What Can Blood Tests Say About Your Heart Health?

During routine medical visits, your physician may recommend you get standard blood tests to check your overall health. Based on your age, family history, and risk factors, you may also need additional blood tests to determine your risk of developing cardiovascular disease (including heart disease and strokes).

In people experiencing heart symptoms, different, more specialized tests can determine if there is an immediate heart problem or if there has been heart damage. Below, we’ll identify which blood tests can give insights into your heart health and when they are useful. 

Blood tests that can determine your risk of heart disease

Your individual risk of heart disease is determined by several factors, such as your age, family history, and other medical conditions. When you see a healthcare provider, they may order certain blood tests to help determine your cardiac risk, including:

• Lipid profile, including blood cholesterol levels and triglycerides

• High-sensitivity C-reactive protein (hs-CRP)

• Lipoprotein (a)

• Apolipoprotein B

Along with a detailed medical history and physical exam, these blood tests can help paint a picture of your overall heart health and risk for cardiovascular disease. We will discuss these tests in more detail here, along with the “ideal level” for each of these tests. Ideal levels are usually set based on large research studies. 

Since lab values can differ slightly from lab to lab, and because every “body” is different, it is important that you discuss your results with your healthcare provider so you can know what your blood test results mean for you and your health. 

Lipid profile (cholesterol test)

A lipid panel measures the amount of cholesterol and fats in the blood. Cholesterol is a waxy, fatlike substance that our bodies need to build essential cells and hormones. The lipid panel gives information about several different kinds of fats in the blood and, in some circumstances, can be checked at home:

• Total cholesterol: This is a measure of all of the parts of blood cholesterol, including your LDL cholesterol, HDL cholesterol, and other lipid components. The higher your total cholesterol, the higher your risk of cardiovascular disease. 

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Ideal level: below 200 mgs per deciliter (mg/dL)

• LDL cholesterol (low-density lipoprotein): This is known as “bad” cholesterol. If you have too much LDL, it can get deposited in the walls of your arteries, leading to blockages and increasing your risk for heart attack and stroke. 

Ideal level: below 100 mg/dL in most people. If you have diabetes or have previously had a heart attack or a stroke, the goal is usually less than 70 mg/dL.

• HDL cholesterol (high-density lipoprotein): This is known as “good” cholesterol. HDL can help remove excess “bad” cholesterol from the blood. High levels of HDL may actually protect you against heart attack and stroke. 

Ideal level: greater than 40 mg/dL if you are male, and greater than 50 mg/dL if you are female

• Non-HDL cholesterol (non-high density lipoprotein cholesterol): This is calculated by subtracting your HDL cholesterol from your total cholesterol. It is the total of all the “bad” cholesterol. It too is associated with an increased risk of heart disease. 

Ideal level: below 130 mg/dL

• Triglycerides: This is another type of fat in the blood that is used for energy in the body. High triglycerides can also be a risk factor for heart attack and stroke. 

Ideal level: below 150 mg/dL

Once your lipid panel has been obtained, your physician may use a tool called the ASCVD Risk Estimator Plus. In people who have not been diagnosed with cardiovascular disease, this tool uses risk factors, like age, smoking, and diabetes along with your cholesterol levels, to calculate your risk of having a cardiovascular event such as a heart attack or stroke. This tool is often used to help determine if someone needs to be started on cholesterol-lowering medications.

High sensitivity C-reactive protein

C-reactive protein (CRP) is a protein made in the liver and is produced in higher levels when the body is under stress because of injury, infection, or another inflammatory process. Higher rates of inflammation can lead to a higher risk of atherosclerosis, which is the formation of fatty plaque in blood vessels and which can cause a heart attack or a stroke. 

A high sensitivity CRP test (hs-CRP) can be helpful in identifying people who have not yet been diagnosed with cardiovascular disease but who have a high risk of developing it in the future.

Ideal level: below 2.0 mg/dL. Since CRP can go up in response to infection or stress, the test is usually repeated within 2 weeks to improve accuracy.

