Heart Screenings: How & When to Check Your Heart Health

You may only think about your heart when it's racing before a big presentation or after a tough workout. But it's important to keep tabs on your heart health, and not just later in life. Risk factors for heart disease can develop as early as your 20s — often hiding in the background, not causing obvious symptoms.

That's where heart screenings come in.

"Screening is all about identifying risk factors early," says Dr. Mahmoud Al Rifai, a preventive cardiologist at Houston Methodist. "If you don't check, you don't see and you don't control. That's why screening is so crucial."

Whether you're just starting to think about your health or already are aware of a few risk factors, here's what you need to know about heart screenings, including what they are, when to get them and how they can help you stay ahead of heart disease.

What is a heart screening?

A heart screening is a set of tests and evaluations that help gauge your risk of heart disease — well before symptoms ever show up.

"The earlier we identify risk factors and start to intervene, the more likely we are to reduce the chance of atherosclerosis, which is the precursor to heart disease," explains Dr. Al Rifai. "Early intervention can also mean avoiding medications, since lifestyle changes are often all that's needed to reduce the risk factors of heart disease."

Heart screenings are part of a broad prevention strategy called "primordial prevention." As Dr. Al Rifai explains it, "this is when we're proactively checking to see if risk factors have developed."

But heart screenings can be used to help with other types of prevention, too, like primary and secondary prevention.

• Primary prevention: Managing existing risk factors before disease appears
• Secondary prevention: Preventing another event after a heart attack or stroke

The risk factors for heart disease

The major risk factors doctors look for during heart screenings include:

• High blood pressure
• High cholesterol
• Type 2 diabetes
• Smoking

These factors can quietly build up over time, which is why early and regular screening is key, even if you feel perfectly healthy.

"During a heart screening, we're also thinking about how your family history impacts your risk," adds Dr. Al Rifai. "If you have a strong family history of heart attack, stroke or diabetes, these are indicators of high risk of heart disease and can prompt earlier and more frequent screening."

The four components of heart screening and when to get checked

Heart screenings aren't just for older adults or people with symptoms. They're a proactive way to protect your health no matter what your age. Whether you're 25 or 55, understanding your risk factors and getting screened can help you stay ahead of heart disease.

Here are the four components of heart screenings:

1. Blood pressure test

High blood pressure, also known as hypertension, is when the force of blood pushing against the walls of your arteries is consistently too high. This makes the heart work harder than normal and, over time, can lead to heart disease.

Fortunately, blood pressure is easily measured using a blood pressure monitor. These devices report two numbers: systolic blood pressure (the top number) and diastolic blood pressure (the bottom number). Both numbers help determine if your blood pressure is normal or needs treatment.

When to get your blood pressure checked:

• Start at age 18

"Your doctor can help you understand how frequently your blood pressure should be checked, which will depend on your health status and family history," adds Dr. Al Rifai.

(Related: What Is a Good Blood Pressure?)

2. Cholesterol test

Your body needs some cholesterol — a waxy, fat-like substance — to build cells and produce hormones, but having too much of it can lead to plaque buildup in your arteries. This buildup can narrow or block blood flow, increasing your risk of heart disease.

A standard lipid profile measures:

• Total cholesterol
• HDL cholesterol
• LDL cholesterol
• Triglycerides

"We use these numbers to screen for high cholesterol," says Dr. Al Rifai. "If levels are high, we can also use this information to decide whether to treat with medication or just lifestyle interventions like diet, exercise and weight loss."

When to get your cholesterol levels checked:

• Men: At least once between ages 20–25
• Women: At least once between ages 30–35

"If someone has family history suggestive of familiar hypercholesterolemia — a family history of premature coronary artery disease or a first-degree relative who had a heart attack at a very young age (less than 45 for men, less than 55 for women) — it raises the suspicion for some kind of genetic predisposition to high cholesterol and earlier screening would be warranted," adds Dr. Al Rifai.

(Related: 2 Key Cholesterol Tests You Might Be Missing)

3. Blood glucose tests

Type 2 diabetes occurs when the body either doesn't produce enough insulin or can't use insulin effectively, which is known as insulin resistance. Insulin is the hormone that helps move glucose from your blood into your cells to be used for energy. When this process doesn't work properly, glucose builds up in the bloodstream, which over time can damage the heart and increase the risk of heart disease.

The two main tests used to monitor blood glucose levels:

• Fasting blood glucose (levels in the blood after an 8-hour fast)
• Hemoglobin A1C (average blood glucose over 3 the last months)

"These tests can identify normal glucose control, prediabetes or type 2 diabetes," says Dr. Al Rifai.

When to get checked:

• Start at age 35

"People who should begin earlier diabetes testing include those who have a BMI over 25, a family history of diabetes or any other risk factor of heart disease," adds Dr. Al Rifai.

4. Assessment of smoking history

Smoking is a major risk factor for heart disease and stroke. During a heart screening, your doctor will ask about:

• Cigarette use
• Vaping
• Smokeless tobacco

"We have decades of data showing a clear link between smoking and heart disease," says Dr. Al Rifai. "And vaping is increasingly important to ask about, especially among younger patients."

When should you get a heart scan?

While basic screenings like cholesterol, blood pressure and blood sugar tests are the first step, sometimes doctors need a more detailed picture of your heart health. That's where risk calculators and heart scans come in.

"We estimate someone's risk of a heart attack or stroke using tools like the PREVENT™ calculator," explains Dr. Al Rifai. "This tool uses data from hundreds of thousands of people and factors in things like age, sex, cholesterol levels, blood pressure, smoking and diabetes to estimate your 10-year risk of developing heart disease."

If your risk is high, your doctor may recommend medications and more aggressive treatment goals.

If your risk is still somewhat unclear, a coronary calcium score test — also known as a heart scan — might be ordered. This is a quick, low-radiation CT scan that measures the amount of calcified plaque in your heart's arteries. The result is a score that helps refine your 10-year heart disease risk level:

• 0 = very low risk
• 1–99 = mild risk
• 100–399 = moderate risk
• 400+ = high risk

"A calcium score helps judge risk when we're not sure," says Dr. Al Rifai. "But it's not a screening tool. And it's not effective for everyone. In younger people, plaque often isn't calcified yet, so the test might miss plaque floating in the bloodstream. In these cases, doctors may consider other imaging options, like carotid ultrasound, to assess early signs of plaque."