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🔬 PDF Prevention Guide · $37

Cardiac Risk Screening: What Tests You Need and When

A clinically rigorous three-layer framework — foundation tests for everyone, intermediate risk refiners for uncertain cases, and advanced imaging for high-risk patients — with honest guidance on what overscreening looks like and tests to be skeptical of.

✓ 5 pages✓ 3-layer framework✓ Age-based schedule✓ CAC score guide✓ PDF download
$37
One-time purchase · Instant PDF download
  • Layer 1: Foundation screening for every adult (6 tests)
  • Layer 2: Intermediate risk refiners — CAC, Lp(a), hsCRP, ABI
  • Layer 3: Advanced imaging — stress echo, CCTA, cardiac MRI
  • Age-by-decade screening schedule (20s through 60s+)
  • Coronary calcium score interpretation guide
  • Overscreening — the tests to approach with caution
Get Cardiac Screening Guide — $37
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50% of people with high cholesterol don't know it. 90% of first cardiac events occur in people with at least one modifiable risk factor.

Most cardiovascular events are not surprises — they occur in people whose risk factors were present and detectable years earlier. The question is whether those risk factors were found, measured, and acted upon. This guide gives patients the framework to know what should be on their preventive care checklist at every decade of life.

It also covers what not to do — over-testing in low-risk patients causes more harm than it prevents, and this guide is honest about where the evidence ends and the hype begins.

What’s inside

90%
Had Risk Factors
Of first cardiovascular events occur in people with at least one identifiable modifiable risk factor
50%
Don't Know
Of people with high cholesterol are unaware of it — foundation screening closes this gap
0
Symptoms Early
Hypertension and early atherosclerosis are asymptomatic — screening is the only way to find them

“The goal of screening is to find the right level of risk for each patient — not to find disease. Over-testing in low-risk patients produces anxiety, unnecessary procedures, and incidental findings that cause more harm than good. The art is knowing which test, in which patient, will actually change what we do next.”

CN
Dr. Christabel Nyange, MD, MPH, FACC
Founder, ElinMed · Board-Certified Cardiologist

Common Questions

Should I get a coronary calcium score? My primary care doctor never mentioned it.
A coronary calcium score is most useful in intermediate-risk patients (10-year ASCVD risk of 7.5-20%) where the decision to start statin therapy is uncertain. A CAC score of 0 supports deferring statin and reassessing in 5 years. A CAC above 100 or in the 75th percentile for your age and sex supports initiating statin therapy. It is less useful in low-risk or already high-risk patients where the decision is clearer without imaging. This guide covers the full decision framework.
What is Lp(a) and should I have it tested?
Lipoprotein(a) is a genetically determined atherogenic particle not captured in a standard lipid panel. High Lp(a) (>50 mg/dL or >125 nmol/L) independently increases cardiovascular risk and is not lowered by statins. Testing is particularly useful in patients with premature CAD, strong family history of early heart disease, or LDL that remains elevated despite maximum therapy. Currently, management involves more aggressive LDL lowering to compensate — and novel RNA-targeted therapies in clinical trials specifically target Lp(a).
My stress test was normal. Does that mean my arteries are clear?
A normal stress test means there is no significant ischemia during the test — but it does not rule out non-obstructive coronary artery disease. Plaque causing less than 70% stenosis typically does not produce a positive stress test but can still rupture and cause MI. For comprehensive anatomical assessment, coronary CT angiography (CCTA) or coronary calcium scoring provides different information than a functional stress test. This guide explains what each test does and does not show.

Know exactly which cardiac tests you need — and which you don't.

The complete evidence-based screening framework, organized by risk level and age.

Get Cardiac Screening Guide — $37