Cardiovascular risk assessment and statin prescribing
I and 43yrs old and have my annual wellness visit with my PCP coming up and would like a comprehensive heart health assessment. Besides the standard lipid panel, what additional tests (e.g., ApoB, Lipoprotein(a), hs-CRP, CAC scan, etc.) would you recommend, even if insurance doesn’t cover them? Also, if the results indicate elevated cardiovascular risk, can a PCP prescribe a statin, or is it better to see a cardiologist directly for comprehensive screening ?
A PCP can prescribe all medications including statins. Do remember that the threshold for starting among PCP’s as well as cardiologists (particularly in South Asians at high risk) can vary which is why you need to be empowered with high quality evidence as it relates to you and ask probing questions so you can advocate for yourself. From a cardiac prevention standpoint, I would love to see an LDL level as a bare minimum. If this is unequivocally high the big goal is to lower it to target (less than 100 in all South Asians and lower numbers-less than 70 or 55 in higher and highest risk groups respectively) I like to see a Lp(a), ApoB , hs-CRP and CAC score for reasons we have shared before, MORE so if you are poorly motivated to start medication or need additional incentive to start lifestyle modification and/or meds. Even if insurance does NOT cover some or all of these, they can be obtained for less than roughly $200 (all included) here in the US and a few thousand rupees in India.