How exactly do you test your “heart health”?

There’s a lot more to “heart health” than just your heart! From cholesterol to sugar-handling, we’ll go through the ins and outs of testing your heart health.

Medical review by

Dr Alasdair Scott MBBS FRCS PhD

gut doctor, PhD and our research director

Published

Key Takeaways

  • “Heart health” looks at the factors that affect your risk of heart disease, stroke and dementia.
  • Heart disease takes years to develop but the factors that cause it start when you’re young, so it’s never too early to check your heart health.
  • Important blood tests to test your heart health include cholesterol and lipid profile, HbA1c and high-sensitivity C-reactive protein.
  • Our cholesterol and heart health blood test covers all the bases for testing your heart health.

How healthy is your heart? Poor heart health is the leading cause of death globally1. Many people don’t realise that the causes of heart disease - like high cholesterol and poor sugar-handling - get to work when you’re young. We’ll explain what’s in a heart health blood test and why it’s worth testing sooner rather than later.

What is “heart health”?

"Heart health" takes a "big picture" view of the health of your cardiovascular system and the factors that affect your risk of heart disease. Your cardiovascular system includes your heart and the blood vessels to all your organs, so cardiovascular disease can affect pretty much every aspect of your health, including heart disease, stroke and dementia to name but a few.

Simply put, if you have good heart health, you’re more likely to live better for longer.

Heart health doesn’t just look at whether you already have cardiovascular disease. It also looks at the factors that put you at higher risk of cardiovascular disease in the future. This is crucial because you don’t want to wait until you have heart disease before doing something about it. You want to prevent getting it in the first place. You can be in your teens or twenties and have poor heart health. So we need to check it early and often.

Would I have any symptoms of poor heart health?

If you have risk factors for poor heart health like poor sugar handling, high cholesterol or high blood pressure, you often won't have any symptoms. That's why testing is important. You won't know you've got these risk factors unless you check.

The signs of poor heart health can begin from an early age, but symptoms usually only come later on in life. It’s never too early to check your heart health. The sooner you check for problems, the earlier you can turn things around and make a difference.

Health or disease crossroads

Why is testing your heart health important?

It’s important to keep your heart in good health so it can support your body during your day-to-day activities. If your heart doesn't work well, you’ll struggle doing the physical things you need or want to do. Even walking up stairs will become a challenge with poor heart health. Good heart health keeps you not only physically but also mentally fit, which is key to allow you to do what you want to do as you get older.

You need to think of health in terms of “lifespan” and “healthspan”. Your lifespan is how long you live - your “healthspan” is how long you live in good health. Optimal heart health extends your lifespan and healthspan (Figure 1). We can optimise our healthspan to live better for longer.

With good heart health, your healthspan will only deteriorate near the end of your life, dropping quickly rather than the long, drawn-out decline if you don't optimise your healthspan (see Figure 1). Testing your heart health lets you know which trajectory you're on and allows you to make changes early enough to change course.

Heart health lifespan healthspan
Figure 1: Healthspan versus Lifespan. If you have poor heart health (yellow curve), your healthspan will start to deteriorate sooner in life, meaning more of your adult life will be spent in poor health. You also won’t live as long. If you can achieve optimal heart health (blue curve), you can extend your healthspan and lifespan so that you live longer in good health.

What are the key factors that affect heart health?

Risk factors for cardiovascular disease are divided into modifiable and non-modifiable. Unlike non-modifiable risk factors, modifiable risk factors are things that you can have an impact on and change. Even if your non-modifiable risk factors make you more likely to have poor heart health, you can still make an impact with your modifiable risk factors.

Modifiable risk-factorsNon-modifiable risk-factors
Lack of exerciseAge
SmokingFamily history (genetics)
Pre-diabetes or diabetes
High cholesterol
High blood pressure
Poor sleep
Poor diet
Drinking alcohol
Being overweight
Poor mental health
Table 1. Modifiable and non-modifiable risk-factors of heart health. Modifiable risk-factors are things you can have an impact on, while non-modifiable risk-factors are things you can’t change.

Heart healthy diet

How do we test heart health with blood tests?

To test your heart health we look at some of the key risk factors that cause heart disease - your cholesterol profile and your sugar handling. We also look for inflammation in your blood vessels. We’ll go through why these markers are important and what the results mean.

Lipids and cholesterol

One of the fundamental causes of cardiovascular disease is the narrowing of blood vessels by a process called atherosclerosis. But atherosclerosis probably wouldn’t occur, were it not for cholesterol2. High cholesterol levels in the blood causes cholesterol to leak into the blood vessel wall, leading to inflammation and narrowing. Narrow blood vessels stop your organs - like your heart and brain - getting enough blood.

A lipid profile test can tell you if your cholesterol and triglycerides levels (both a type of “lipid” or “fat”) are in the optimal range.

If your cholesterol and triglycerides are high in early life, this increases your risk of heart disease and you’re much more likely to have heart problems later in life. For example, a study3 found that increased blood cholesterol in young adult men was associated with 72% higher risk of developing cardiovascular disease and 64% higher risk of death before age 50.

But not all cholesterol is created equal. You should be trying to boost your levels of “good”, HDL cholesterol but reduce your levels of “bad”, non-HDL cholesterol and triglycerides. Your lipid profile will go through each of these markers and show where you are compared to “optimal”.

