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In the Stands

Know your heart

Rob never missed a game. He'd leave work early to make a 4pm first pitch, and whether it was a practice, a tournament, or a Tuesday night in the rain, he was in the stands. His kids, Kate and Rex, grew up knowing that someone was always watching, always pulling for them, and always there afterward with an honest scouting report.

This page is about keeping more parents and grandparents in the stands.

Get checked

Why it matters

Why “I feel fine” isn’t enough

Heart disease and diabetes often develop quietly for years before anyone feels a thing, and the standard yearly checkup doesn't always catch them early. The right tests exist and are easy to ask for. You just have to know what to ask.

  • The #1 killer

    Heart disease is the leading cause of death in the United States.

  • Often silent

    It can go undiagnosed until a heart attack.

  • Easy to miss

    A normal routine blood panel can still miss some of the biggest risk factors. Those tests usually aren't included unless you ask.

Source: CDC, About Heart Disease; AHA/ACC 2018 Cholesterol Guideline (risk-enhancing factors); MedlinePlus, Lipoprotein (a) Blood Test

Step 1

Know your numbers

A routine physical usually covers the basics. These usually are not included unless you or your doctor ask.

Heart and arteries

  • ApoB

    Counts the particles that carry cholesterol into artery walls. Can flag risk even when your regular cholesterol looks fine.

    Target130 mg/dL or higher is a recognized risk factor. Lower is better.

  • Lp(a)

    A risk factor set by your genes that runs in families. Diet and exercise barely move it, so one test usually covers you for life.

    TargetUnder 50 mg/dL (under 125 nmol/L)

  • hs-CRP

    Measures inflammation, which plays a part in heart disease.

    TargetUnder 2 mg/L

  • Urine albumin-to-creatinine ratio (uACR)

    A simple urine test. Protein in the urine is an early sign of damage to blood vessels and kidneys.

    TargetUnder 30 mg/g

  • Blood pressure

    Still one of the biggest drivers of heart attack and stroke, and it usually has no symptoms.

    TargetUnder 130/80

If a parent or grandparent had heart disease, ask for Lp(a). It runs in families, a routine cholesterol test doesn't include it, and most people with a high level don't know it.

Blood sugar

  • A1c

    Your average blood sugar over the past few months. A standard test, but it rises late: by the time it is high, the problem is underway.

    TargetUnder 5.7%

  • Fasting insulin, with fasting glucose

    Insulin resistance sets the stage for prediabetes and type 2 diabetes, and you can't see it from the outside.

    TargetNo single agreed cutoff. Ask your doctor to read it with you.

Source: MedlinePlus, Apolipoprotein B; AHA/ACC 2018 Cholesterol Guideline (risk-enhancing factors); MedlinePlus, Lipoprotein (a) Blood Test; American Heart Association, What Is Lp(a)?; MedlinePlus, C-Reactive Protein Test; National Kidney Foundation, uACR Urine Test; ACC/AHA 2017 High Blood Pressure Guideline; CDC, Diabetes Testing; CDC, Insulin Resistance and Diabetes

Step 2

Check your blood pressure at home

Readings at the doctor's office can run high from nerves, or look normal on a good day. A week of home readings gives the real picture.

  1. Use an upper-arm cuff that has been validated for accuracy.
  2. Sit quietly for 5 minutes, back supported, feet flat, arm resting at chest height.
  3. Take 2 readings, a minute or two apart, morning and evening, for a week.
  4. Average them. If the average is 130/80 or higher, share it with your doctor.

Source: CDC, Measuring Your Blood Pressure; ACC/AHA 2017 High Blood Pressure Guideline

Step 3

Look at the arteries themselves

Blood tests show what is driving plaque. Imaging shows whether plaque is already there.

  • Hard (calcified) plaque is older and more stable. A simple CT scan can see it.
  • Soft (non-calcified) plaque is newer and more likely to rupture. A basic calcium scan can't see it.

  • Coronary calcium (CAC) score

    Shows
    Hard plaque only
    Good
    A quick CT scan, no needles and no dye. A score of 0 is normal.
    Watch for
    Misses soft plaque. Younger people's plaque is often still soft, so a 0 does not rule everything out.

  • Coronary CT angiogram (CCTA)

    Shows
    Soft and hard plaque, and any narrowing
    Good
    The most detailed look at the arteries without a catheter.
    Watch for
    Needs contrast dye through an IV and more radiation. Generally used when there are symptoms, not as a routine screening test.

Which scan makes sense?

  • 40 or older

    A calcium score is a sensible, inexpensive starting point. Ask your doctor whether it makes sense for you.

  • Under 40 with risk factors

    High Lp(a), high ApoB, or family history. A calcium score can read 0 while soft plaque is there, so ask a preventive cardiologist what the right next step is.

  • Chest pain, shortness of breath, or other symptoms

    Don't wait on screening. See a doctor now.

Source: National Heart, Lung, and Blood Institute, Heart Tests; American College of Cardiology, Coronary Artery Calcium Guidelines; Calcium score and CT angiography for screening people without symptoms (review)

Get your checklist

Bring this to your next appointment

Your checklist

Tick them off as you go, or take a screenshot and show your doctor.

Ask your doctor to add these to your blood work
At home
Talk to your doctor about imaging if

What to say

“I'd like a more complete heart risk assessment. Can we add ApoB, a one-time Lp(a), hs-CRP, and fasting insulin to my blood work?”

If your doctor or insurance says no

Ask what it would cost to pay for the test yourself, and ask for a referral to a preventive cardiologist or a lipid specialist (lipidologist). They focus on stopping heart disease before it starts.

Get checked for the people in your stands

Every kid on every field has someone they're playing for. Getting checked isn't about fear. It's about being there for the next game, the next season, and everything after.

Make the appointment. Ask for the tests. Then go cheer.

An emergency

Signs of a heart attack

If you notice these in yourself or someone else, call 911 right away.

  • Chest pain or discomfort
  • Feeling weak, light-headed, or faint
  • Pain or discomfort in the jaw, neck, or back
  • Pain or discomfort in one or both arms or shoulders
  • Shortness of breath

Other symptoms can include unusual tiredness, and nausea or vomiting. Women are more likely to have these.

Source: CDC, Heart Attack Symptoms, Risk, and Recovery

About this page

Where this comes from

This page is for general education only and is not medical advice. Target ranges vary by person, age, and health history. Talk with your doctor before making decisions about testing or treatment. If you have chest pain, shortness of breath, or other symptoms of a heart attack, call 911.

Everything on this page comes from the public sources below.

Rob's storyAbout the fund