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A brief guide to predicting heart attacks
Heart attacks often cannot be predicted accurately, but in many cases the risk can be assessed several years in advance.
Blood tests such as LDL cholesterol, blood sugar (HbA1c), triglycerides and sometimes Lp(a) or ApoB help to estimate the risk.
Risk calculators weigh together factors such as age, blood pressure, smoking, diabetes and blood lipids for a more accurate risk assessment.
Coronary artery calcium score (CAC) can provide valuable information in people without symptoms but with an uncertain risk profile and help determine whether preventive treatment should be intensified.
CT coronary artery is used primarily for symptoms such as chest pressure, exertion-induced shortness of breath or decreased fitness to investigate whether there is narrowing in the coronary arteries of the heart.
Normal blood tests do not rule out coronary artery disease. New chest symptoms or shortness of breath should always be assessed by healthcare professionals, even if previous health checks have been normal.
The best risk assessment is based on a comprehensive picture, where the right examination is chosen based on the person's risk factors, heredity and any symptoms.
A heart attack is often experienced as something that comes suddenly. For many people, it therefore feels completely unpredictable. At the same time, the most common cause begins much earlier through gradual hardening of the arteries in the heart's coronary arteries, often driven by blood fats, blood pressure, blood sugar, smoking and heredity. The question is therefore not only whether you can predict a heart attack, but how early you can detect increased risk and which examinations actually provide the best guidance.
Is it possible to predict a heart attack? The best examinations to assess the risk
The short answer is: often yes, but not with complete certainty. No single examination can say exactly who will have a heart attack and when, but modern risk assessment can identify people with a clearly increased likelihood of future cardiovascular disease. Today, classic risk factors are combined with blood tests, risk calculators and, in some cases, imaging diagnostics to get a much clearer picture than just “high or low cholesterol”.
Risk of heart attack starts with the big picture
A heart attack usually occurs when an atherosclerotic coronary plaque ruptures or is damaged, causing a blood clot to form and stop blood flow to part of the heart muscle. Therefore, the primary goal is to assess the risk of atherosclerosis, i.e. pathological plaque formation in the blood vessels, before symptoms have occurred.
Risk assessment does not just look at a single test result. Several factors such as age, gender, smoking, blood pressure, LDL cholesterol, diabetes, kidney function, obesity, physical activity and family history are weighed together. European guidelines recommend SCORE2 for many apparently healthy adults without known cardiovascular disease, while American guidelines increasingly use PREVENT-based models to estimate future risk.
This means in practice that two people with the same cholesterol can have completely different risks. A 52-year-old non-smoker with normal blood pressure and good fitness is assessed differently than a person of the same age with diabetes, high blood pressure and a parent who had a heart attack before the age of 55. This is precisely why a structured health check up becomes more valuable than just “taking a cholesterol test”.
Which blood tests are most useful for assessing heart attack risk?
The most important blood tests in primary prevention are those that show blood fat levels and blood sugar load. A lipid test usually includes total cholesterol, LDL, HDL and triglycerides. Guidelines particularly emphasize LDL cholesterol and non-HDL-cholesterol because these reflect the amount of atherogenic, i.e. plaque-driving, lipoproteins.
Blood suger status is also central. Diabetes and prediabetes clearly increase the risk of heart attack, even when symptoms are absent. Therefore, fasting glucose and HbA1c are often important parts of a risk assessment, especially in the case of abdominal obesity, high blood pressure or a heredity for type 2 diabetes.
A blood test that has become increasingly important is lipoprotein(a), abbreviated Lp(a). It is not included in a standard blood lipid panel, but high levels are largely genetically controlled and linked to an increased risk of heart attack and stroke. Current recommendations from both Europe and the United States emphasize that adults should have Lp(a) measured at least once in their lives, especially if there is a family history of early cardiovascular disease or an unexpectedly high risk despite otherwise reasonable values.
In some cases, apolipoprotein B, often called ApoB, can also provide a better measure of the amount of harmful lipoprotein particles than traditional LDL. It can be particularly valuable in cases of high triglycerides, metabolic syndrome or when standard lipid values give an unclear picture. This type of in-depth analysis is not necessary for everyone, but can be crucial when you want to assess risk more accurately.
When is calcium scoring of the heart's vessels one of the best examinations?
For people without known heart disease but with an uncertain risk profile, coronary calcium scoring is one of the most useful examinations. It is performed with a low-dose CT and measures the amount of calcium in the coronary arteries of the heart. Calcium in the artery wall is a sign of established atherosclerosis, even in people who feel completely healthy.
The strength of the examination is that it can reclassify risk. A person with “borderline values” in blood tests and moderate calculated risk may turn out to have a zero calcium score, which often indicates a lower short-term risk. Conversely, a clearly elevated calcium score indicates that preventive treatment, such as more intensive cholesterol lowering, may be justified. European guidelines therefore recommend increased CAC assessment as a risk modifier when treatment decisions are close to the borderline.
High levels of coronary calcium are not just “a little abnormal”. Very high values, especially in combination with diabetes, are linked to very high future risk. At the same time, the examination should be used selectively and not as a general screening for all young healthy people, since the benefit is greatest when it can actually influence the treatment.
When are more than blood tests needed, such as CT coronary artery or other cardiac examination?
Blood tests and risk calculations are mainly used to estimate future risk in people who do not have any clear symptoms. However, if someone has pressure on the chest during exertion, new shortness of breath, unexplained decrease in fitness or recurring discomfort in the jaw, back or arm, a regular health check is not enough. In this case, it is necessary to investigate whether coronary artery disease already exists.
When stable coronary artery disease is suspected, computed tomography of the coronary arteries, so-called CT coronary arteries or CT coronary angiography, has gained an increasingly strong role. The method is recommended for people with a low to moderate probability of narrowing, as it can both show vascular changes and help assess future risk of cardiac events.
It is also important to distinguish between risk assessment and acute diagnostics. If a person presents with a suspected ongoing heart attack, an ECG and high-sensitivity troponin are used in the emergency department to quickly determine whether the heart muscle has been damaged.
What symptoms should you not try to “risk assess away”?
It is possible to reduce the risk of heart attack and detect risk in advance, but symptoms must always be taken seriously. Chest pain or pressure on the chest is classic, but a heart attack can also cause shortness of breath, cold sweats, nausea, dizziness or pain in the jaw, neck, back, shoulder or arm. Women, the elderly and people with diabetes may have less typical symptoms, sometimes without obvious chest pain.
A common question is: “Can I be calm if my tests looked fine a year ago?” The answer is no, if you now have symptoms that could come from the heart. Normal blood lipids or a previously normal blood pressure do not rule out acute coronary artery disease. In the event of new or ongoing alarm symptoms, you should seek emergency care, not book a future health check.
Another common question is whether a heart attack is always preceded by clear warning signs. It is not. Some people experience increasing angina over days or weeks, while others become ill more abruptly. This is precisely why preventive risk assessment is valuable even when you feel completely healthy.
The most accurate way forward is rarely to look for a single “magic test”. It is rather about matching the right examination to the right person: basic blood tests for many, in-depth testing with Lp(a) or ApoB when the risk picture requires it, and coronary calcification or CT coronary arteries when the answer actually affects the next medical decision. This makes the risk assessment not only more accurate, but also more useful in real life.
Do you want to know what your blood lipids, blood sugar and other cardiovascular-related values look like? Order a health check up from us at Testmottagningen.se, you will receive fast test results and a written medical opinion digitally with an interpretation of your values together with the information you provide in your health declaration.
