If you already feel like you have your bases covered in terms of diet and lifestyle, you may be wondering what the next level is for protecting your heart—especially if cardiovascular disease runs in your family. Because heart disease is such a massive problem here in the States, there's actually an entire medical field devoted to preventing it: preventive cardiology.
- Michael Share, MD, Michael Share, MD, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, California.
- Nieca Goldberg, MD, medical director of Atria New York City, clinical associate professor of medicine at NYU Grossman School of Medicine, and the medical director of New York University’s Women’s Heart Program
Here, two cardiologists explain exactly what preventive cardiologists do, when it's time for you to consider seeking one out, and how much they cost. Keep reading for everything you need to know.
What is preventive cardiology?
According to Michael Share, MD, a cardiologist at Cedars-Sinai Medical Center, those looking for a preventive cardiologist tend to fall into two groups. The first typically want to assess their cardiovascular risk, such as knowing their odds of having a heart attack. That desire may spark from the diagnosis of a parent or sibling. "If someone in your immediate family had a heart attack, that's when it could be helpful to go to a preventive cardiologist to assess and reduce your risk," says Nieca Goldberg, MD, a cardiologist and the medical director of NYU Women's Heart Program.
The second group has experienced a cardiovascular problem in the past and wants to do everything they can to prevent it from happening again. "Often, someone's primary care doctor will refer a patient to me after seeing that their cholesterol is high, as a next step," Dr. Share says.
What happens between you and your doc, then, is completely personalized. "What preventive cardiologists do is really look at someone's personal risk and tailor [a plan] for that specific person," Dr. Goldberg says. This, she says, really involves pinpointing what someone can do more of to take control of their own heart health. For one person, that may be connecting them to a registered dietitian or health coach who can help recommend healthier eating habits. For someone else, it may be considering taking medication. The key, she says, is for the doctor to formulate an individual plan for that specific person.
What to expect from a preventive cardiologist appointment
To determine exactly what your risk factors are, prepare to tell all on your family history, diet, and lifestyle habits. New patients may also complete a full physical exam and blood tests, including a cholesterol test. "This test is called a blood lipid panel, and it measures the specific lipids in the blood to check HDL and LDL cholesterol," Dr. Goldberg says.
Dr. Share says that there are other tests a doctor can perform at a preventive cardiologist appointment that can help better assess a person's heart-health risks. One is an electrocardiogram (ECG), a simple test that measures the heart's electrical activity. ECGs are usually done if someone is having trouble breathing, experiencing chest pain, feeling weak, or notice an irregular heartbeat and can help determine the root problem of these symptoms.
You also may undergo a stress test, which shows how the heart works during physical activity. Typically this involves the patient walking and jogging on a treadmill while being hooked up to a machine to record the heart's activity.
"Another test that is often performed is a coronary calcium scan," Dr. Share says, adding that it is usually done on patients who don't have any symptoms of heart disease, but may be at risk for getting it. "This test checks for calcium buildup in the coronary arteries, and, in this case, the calcium is bad. It's not the same type of calcium that keeps your bones strong," he says, noting that they are not typically recommended for people under the age of 40 since buildup tends to not happen that early. "If you have a significant family history of heart attacks, strokes, bypass surgery, or heart failure, then getting a coronary calcium scan may be something you want to ask your doctor about because it's an extra way to assess your personal risk," Dr. Share says. "But it's not necessary by any means; it's more of an extra preventive step."
Other than testing, preventive cardiologists may recommend medication—specifically statins—to someone to minimize their risk. This, along with any other questions you may have about your heart, is something you can ask about at a preventive cardiologist appointment.
How much does it cost to see a preventive cardiologist?
According to Dr. Share, since preventive cardiologists are specialists, visits may not be covered by someone's insurance, making them more expensive than seeing a primary care doctor. A typical visit can cost in the hundreds, and that's before the cost of any tests.
"That said, a primary care doctor can do much of what a preventive cardiologist can do," Dr. Share says. "A primary care doctor can measure cholesterol, look at someone's other risk factors, and give a good assessment of what their risk for heart disease is." So if you're not talking with your primary care doctor about heart disease—and are concerned about it—make a list of questions to ask before your next appointment.
If a primary care doctor recommends an ECG or stress test from a preventive cardiologist, those tests can range from $50 to $175, or more. Dr. Share says the one test that isn't regularly covered by insurance is the coronary calcium scan, since it isn't medically necessary. "That test typically costs between $150 and $250, depending on where someone lives," he says, emphasizing that it's just an extra tool. In terms of medication, if a preventive cardiologist prescribes statins, they must be covered fully by insurance.
Heart health is someone everyone should be mindful of—even if you're in your 20s and 30s. Dr. Share reiterates that much of someone's concerns about their personal risks can be voiced to their primary care doctor. But if you want or need to speak to a specialist, they can provide even more insight into how to minimize your risk for heart disease. Regardless of whether make an appointment or not, the cornerstone of preventive cardiology still comes down to diet and lifestyle. And that's a proactive step you can take without whipping out your insurance card.
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