“Your blood is whispering a story — about every vessel, every cell, every risk you’re carrying. Is anyone listening?”
Today I want to talk about what might be lurking in your blood that your doctors don’t warn you about.
I wrote recently about the importance of vascular screening tests in my article The Life-Saving Benefits of Vascular Screenings. Please read this article if you haven’t already and consider asking your doctor to order appropriate vascular screenings.
And keep reading this article for a more in-depth follow-up to that article now that I recently took my own advice and had vascular screenings and the additional blood tests that I realized were still missing.
Just before my recent cardiology appointment, I had a series of vascular screenings — tests I had to specifically ask my cardiologist to order. One of my cousins recommended this to me based on our shared history of familial strokes, including a stroke my father had.
Why don’t cardiologists focus on stroke prevention? The same arteries that supply blood to your heart also feed your brain. Doctors call strokes “brain attacks.” Damage to one system affects the other. In reality, good cardiology is good stroke prevention — but in reality, most cardiologists ignore stroke prevention.
Vascular screenings, which measure blood flow through key arteries such as the carotid and iliac, can reveal hidden blockages or narrowing long before stroke or TIAA symptoms appear. Fortunately, when my cardiologist reviewed the results, she confirmed that everything looked fine.
Sadly, most people never get these screenings before having a stroke, and unfortunately most doctors, including most cardiologists (even mine, who I consider to be excellent), do not routinely order vascular screenings for people who are asymptomatic, even with family history of stroke, unless other clear risk indicators exist, such as:
- Carotid bruit — an abnormal whooshing sound heard with a stethoscope over the carotid artery in the neck, caused by turbulent blood flow through a partially narrowed artery;
- aneurysm symptoms; or
- known atherosclerosis (meaning documented buildup of plaque in the arteries, such as with coronary artery disease).
But like many men my age, I have known atherosclerosis, with two coronary artery stents placed back in 2019, yet even with this risk factor, my cardiologist did not proactively order a vascular screening, despite the fact that:
- The Society for Vascular Surgery takes the position that carotid ultrasound may be reasonable in patients with known atherosclerosis elsewhere, particularly men over 65 or women over 70. Okay, so I’m not yet 65, but I’m still within the “known atherosclerosis” category.
- The American Heart Association / American Stroke Association takes a similar position — that screening may be considered in patients with multiple vascular risk factors or known CAD. Note that the American Stroke Association is a division of the American Heart Association, created in 1997 to focus specifically on stroke prevention, treatment, and recovery, and they operate under the same governance, publish together in journals such as Stroke and Circulation, and share the same official website (heart.org/stroke). They differ in focus, but they are two arms of the same body.
The result: even with a strong family history of stroke or aneurysm, and even with known coronary artery disease, patients rarely get offered these screenings unless they specifically request them. My experience — having to ask my cardiologist for carotid and aortic/iliac vascular screenings despite family history — is common, not an exception.
The big problem is that most people — including those at potential high risk for stroke — never ask for these screenings, and as an Elder Law attorney who sees the devastating aftermath of massive strokes on a regular basis, I want to do everything possible to get the word out to help prevent this from happening to others, especially when there are overlooked tools for risk prevention.
Vascular Screenings for Stroke Prevention … Half the Picture
The two most common vascular screenings (and the ones I had after I requested them) are:
Carotid artery ultrasound, which checks for plaque buildup or narrowing in the carotid arteries in the neck that supply blood to the brain. This is the one used for early detection of arterial disease that could lead to strokes.
Abdominal aortic and iliac artery ultrasound, which evaluates for aneurysms or blockages in the abdominal aorta and the iliac arteries that supply the legs and pelvis. Sometimes called an “AAA screening,” as it looks for abdominal aortic aneurysms, which are structural weaknesses in the main artery of the abdomen. If an AAA ruptures, it can cause massive internal bleeding. While an AAA does not directly cause a clot or blockage to the brain resulting in stroke, people who have an AAA often share the same risk factors as those prone to stroke — including high blood pressure, high cholesterol, atherosclerosis, and older age.
As important as vascular screenings are in stroke prevention, I have now also learned (through my own research) that it takes both vascular imaging and specialized blood chemistry to provide the clearest picture of your overall vascular health. Vascular screenings show how well blood is flowing, and the specialized blood tests reveal the quality of the blood flowing through it. Both of these tests are essential in the quest for preventing stroke.
