Heart disease is the leading cause of death in women in the U.S.  However, if you are a pre-menopausal, asymptomatic female, don't overreact.  Tthe most valuable tests to have to indicate your heart disease risk are the old standbys – blood pressure, cholesterol level, weight and blood sugar. 

There's no question that you need to see a doctor when you're not well.  But what about regular visits to the doctor for physical examinations by people who believe they are well?  Think about these facts:

• Women are at risk for heart disease and heart attacks, just like men. While they develop heart problems later in life than men, by about age 65, a woman's and man's risk is almost the same.
• Heart disease doesn't happen overnight.  Your doctor can easily identify conditions that increase your risk as well as early warning signs.
• Heart disease – and even a heart attack – may or may not produce symptoms.
• Heart disease can be prevented/delayed with appropriate care and life style choices.

In fact, routine well visits to your doctor are extremely useful to help reduce your risk for cardiovascular disease.

• An unhealthful cholesterol level can be identified by an exam and a blood test.  Today's cholesterol lowering drugs can reduce future risk of heart disease by about 33%.
• By identifying high blood pressure and prescribing appropriate medication the future risk of stroke and heart attack can be reduced significantly.
• According to the American Diabetes Foundation 2 out of 3 people with diabetes die from heart disease and stroke.  Simple tests can identify the problem so your doctor can initiate treatment before major damage has been done.
• Early menopause, natural or surgical, can double a woman's risk for developing heart disease.
• Doctors may identify one or more of a vast number of differing health problems from observations made during a regular exam.
• Your doctor can help you stop smoking and build a plan for exercise

If your doctor suspects you're at risk for heart disease, there are a number of traditional diagnostic tools used to look for cardiovascular disease in general and coronary artery disease in particular.  Some of them are heart imaging techniques, that is, ways of creating pictures of the inside of the heart that can show the presence and extent of heart disease.  These diagnostic tools include:

• Blood tests: when cells (including heart muscle cells) die, enzymes are released into the blood; blood tests can detect the presence and amount of these enzymes
• Electrocardiogram (EKG, ECG, or cardiogram): a measurement of the heart's electrical activity (which controls the heartbeat) made by an EKG machine, which is attached to the chest with wires called "electrodes" 
• portable EKG: if an EKG doesn't give conclusive results, one may get a portable EKG machine, called a "Holter monitor," to wear for a day; it monitors the heart rate and notes any arrhythmias (irregularities)
• Stress EKG (stress test): an electrocardiogram made while the person is exercising (usually by jogging on a treadmill or riding a stationary bike)
• if one is unable to exercise, a drug can be injected that makes the heart react as it would during exercise
• Echocardiogram: sound waves are bounced off the heart to produce still and moving images of it (similar to ultrasound imaging used with pregnant women to produce images of fetuses.) 
• a "stress echo" is a stress test and echocardiogram done at the same time
• Cardiac catheterization: in this more invasive test, a small tube (catheter) is inserted through a blood vessel and threaded up into the heart, to measure blood flow and pressure
• Coronary angiogram (also called arteriogram): an x-ray of the inside of the coronary arteries to look for blockages
• during cardiac catheterization, a contrast dye is injected into the catheter that enables blockages to be seen on the x-ray
• the process of making an angiogram is called angiography

Recently, a new type of imaging test, EBCT (electron beam computerized tomography or "Ultrafast CT" ), has received a lot of publicity and advertising.  EBCT, often called a "heart scan," is a type of computerized tomography (popularly known as CT scan or "CAT scan").  Computerized tomography is a sophisticated imaging system that creates a series of very detailed, cross-sectional images of organs and tissues. EBCT is a variation that works much more quickly.  It provides an accurate measurement of calcium deposits in the coronary arteries.  These calcium deposits are reported as a "calcium score;"  the higher the score, the greater the amount of calcium deposits.  Scores range from 0 (no evidence of calcium deposits) to over 400 (very high amounts of calcium are present).

There does appear to be a correlation between large calcium deposits in the coronary arteries and the development of coronary artery disease.  However, the correlation seems age-dependent; that is, it is stronger for younger people (up to about 50) than older (above 50).  People over 50 seem to develop calcium deposits naturally, so they're not as accurate a predictor of future CAD. 

Moreover, the medical profession believes certain standards must be met before a screening test (a diagnostic tool, such as EBCT) can be called cost-effective. One of these is that it must provide information that will affect treatment and prognosis.  So far, there are no studies showing that EBCT "heart scanning" has any significant effect on reducing deaths from CAD or improving the lives of people with it. 

For example, EBCT will identify small build-ups of calcium (such as 10-20%), but these results generally don't lead to changes in treatment, other than re-emphasizing the importance of reducing risk factors, such as smoking and cholesterol.  Further, the test finds only calcium deposits that have become hard (called "hard plaque"); it does not find "soft plaque" which can also cause heart attacks.

Besides being of limited value in the early detection of CAD, EBCT is unavailable in many areas, expensive, and generally not covered by insurance.  A team of experts from the American College of Cardiology, American Heart Association, and the American College of Physicians-American Society of Internal Medicine concluded that: "The proper role of EBCT is controversial and will be the subject of future ACC/AHA statements."

Three-Dimensional Helical Computed Tomography (or DHCT) is another advanced variation on traditional CT scanning.  Like EBCT, there are many places where it isn't available, it's expensive and generally not covered by insurance, and at present may be of limited value in the early detection of CAD.