan which is scheduled in 2 weeks. I am concerned if that score comes in low, and low risk, we still don’t know if she has actual plaque issues. I notice this test is not on your list here. Also her doctor said she has to get on the statins no matter what the Calcium Score says. Since you say don’t get hung up on the LDL and Total numbers, should we ignore those? Her A1C is 6.1, which suggests there could be high Lp(a) or OxLDL. Putting that side by side with 2.7 US-CRP, and the fact she has been on HC-Losartan for some years, it seems something is needed, but will statins fix this? Any thoughts you have will be greatly appreciated. Thanks Dr. Sinatra for being true blue.

  5. Amarjit and Jasjit

    on September 10, 2019 at 6:55 am

    Dr. Sinatra,
    You are God sent awesome humanitarian. My mother has Leaky Heart Valves. I read your articles most ofthe time. DOCTORS, so to speak do not have the knowledge of naturopathy/ alternative medicine along with conventional medicine expertise. You are a genius combination of both. Please let me know how can I bring my mother to see you at your practice clinic. Hope to hear from you soon. It is urgent! GOD BLESS!

  6. C.L.A.

    on December 7, 2020 at 10:42 am

    Hi Glenn,
    Look for another Dr.
    If I were in your position, I would ask y he is not performing the tests you want
    Also, ask him if he is receiving a perk from the pharmaceutical co. That makes statin.
    Good Luck!
    Keep looking!!

  7. Lida Krieger

    on December 8, 2020 at 12:39 pm

    Why can’t this be printed so that we can have it on hand to refer to as needed?

  8. Deb

    on December 8, 2020 at 11:34 pm

    I’m sure you extended or even saved the life of my ex husband. I asked his CARDIOLOGIST to run the tests you suggested and he refused. I had him go to his regular doctor and he ran the tests. Following your test guidelines his ferritin was 5 times above the limit and his regular doctor sluffed it off. I’m able to order tests myself in Michigan so I order the full iron panel that you suggested if ferritin came back high. I brought those tests to his doctor saying he needed a hemochromatosis test, he again refused. Found a new doctor I didn’t feel it was necessary for him to pay out of pocket for a hemochromatosis test when he actually had insurance. He ordered the test which came back with both genetic markers and have been doing phlebotomies. This doctor would not take him down below 300 so I found another doctor that keeps him in the 75 range. I told my doctor about it and she now started testing ferritin in her patients recently and as come across four. This is a test everyone should get especially when 1 in 200 has this. I actually carry one genetic marker myself. Thank you thank you thank you for all your information. I also found out I have Lipo-a because of you which is unfortunately high and a HDL of 98 which I know can be disfunctional

  9. HeartMD Editor

    on December 9, 2020 at 8:47 am

    Hi Linda, We recommend copying and pasting the article copy into a Word document, then formatting the font to your liking and printing from there. If you don’t have Word on your computer, you can use Google Docs to create a Word document online.

  10. DIANA

    on July 9, 2021 at 2:01 pm

    Hi, Thank you for your time, it’s truly a blessing!
    I have a question about the test called Lexiscan that my doctor wants me to do because my ECG came back as left branch bundle blockage. He also has ordered a CT calcium score and a Echocardiogram.
    My concern is with the Lexiscan because of the FDA warning I found online about it causing a heart attack, and other bad side effects from reviews online that last for a long time after the test like uncontrollable itching.
    I hope to here from you before 7/27/21
    Thank you so much!!

  11. DIANA

    on July 13, 2021 at 4:52 pm

    Hi, I’m writing again because of a strange thing that happened while I was taking a CT Cardio Calcium Score test.
    I was feeling a little anxious about the test but not enough to cause what happened. So as the scan was going the tech stopped it and came in to check my pulse because the monitor reached 254 pulse then went to 150 within seconds and then when he started the test again my pulse shot up again. He then had me put my arms to my side but the same thing happened my pulse shot up so high he was afraid I was going to have a stroke. The tech said it was hard to get the pictures because my heart was beating so fast. I’m not sure what to think about it, I know the way I was feeling was something I deal with occasionally when I get frightened.
    I was hoping you could help me understand what caused this to happen. The tech said he thought either Tachycardia or AFib.
    Any insight would be appreciated very much! I’m thinking about cancelling the Lexiscan because I’m frightened to take it…
    Thank you for your time!

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