My next step … getting the elusive and specialized blood tests that are so challenging to get.
Lipoprotein(a) and Stroke Risk — New Drugs on the Horizon
Prior to my recent cardiology exam, besides the vascular screenings, my cardiologist had ordered a more advanced version of the normal lipid panel that test your cholesterol — a test that included lipoprotein(a), a particle that carries cholesterol in the blood. My regular cholesterol levels (LDL and HDL) are great, but my lipoprotein(a) results came back slightly elevated. Good to know, but not yet very practical as there are currently no existing drugs specifically approved for the primary purpose of reducing lipoprotein(a) to directly mitigate cardiovascular risk. But there are drugs in development designed specifically to target lipoprotein(a).
What surprised me was what my cardiologist didn’t say . . . something I only found out on my own through later research. My cardiologist never mentioned that high lipoprotein(a) is linked not only to heart attacks but also to stroke risk. That’s probably because cardiologists are focused on the heart, and for some reason they don’t look at or even think about risk factors for stroke.
Stroke prevention is mostly in the realm of vascular specialists, but even these doctors don’t look at blood chemistry, only blood flow through the Doppler ultrasound vascular screening tests already explained above. Some major hospital systems have what they call interdisciplinary stroke prevention teams, but even these teams focus on reducing risk for people who have already had a stroke, not preventing strokes in the first place.
What the Science Says About Blood Tests and Stroke Risk
Research shows that a growing number of blood biomarkers can help predict who is at higher risk of stroke, even before symptoms appear. Here are a few of the most important ones:
• Lipoprotein(a) [Lp(a)] – Elevated levels increase risk of both heart attack and ischemic stroke.
• High-sensitivity C-reactive protein (hs-CRP) – Indicates chronic inflammation, which contributes to vessel damage.
• Homocysteine – High levels may weaken arteries and promote clot formation.
• Fibrinogen – A key clotting factor; excess levels increase the risk of blood clots and stroke.
• NT-proBNP and GDF-15 – Markers of heart stress that also predict stroke risk, especially in people with atrial fibrillation.
• Troponin – Commonly used in heart-attack diagnosis, but new studies show it can also predict both heart attack and stroke risk.
Studies from institutions such as UCLA Health and Nature Scientific Reports confirm that when these advanced biomarkers are measured together, the ability to predict future stroke risk is significantly improved compared to traditional cholesterol and glucose testing alone.
In other words, it’s not just about whether your “cholesterol is high.” It’s about whether the overall biochemical environment of your blood is setting the stage for inflammation, vessel damage, and clot formation.
Why Standard Lab Panels Often Miss the Mark
Most insurance-covered “routine labs” only test the basics: total cholesterol, HDL, LDL, triglycerides, and glucose. They rarely include these advanced markers mentioned above that reveal how your blood chemistry may be trending toward stroke risk.
Even when doctors know these tests would be valuable, insurance companies often refuse to cover them unless a specific condition has already been diagnosed — meaning the health care system rewards treatment rather than prevention.
When Doctors Don’t Talk to Each Other: The Divide Between Specialists and Primary Care
One of the biggest frustrations patients face today is the lack of coordination between specialists and primary care doctors. Each tends to stay in their own lane — even when the patient’s health would benefit from overlap.
For example, during my recent visit, I asked my cardiologist to include glucose and A1c testing in my blood work. She explained that cardiologists usually don’t order those tests because they “don’t want to step on the toes” of the patient’s primary care physician.
Let that sink in: I was in front of a heart specialist who could see every detail of my lipid profile and vascular condition — yet she was hesitant to check my blood sugar, even though diabetes is one of the biggest risk factors for both heart disease and stroke.
This sort of medical territorialism isn’t about neglect or ego. It’s largely systemic — a product of billing codes, insurance policies, and electronic health-record silos that keep each doctor’s practice financially and administratively separate. Cardiologists are reimbursed for cardiovascular testing, not metabolic screening. Primary care doctors, meanwhile, are expected to manage the “whole picture” — but they often lack the time or specialized tools to do so.
The result? You, the patient, may have to visit two different offices, pay for two sets of blood draws, and wait twice for results — all to assemble what should have been a single, integrated health picture.
