Getting your heart checked, from cheap to expensive

If you want to know where your blood vessels stand right now, you are spoiled for choice: blood tests, home devices, scans and commercial "biological age clocks" are available in abundance. Yet the quality of the evidence behind them varies enormously. Below we compare the most widely used measurements on what they actually measure and who they make sense for. For the bigger picture, read Heart & blood vessels.

Two blood values you need to ask your GP to add

A standard cholesterol result shows LDL, but ApoB predicts your risk of atherosclerosis better than LDL does, even when your LDL looks normal. Research involving more than a million people consistently shows that ApoB more directly reflects the number of risky particles circulating in your blood. The test is inexpensive, requires only a blood draw and can be requested from most GPs. While you are at it, ask for Lp(a) as well: that value is largely genetically determined and rounds out your lipid risk picture.

A second underrated value is hsCRP, the sensitive marker for chronic low-grade inflammation. An elevated hsCRP predicts cardiovascular problems over decades, independently of cholesterol, in people with no known heart disease. Research involving nearly 28,000 people confirms that it is an independent risk factor, not a by-product of other abnormalities. This test belongs in a basic blood panel too, and costs very little.

Almost nobody measures their blood pressure correctly

Persistently high or highly variable blood pressure demonstrably raises your risk of stroke and heart attack, and the evidence for that is solid. Even so, a single reading at your GP's office is not worth much: white-coat effect and masked hypertension make a one-off measurement unreliable. Taking readings at fixed times over several days at home gives a far more realistic picture, and that series is what you should discuss with your doctor.

If you want to go a step further, a 24-hour ambulatory blood pressure monitor adds something useful, particularly the nighttime reading. Large studies link nighttime blood pressure to an elevated risk of cardiovascular disease, and it reflects how your blood vessels are ageing, although the extra predictive gain over good home monitoring is modest in absolute terms. Blood pressure alone is not a complete measure of biological age, but it is one of the cheapest and most direct signals you have.

The calcium scan: useful when there is doubt

A coronary artery calcium score (CAC scan) maps calcium deposits in your coronary arteries. The clinical value sits at the extremes: a score of zero offers well-founded reassurance and can justify deferring medication; a score above 300 in someone with no known heart disease is reason for a serious conversation with a cardiologist. For the large middle group the score is less decisive, and the likelihood of unnecessary worry and follow-up investigations has to be weighed in.

The scan is not free, involves a small radiation dose and sometimes turns up incidental findings unrelated to your heart that nonetheless trigger further workup. Use it as a decision-making aid when your risk profile remains unclear after blood tests, not as a routine check for everyone over forty.

Resting heart rate and HRV are signals, not a diagnosis

Your resting heart rate costs nothing to measure and says more than most people realise. A persistently high heart rate, above 80 to 90 beats per minute, is associated with a significantly higher risk of premature death, independently of other risk factors. Whether a high resting heart rate actively accelerates biological ageing is less well established; that hypothesis comes mainly from animal studies. Practically speaking, a persistently high resting heart rate is a signal to work on your fitness. A very low heart rate later in life is not automatically a good sign either, and can indicate a sinus node that is no longer functioning well.

Heart rate variability (HRV) measures how flexibly your nervous system responds to the shifting demands of your body. Higher HRV is associated with better health and resilience, but it is a signal, not a guarantee. Slow breathing is the best-supported way to raise your HRV. HRV trackers on smartwatches and rings are handy for following trends, but the absolute numbers vary widely between devices and cannot be compared with clinical research values.

What an epigenetic ageing clock can do, and what it gets you

Epigenetic "age clocks" that estimate your biological age based on DNA methylation have gained considerable momentum in recent years. They measure something real and, in research settings, correlate with disease risk. Commercial versions of these tests, however, still fall short of what they promise: the individual margin of error is large, there are almost no standardised reference values, and it is far from clear what you should actually do with the result. Until those questions are answered, an ApoB test combined with proper blood pressure monitoring is a far more robust investment in understanding your vascular health.

What you can arrange with your GP

For most people over 40, a basic blood panel covering ApoB, Lp(a) and hsCRP, combined with home blood pressure readings taken over several days, already paints a solid picture. It is accessible, affordable and something you can request from your GP. A CAC scan adds the most value when your risk profile remains unclear after those blood tests. If you want to track resting heart rate and HRV, treat them as a complement to this foundation, not a replacement for it. Women approaching or going through menopause deserve particular attention: menopause shifts the risk profile in several ways at once, and that warrants a personal conversation with your doctor about what these values mean for your specific situation.