How Doctors Diagnose Coronary Artery Disease

To find out if you have or are at risk for coronary artery disease, your doctor will start by doing a physical exam. He or she will ask questions about your health and your risk factors. Risk factors are the things that increase your risk. You may then have several different kinds of tests to check your risk for getting heart disease. If your doctor thinks you have heart disease, you will need more tests to make sure.

Tests to measure your risk for coronary artery disease

There are several tests your doctor can use to check your risk for getting heart disease. These may include:

• Blood pressure tests. High blood pressure increases your risk for heart disease.
• Cholesterol test (a blood test). High cholesterol increases your risk for heart disease.
• Fasting blood sugar test (a blood test) to check for diabetes. The U.S. Preventive Services Task Force suggests that people with high blood pressure or high cholesterol be routinely screened for diabetes. People with diabetes benefit more from treatment for high blood pressure and high cholesterol than do people who do not have diabetes.⁵
• C-reactive protein test (a blood test). High CRP levels can mean swelling (inflammation) in the blood vessels, which increases risk for heart disease and heart attack.⁶
• Homocysteine test (a blood test) to check for elevated homocysteine levels and mutations of a specific gene (MTHFR). But this test is rarely done. Studies show that the link between homocysteine levels and heart disease is weaker than once believed.
• Coronary artery calcium scanning. This test uses a special kind of X-ray to check for buildup of calcium in the heart's arteries. The result is a number, or score. If you have a high score, you may need more tests to check for heart disease or to find out how bad it is.