Inside your Heart Health Check - Part 2
How to reduce your risk of heart attacks in the future
In part one of your heart health check you had a discussion with your doctor about your future risk of heart disease.
In Part 2 we’re covering what we do with your test results, and the actions you should consider taking.
A recap of part 1…
This included a detailed understanding of conditions that have affected your family, and ideally considered other vessel-related conditions including diabetes, strokes and dementia.
If you’ve missed part 1, you can read it here:
Your doctor will better understand you own medical history, as well as have a better understanding of you diet and lifestyle including smoking and alcohol intake.
Based on this we decide on the initial relevant investigations to arrange for you. This may include the following:
A cardio-metabolic blood profile may include the following tests:
A full blood count, which includes:
including your red blood cells and haemoglobin (oxygen carrying cells)
white cell counts (markers that fight infection)
Biochemistry which includes:
Liver function
Kidney function
Electrolytes including sodium and potassium
Calcium & phosphate
Uric acid (a useful marker for gout)
Glucose (fasting)
Full Lipid Profile
Total cholesterol
Triglycerides
High density lipoprotein (HDL)
Low density lipoprotein (LDL)
non-HDL
Hba1c
Your average blood glucose level over 8-12 weeks
Thyroid function
TSH +/- T4, T3 and antibodies
This is a typical blood test profile, but not all of these would necessarily be included, and there may be more to consider depending on your specific case.
It depends on your risk, what’s useful and what might change the course of action we take. I may have included an ECG (12 lead heart tracing) or an echocardiogram (ultrasound scan of the heart).
This depends on your risk and examination done in first consultation.
In just the last month, I have identified changes in many patients that have required intervention sooner whether that be related to chest pains.
What’s going to kill you?
A cardiovascular related condition including heart attack, stroke and even dementia. It might be something else, but these are the most likely.
It’s not that we can ever prevent these from happening, it’s more that we can kick the can down the road so to say. But rather this happen to you at 90, than 60 years old.
The biggest risk factors for heart disease are the following, in roughly this order:
1. High blood pressure
2. Smoking
3. High cholesterol
4. Family history
5. Diabetes
The first 3 will dictate the bulk of your risk.
Now you’ll notice that a sedentary life (lack of exercise) and nutrition are not up there.
And neither is your weight.
But they will impact your cholesterol and blood pressure and diabetes risk and ultimately, these then lead to an increased risk of heart disease.
Let’s go through your results
You’ve sat down for your test results. This is how the consultation goes.
In front of me I have your blood test results, possibly an ECG or an echocardiogram.
As we go through the consultation we gradually build a picture together, because it’s your understanding that is as important as mine.
We know your family history and have a better understanding of your own medical history and lifestyle.
We’ve got your blood pressure, height, weight, BMI. Then comes your ECG result.
Electrocardiogram (ECG)
The ECG helps me to detect conditions such as atrial fibrillation (an irregular heart rhythm that increases stroke risk), evidence of a previous heart attack you may not have known about.
There might be findings suggestive of thickening of the heart muscle or abnormalities in the heart’s conduction system.
Cholesterol
Your cholesterol comes next, and we discuss this in significant detail, because it isn’t just about your total cholesterol.
It’s about understanding the break down between different types of cholesterol.
For a full explanation of cholesterol, have a look at this article where I break down my own cholesterol in more detail to better understand the profile:
Using your cholesterol, family history and blood pressure I calculate your cardiovascular risk score. This is a statistical test to estimate your risk of a heart attack or stroke in the next 5 years.
In Australia when this hits 5% this is usually when we consider this risk to be rising higher and start to have conversations as to whether a cholesterol medication could be beneficial for you.
You might be thinking that’s actually not very high.
But for someone in their 50’s with a five year risk of 5%, their lifetime risk is much, much higher.
Hence why it’s important to consider cholesterol medicine including statins.
By reducing cholesterol and blood pressure, your overall risk can be reduced and can even avoid cholesterol medicine for some time.
If you’re making lifestyle changes with nutrition, exercise or stopping smoking these need to continue in the long-run to have meaningful impact.
A snap shot of good cholesterol may be reassuring but it’s really what’s going on over decades that matters.
