Start with the basics: blood pressure, a cholesterol panel, blood sugar and your family history. They do most of the work. ApoB and a one-time Lp(a) test add useful detail for some people, and a heart scan helps most when your risk sits in the middle and a decision could go either way.
The tests, in plain English
Think of your arteries like the pipes in a house. Blood tests show how much is flowing through that could clog them. A heart scan looks inside the pipes for buildup that's already there.
Blood pressure
The biggest single number for heart risk. It measures how hard your blood pushes on your artery walls, and high pressure wears them down over time. Quick, cheap, and worth repeating at home to confirm a high reading.
For: Every adultCholesterol panel
It shows how much cholesterol and fat are in your blood, which is what slowly builds up as plaque. LDL, HDL and triglycerides are the starting point for almost every heart conversation.
For: Every adultApoB
Counts the particles that actually get stuck in artery walls. Think of it as counting the delivery trucks, not just weighing what they carry. It can flag risk when a regular panel looks fine.
For: Anyone wanting a closer look, or with borderline numbersLp(a)
An inherited marker that raises heart risk on its own, even when your other numbers look healthy. Your level barely changes, so most people only need it tested once.
For: Anyone with heart disease early in the familyCalcium score
A quick CT scan that shows hardened plaque already sitting in the heart's arteries. You get a number: zero means none was found, and higher means more buildup.
For: People whose risk is borderline and a decision is closeCoronary CT angiogram
A more detailed scan that shows soft and hard plaque, plus any narrowing. A dye goes in through an IV so the scan can show how open each artery is.
For: Usually when a doctor thinks more detail would change the plan
