Q: I have a strong family history of heart disease. My cholesterol, including my LDL, is okay, but I’m still worried. Are there any other tests that can determine my heart disease risk?

Cholesterol testing is a good screening method, but there are several additional tests that can more accurately predict your risk for heart disease. It is often said that you’re probably not at risk for heart disease if your total cholesterol, including LDL (Low Density Lipoprotein), is low. However, a recent study published in the American Heart Journal concluded that almost half of the patients hospitalized for cardiovascular disease had low LDL levels (less than 100 mg/dL).

How can this be? It may have something to with the type of LDL these heart disease patients had. According to The National Cholesterol Education Program, new risk factors for heart disease include high amounts of small, dense LDL. This type of LDL is easily oxidized by free radicals and can penetrate into the delicate inner lining of the blood vessel walls to form plaque. In contrast, large LDL do not put you at increased risk.

Since your family history is a concern, it would be a good idea to ask your doctor to have a special test done to measure the type of LDL you have (large or small), and another LDL test that measures another heart disease risk factor known as lipoprotein a.

Cholesterol is not the only contributor to heart disease. Research shows that inflammation can also be a major player in its development. Another test that can be helpful in assessing your risk is a high-sensitivity c-reactive protein (CRP) test. CRP is as an independent risk factor for heart disease – a known inflammatory compound that could be damaging your blood vessel walls, setting you up for plaque formation and eventually a heart attack. Another pro-inflammatory compound that can be measured is homocysteine, an amino acid that is a byproduct of your body’s metabolism. It too can increase inflammation of your blood vessel walls.

Finally, include a fibrinogen test in your comprehensive laboratory testing for heart disease. Fibrinogen is a blood clotting factor. If it is high, you are at risk of forming blood clots that could contribute to a heart attack or stroke.

These specialized tests can give you a much better picture of your risk for heart disease and provide direction on how aggressive you should be with prevention and treatment. But even if your results from all of these tests are within normal ranges, you will still be better off if you choose a heart-healthy lifestyle.