We really need to be aiming for "optimal" (and not just “normal”) levels to give you a better chance than the average "normal" person of improving your healthspan. Find out more about the optimal cholesterol and triglyceride levels here.

If you just want to check your lipid profile, you can use our Quick & Easy Cholesterol Blood Test.

HDL versus non-HDL cholesterol
Figure 2: HDL versus non-HDL cholesterol. HDL is “good” cholesterol which removes excess fats from blood vessels and organs. Non-HDL cholesterol is “bad” because it does the opposite, depositing fats in your blood vessels and organs and causing disease.

Sugar handling (HbA1c)

How your body handles sugar is another key risk factor for developing cardiovascular disease. Haemoglobin A1c (HbA1c) is a biomarker of your average blood sugar levels for the last 2-3 months. If these levels are raised, your blood sugar control is poor and you’re more likely to develop pre-diabetes and diabetes.

Both pre-diabetes (the stage before diabetes) and diabetes itself are associated with an increased risk of heart disease and stroke. However, it’s important to understand that although pre-diabetes and diabetes are specific points along the scale, HbA1c is really a continuum from good to poor sugar handling.

Even before you get to pre-diabetes, having a higher HbA1c is associated with a higher risk of developing heart disease4. Not only that, but higher HbA1c puts you at increased risk for dementia5 and even cancer6.

You can test your HbA1c today with our Pre-diabetes & Sugar Handling HbA1c Test.

HbA1c (mmol/mol)Diagnosis
30 - 35Optimal
Under 42Normal
42 - 47Pre-diabetes
48 and aboveDiabetes
Table 2. Diagnosis at different HbA1c levels. The optimal range for HbA1c is between 30 to 35mmol/mol, but under 42mmol/mol is considered normal. 42 to 47mmol/mol is pre-diabetic while 48mmol/mol and above is diabetic.

Once again, we’re aiming to optimise our healthspan, so just keeping below the diabetes diagnosis range isn’t good enough. We need to aim for between 30 to 35mmol/mol HbA1c to optimise our health. You can find out more about pre-diabetes and what your HbA1c levels mean here.

High Sensitivity C-reactive protein (CRP)

C-reactive protein (CRP) is a molecule produced by the liver when there is inflammation somewhere in your body. In cardiovascular disease, atherosclerosis involves inflammation in the blood vessel wall. Due to this inflammation, your CRP protein can increase slightly, which can be measured with a high-sensitivity CRP test.

Raised CRP levels are associated with a higher risk of cardiovascular disease and data from research studies shows that you should keep your CRP under 2 mg/L7.

Important non-blood tests

Monitoring your heart health isn’t just about blood tests. There are a couple of other things that are important to keep an eye on.

Blood pressure

If you have high blood pressure (over 140mmHg systolic, over 90mmHg diastolic), your heart is working harder than it should be. High blood pressure also encourages fats and cholesterol to build up in your arteries, causing damage, narrowing and increasing your risk of heart disease.

Keeping an eye on your blood pressure to make sure it stays in the optimal range (between 90-120mmHg systolic and 60-80mmHg diastolic) is important to reduce your heart risk. You can check your blood pressure in most pharmacies or with your GP.

Blood pressure kit

Weight

Carrying more fat around your abdomen (stomach) is a risk factor for cardiovascular disease. Guidance from the National Institute for Health and Care Excellence encourages us to keep our waist measurement to less than half our height8.

When and how often should I check my heart health?

By the time you get symptoms from cardiovascular disease, it’s too late, the damage is done. The process leading up to this point takes years but the signs are there when you’re young, even in your teens and twenties. The key message is that you should be checking your heart health early and often.

Our Complete Heart Health, Cholesterol & Diabetes Blood Test is your heart health “MOT”, showing you the path you’re on and predicting your future health.

Unfortunately, the NHS doesn’t take a particularly proactive approach when it comes to heart health. The routine NHS Health Check is often the first time people have their cholesterol and HbA1c checked. But it’s only offered to you when you turn 40 and even then, you only get one every 5 years.

This is too late and not often enough. You may have been living with high cholesterol and poor sugar handling for decades by this point. To compare, in the USA, the recommendation is to check your cholesterol every 5 years from turning 20 and more frequently as you get older9. If your HbA1c or lipid profile is not optimal, you should be checking more often.

AgeHow often to check your heart health
20 - 40Every 5 years
40 - 60Every 1-2 years
60 plusEvery year
Table 3. How often should you check your heart health?9

What should I do if my heart health isn’t optimal?

If your heart health isn’t optimal, you need to focus on improving your heart health through your modifiable risk factors (things that you can change to make a difference). Find out the top 7 ways to optimise your cholesterol levels and improve your heart health.

Heart health

But knowing what to do is only half the battle, actually putting lifestyle changes into practice is hard. That’s why we’ve created the Health Reset programme at Selph.

We’ll help you make a plan to get your heart health on track by optimising your nutrition, exercise, sleep, stress and social engagement - the five key factors that the scientific evidence shows are fundamental to health. What’s more, our health coaches will help you put your plan into action, giving you the support and accountability you need to make changes that stick.

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