Lipoprotein (a)

Lipoprotein (a), abbreviated Lp(a), is LDL cholesterol attached to a protein called apoprotein (a). Levels of Lp(a) depend on your genetics and family history. High levels of Lp(a) increase the risk of buildup of cholesterol in the arteries and, with it, the risk of heart attack and stroke. If you have a family history of cardiovascular disease, this test can give useful information about your personal risk of heart disease .

Ideal level: below 30 mg/dL

Apolipoprotein B (ApoB)

Apolipoprotein B, or ApoB, is a protein found in cholesterol. High levels of Apo B are linked to a higher risk of heart problems. 

Ideal level: below 100 mg/dL

Blood tests that check for immediate heart problems

If you have symptoms that are indicative of heart disease, such as chest pain, difficulty breathing, or a recent diagnosis of a heart condition, you’ll probably need a different set of heart blood tests. 

The following heart blood tests can identify heart strain or damage and are used in combination with other information, like physical examination and other blood tests, to determine if a heart problem might be present:

• Cardiac enzyme tests, like troponin I and T

• B-type natriuretic peptide, or BNP

Troponin I and T

Troponins, also called “cardiac enzymes,” are proteins found only in the cells of heart muscles. When heart muscle cells become damaged, such as during a heart attack when the heart muscle isn’t getting enough blood flow, troponins can be released into the bloodstream. It is possible for people to have elevated troponin levels without having a heart attack, such as in congestive heart failure or kidney failure.

Brain natriuretic peptides (BNP) 

Brain natriuretic peptide (BNP) is a protein created by the heart and blood vessels that helps regulate blood pressure by balancing fluids and salt in the body. BNP is usually ordered to find out if symptoms of shortness of breath or swelling in the legs is because of heart failure. It can also be used in people who have already been diagnosed with heart failure to measure how well treatment is working.

Other blood tests that can give information about overall health

Even if you don’t have a heart problem or risk factors for heart disease, it’s likely you will need blood tests every now and then. Although not specifically for heart problems, some routine blood tests can provide valuable information about your overall health — including your heart:

• Complete blood count, or CBC: measures levels of different components of your blood. The result usually includes a level for hemoglobin (Hgb), hematocrit (Hct), platelets (Plt), and white blood cells (WBC). When hemoglobin is low, less oxygen is provided to the heart muscle, which can lead to chest pain and heart attacks.

• Chemistry, or comprehensive metabolic panel (CMP): measures the levels of electrolytes in your blood, such as sodium, potassium, and calcium. It also gives information about your kidney and liver function. Electrolytes, particularly potassium and calcium, are key to the normal function of the heart. If the chemistries of the body are abnormal, you could have a higher risk for abnormal heart rhythms, or arrhythmias. 

• Blood glucose: measures the amount of glucose (sugar) in your blood. This can either be a random blood glucose level taken any time or a fasting blood glucose, taken after not eating for 8 or more hours. A high blood glucose level could mean you have  diabetes or prediabetes, both of which increase your risk of heart disease.

• Hemoglobin A1c (Hg A1c): gives a broader picture of your glucose level over a 2- to 3-month period. The higher the A1c, the higher the risk of getting complications from diabetes, which include heart and vascular issues. 

• Thyroid panel: measures the levels of thyroid hormones in the blood, including thyroid stimulating hormone (TSH), thyroxine (T4), and triiodothyronine, known as T3. Thyroid hormones regulate several vital functions in the body, including heart rates. Abnormally low or high thyroid hormones can cause fast or slow heart rates, and even heart failure. 

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Written by:

Alice Perlowski, MD, MA, FACC

Dr. Alice Perlowski is a board-certified cardiologist and fellow of the American College of Cardiology. She has seen patients and supervised trainees in the academic and private sector, with focuses in interventional cardiology, vascular medicine, preventative cardiology, and women’s heart health.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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