The lipid profile (a measure of the level of various fats in the blood) is crucial for everyone. Keeping LDL cholesterol in check lowers heart-disease risk in both sexes, but maintaining a healthy triglyceride and HDL level is especially important for women. Likewise, diabetes is a bigger risk factor for women than for men, and it can set in without ever causing symptoms. So every woman should ask her doctor about whether to have her blood sugar tested. In addition to a routine glucose reading, some women benefit from a test called hemoglobin A1c, which estimates average blood-sugar levels over a period of a month.
Inflammation is another strong predictor of cardiovascular trouble. Many with high blood levels of an inflammatory marker called C-reactive protein (or CRP) face a greater risk for heart attack and stroke–and women with high CRP levels do not always have high cholesterol. Though CRP testing is not included in most annual physicals, many doctors believe that it should be used in women who have risk factors for atherosclerosis.
A treadmill (“stress”) test can gauge a woman’s exercise capacity and recovery time, and an electrocardiogram taken during the stress test can reveal impaired blood flow to the heart muscle. But breast tissue can distort the EKG signal, making the test less reliable in women than in men. Other imaging techniques such as echocardiography (which employs ultrasound) and nuclear imaging (which looks at blood flow through the heart muscle) may yield more accurate results. Preliminary findings suggest that for women with symptoms of cardiovascular disease, MRI scanning may someday offer an even clearer assessment of risk.
Diagnostic tests can also unmask heart attacks as they’re happening–a critical matter because women’s symptoms are subtler than men’s and often go unrecognized. Studies show that men having heart attacks are more likely to have elevated levels of creatine kinase-MB and troponins (proteins released when the heart muscle is damaged), while women are more likely to show increases in CRP and brain natriuretic peptide (a hormone produced when the heart is under stress). So keep counting that cholesterol, but talk to your doctor about other tests worth taking. When it comes to heart disease, information can save lives.
