How should I talk about my cardiac risk at my next doctor's appointment?

Come prepared with three specific pieces of information: your home blood pressure average from two weeks of morning and evening measurements; your family history of premature cardiovascular events (specifically any first-degree relative, parent, sibling, who had a heart attack, stroke, or cardiac death before age 60); and whether your Lp(a) has ever been measured. With these three, you can ask: "Given my family history and my home blood pressure average, what should my specific cardiovascular risk assessment include, and specifically, has my Lp(a) been measured?"

The framing matters. "Is my heart okay?" is a question that invites a reassuring non-answer. "What specific tests do I need to assess my actual cardiovascular risk, given my family history and my race-specific risk factors?" is a question that requires a specific clinical response. A physician who gives you a specific answer about Lp(a), ApoB, home blood pressure monitoring, and CAC scoring is engaging with your actual risk profile. A physician who says "your cholesterol looks fine, see you next year" is not. You are entitled to the first kind of conversation. You may need to ask for it explicitly. (2017 ACC/AHA Hypertension Guidelines)

Cardiologist's calibrated position, Solid (1) for this question framework.

What to do: Write down the three data points and the specific question before your appointment. Bring them. The prepared patient gets a better appointment.

For the full picture, read The Cardiac Inheritance.