Heart health should always be top of mind, but once older adults reach 60 and up, the statistics  can make it seem all the more important.

• Heart disease is the leading cause of death in the U.S.
• In 2020, 8 of 10 heart disease deaths were in those age 65 and above.

So, the natural next question, for many people, is: What tests do I need? While many people may equate being a certain age to needing more and more heart tests, that’s not necessarily so for those who have so far been heart healthy.

“In general, the idea of ‘I’m curious’ is not a good idea to do [a test]”

“In general, the idea of ‘I’m curious’ is not a good idea to do [a test],” says James N. Kirkpatrick MD, chair of the geriatric cardiology section of the American College of Cardiology and professor of medicine, director of the echocardiography library and attending physician at the University of Washington Medical Center, Seattle.

Besides unneeded expense and the time needed to test, false positives are always a possibility, he warns, and that could lead to proceeding to more invasive tests—for nothing.

One test, for instance, that many people think should be routine at a certain age is the treadmill or stress test. It shouldn’t be routine, Kirkpatrick says. “It’s expensive and it’s notorious for having abnormalities show up that aren’t there and for missing things [that are abnormal].” The treadmill can tell you one thing accurately for sure, he says, and that’s that you can go a long way on the treadmill. However, if you can go a long way, you probably don’t need a treadmill test to begin with, he says.

However, if a patient says he’s been a lifelong exerciser but now gets short of breath, that might indicate a stress test is needed, Kirkpatrick says.

New Guidelines for Heart Health

In 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued a joint guideline on the primary prevention of cardiovascular disease, a guideline for healthcare providers. That addresses the people who haven’t had a heart attack or other significant heart issue and focuses on how they can stay heart-healthy.  The ACC also developed what it calls  Appropriate Use Criteria to help healthcare providers decide on the right test for the right patient.

What tests might primary prevention of heart disease call for? Fewer than you might guess.

• Calculating your risk of ASCVD (atherosclerotic cardiovascular disease) over the next 10 years is advised. According to the guidelines, adults 40-75 who are being evaluated for cardiovascular disease prevention should have a 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as blood pressure medicines, antihypertensive therapy, a statin, or aspirin.  To use the tool, your doctor plugs in age, gender, race, information about cholesterol, blood pressure and other heath information and produces a 10-year risk. Your doctor can assess if a statin to lower risk might be needed based on the risk prediction.
• A health care provider might also get your coronary calcium score to decide if a statin is in order. A CT scan gets pictures of the walls of your coronary arteries, and a computer program checks for calcium and measures it, producing a score that predicts cardiovascular event risk.

Using Symptoms as a Heart Health Guide

When older adults concerned about heart issues see their doctor and want a list of what tests they need, the better approach, Kirkpatrick first suggests: “Let’s look at what we can modify in terms of your risk factors.” That usually includes reducing salt, reducing red meat, exercising, and being sure cholesterol and blood pressure are under control.

Heart disease risk factors (such as high blood pressure) and heart disease diagnoses are more common among some racial and ethnic groups, as the Cleveland Clinic explains, so prevention strategies may be even more important, depending on your background.  Among those at higher risk are Hispanic, African American, Asian and American Indian people. For example, while 47% of black adults have cardiovascular disease, 36% of white adults do.

Deciding if a test is needed should be based on symptoms that might indicate heart disease, not someone’s worry they will get it.

For instance, if a patient has unexplained chest pain, an echocardiogram might help figure out what is causing it.

Deciding on tests should be a case-by-case basis, Kirkpatrick says.  Suppose a patient says his cousin suddenly died, and the cause was aortic dissection. This medical emergency, involving a tear in the inner lining of the large blood vessel branching off from the heart, can run in families. For that patient, Kirkpatrick says, he would likely order additional testing and even genetic testing.

Asking the Right Questions

If your doctor suggests a heart test—and there are explainers here for numerous ones—be sure to ask why it’s needed, if there are alternative tests and what risks it may have.  Then decide together.

Want to know more about loving your heart?  Register for our class on Heart Rate Monitor Apps, scheduled for Thursday, February 16 at 12pm EST. If you are curious about your heart rate, but not ready to commit to a fitness tracker, this class is for you! 

Want to do even more to stay healthy?  Senior Planet offers daily fitness and wellness classes online and talks and discussion groups, too. Check out the schedule here. 

This article offered by Senior Planet and Older Adults Technology Services is for informational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. If you think you may have a medical emergency call 911 immediately.

Kathleen Doheny is a Los Angeles-based independent journalist, specializing in health, behavior, fitness and lifestyle stories. Besides writing for Senior Planet, she reports for WebMD, Medscape, Endocrine Web, Practical Pain Management, Spine Universe and other sites.  She is a mom, mother-in-law and proud and happy Mimi who likes to hike, jog and shop.

Doheny photo: Shaun Newton