The tests you need
This article appeared in Which heart tests you need depends on whether you have symptoms that could indicate heart disease, such as angina (chest pain) and shortness of breath.
People without symptoms should focus on tests for high blood pressure, cholesterol, and blood sugar levels, since the best way to prevent heart attacks and strokes is to control those risk factors. And you don't need high-tech tests to check for them. "The question is not whether you can test for disease, but whether you should," Ridker says. "If a test can't define the necessary therapy and doesn't help with follow-up, then it should not be ordered."
In our survey, 12 percent of healthy respondents said they underwent stress testing, which measures the heart's function while it is stressed by exercise. That's usually a bad idea because in low-risk people the test produces a lot of falsely positive results. The exceptions: older airline pilots, bus drivers, and others whose job affects public safety, or people who are middle-aged or older with multiple heart risk factors who are starting to exercise.
People with symptoms usually need an exercise stress test, possibly with an echocardiogram (which uses sound waves), or a nuclear test (which uses radioactive material) to produce an image of the heart.
CT angiography might be appropriate for people with inconclusive stress-test results to see whether a somewhat more invasive test, standard angiography, is necessary. But the results are often so uncertain that they have to be followed up with standard angiography anyway.
In standard angiography, a doctor threads a tube from the groin into the coronary arteries and injects a dye so that blockages show up on X-ray. Skipping the stress test and going straight to angiography is warranted only for people at very high risk of having a heart attack or who have symptoms or underlying conditions that could make stress testing risky, such as chest pain that occurs even at rest.