Lifestyle recommendations
Let’s take a look from a whole heart health perspective.
1. The Portfolio approach.
This has strong evidence for helping to reduce cholesterol. I give handouts from Canada and Australia.
Canada?!
Canadian handouts are beautiful, and very easy for patients to follow.
2. I may mention the Mediterranean approach.
Actually the portfolio approach is likely more impactful, and removes cultural connotations that the mediterranean approach comes with. It may feel abstract for someone who is not of European descent.
3. Key nutritional changes
Reducing sugar intake - not necessarily carbs - I’m being specific when I say sugar.
Reduced fried foods
Excessive alcohol
Reduced ultra processed food (UPF) will help to reduce many proven detrimental foods to cholesterol and heart health… and others that we are suspicious about but not proven.
4. What needs to increase?
Fruit
Vegetables
Fibre
Protein - even better from plant-based sources.
How? Look to the portfolio diet approach.
4. Exercise matters
Especially when it comes to your blood pressure. Blood pressure rises during exercise. But what goes up, must come down.
But if you do nothing and don’t exercise the blood pressure will rise.
5. Sleep and stress.
They go hand in hand.
They also affect your eating habits, as with high stress and reduced sleep, it drives you to seek energy from food, and from unhealthier higher calorific sources too, that contribute to poor heart health.
If you’re overweight the this may come into the conversation.
High levels of activity and good nutrition do significant reduce the impacts of excess weight, but in doing so this will also help you to reduce your weight.
Lower weight reduces strain on the heart and can have a significant impact on reducing heart problems for some people.
Depending on your risk we will discuss further tests. The two commonest ones I discuss with patients include:
Do you need more tests?
Part of the heart health check identifies people that will benefit from an earlier cardiology assessment.
I will refer to a cardiologist if interventions may be required sooner.
Or if I have picked up conditions that suggest a very high risk of a major condition affecting your heart that they can investigate and take action on.
There are other tests that I may arrange depending on the patient in front of me.
They include ECG and/or echocardiogram if it is now felt to be relevant to do so.
It may be a 24 hour blood pressure monitor, or a longer ECG on your heart known as a ‘tape’ or a 24 hour monitor.
There are also other markers though, that are not included within medicare funding in Australia (if reading in the UK this is equivalent to the NHS), and these you might want to consider.
1. Lp(a) - pronounced ‘el, pee, little a’
This is a specific cholesterol marker that doesn’t change easily with lifestyle management, and high levels are genetically determined, i.e. passed down in your family.
Having lp(a) significantly increases the risk of heart disease. If there is a strong family history of heart disease I typically recommend this test.
In Australia it is relatively cheap, at around $60 (at the time of writing - April 2026).
You can read more about more specialised cholesterol tests here:
If this is raised, you can’t change it significantly, but you may active and intense when it comes to optimising your lifestyle and cholesterol management.
Depending on other related tests and your medical history this could warrant an opinion or referral to a cardiologist.
2. A CT Coronary calcium score
They are commonly done in Australia now, and come in at least 5 times cheaper than getting it done in the UK.
It’s not a perfect test but it can really help to understand hard calcification that is lining your arteries around your heart known as coronary arteries.
Blockages of coronary arteries are what cause heart attacks.
This is not a perfect test, so we cannot use it to be absolutely sure on the state of health of your blood vessels, but it is expected to be around 95%.
While that is a high accuracy rate, it does mean a 1 in 20 inaccuracy rate.
Most active plaques that are going to cause heart attacks are soft, which are not seen on this scan.
So if that’s the case why do it?
If there’s significant calcification then this can suggest a higher chance of blockage and actions required to treat blockages before they become heart attacks.
If it’s very severe this will may indicate a cardiology referral for more investigations.
If it’s slightly higher levels of calcification than expected, you long term risk may be higher, which may determine when you would consider medication, or be more intensive with your diet and lifestyle.
There’s a lot to a heart health check.
It’s not always possible to cover everything in one go. Sometimes it does require more than one appointment, and follow ups too.
But this is how prevention medicine is starting to be practiced with support from the public health system.
If you’re in the Northern Rivers or Gold Coast and want to book a consultation to discuss your heart health head to KiranSodha.com for more info.