In an ideal world, your cardiologist and primary care doctor would share labs, coordinate care, and discuss findings directly. But until that kind of communication becomes standard practice, patients have to take the lead. If you’re seeing a cardiologist, don’t hesitate to ask them to include tests for glucose, A1c, and other metabolic markers that affect cardiovascular health. And if your primary care doctor is ordering labs, ask for advanced lipid and inflammatory markers, too.
Preventing stroke isn’t about which doctor “owns” the test — it’s about connecting the dots before it’s too late.
Where Can You Go for Stroke Prevention If You Haven’t Had a Stroke?
You may have seen recent television ads from major hospitals such as the George Washington University Hospital Stroke Center promoting stroke prevention. These campaigns raise important awareness — but it’s worth knowing that most hospital “stroke centers” are designed primarily to treat or manage people who already have had a stroke, a transient ischemic attack (TIA), or another vascular condition.
Even the Johns Hopkins Stroke Prevention and Recovery Center (SPARC), which technically offers primary and secondary prevention, is only open one day per week and requires a referral from a primary care provider. In practice, that means it’s nearly impossible for a healthy person to get an appointment there unless their doctor has already identified a serious vascular concern. And the Johns Hopkins Heart and Vascular Institute only offers assistance if you are already “high risk.”
In short, there’s currently no widely accessible hospital-based stroke prevention clinic in the DMV for people who simply want to be proactive and stay healthy.
What Can You Do Instead?
This gap in the health care system leaves prevention-minded patients with only two real options:
Work Closely with Your Primary Physician and Cardiologist
Ask your primary care doctor or cardiologist to order a comprehensive blood panel that includes all the advanced stroke-related biomarkers listed above such as lipoprotein(a), high-sensitivity CRP, homocysteine, and fibrinogen, along with imaging such as carotid ultrasound or coronary calcium scoring if indicated.
Some doctors may resist, saying those tests are “not indicated” or “not routinely covered.” But if you have any cardiac disease, these tests are indicated. And my insurance covered my vascular screenings . . . yours may too.
Consider Functional Medicine for Specialized Blood Tests
If your primary physician or cardiologist won’t order advanced stroke-risk labs or vascular imaging, you still have options, but not many. The easiest route is to see a Function Medicine practitioner.
Functional Medicine practices specialize in broad blood chemistry and lifestyle-based prevention, though most are out-of-pocket (not covered by insurance). You can search by ZIP code here:
https://www.ifm.org/find-a-practitioner/
While this route isn’t ideal for everyone, it may be the only practical way to access the full spectrum of stroke-relevant biomarkers before any symptoms develop.
Consider Preventive Cardiology
Other potential options — but ones that may require a referral from your primary cardiologist:
Says it’s for people “at risk for heart disease but not yet diagnosed.” I got here via a referral from my Inova cardiologist. But this was just for the vascular screenings, not for the blood tests.
MedStar Health — Preventive Cardiology (DMV)
This group claims to assess personal risk and build a proactive plan. MedStar has cardiology clinics across DC, Maryland, and Northern Virginia.
Georgetown University/MedStar — Preventive Cardiology (D.C.)
Evaluation of risk factors with individualized plans; theoretically not limited to post-event patients.
GW Medical Faculty Associates — Preventive Cardiology/Lipids (D.C.)
Staying proactive means taking the initiative yourself — asking for tests that reveal the early warning signs of stroke risk, long before a neurologist ever gets involved.
Taking Control of Your Own Data
If you’re serious about protecting your brain and preserving independence as you age, consider investing in a comprehensive blood panel every year or two — whether through your own physician or a private functional medicine provider.
Yes, it’s an out-of-pocket expense for some, but one that could buy decades of quality life. When you get the results, take them to your primary care doctor or cardiologist. Don’t assume they’ll automatically run these tests on their own.
For help finding a practitioner who focuses on preventative blood chemistry, you can also start with the Institute for Functional Medicine’s Practitioner Directory.
The Bottom Line
Your blood can tell you far more than most lab reports reveal. If you want to age well and avoid the life-changing impact of a stroke, consider going beyond what insurance covers.
Ask your doctor — or a preventive care specialist — to test the biomarkers that modern research shows really matter. Don’t accept the narrow “routine labs” as sufficient. And don’t assume specialists coordinate automatically. Be proactive.
The difference between a healthy future and a devastating event may be simply a few overlooked numbers on a lab report — and one well-timed conversation with the right doctor.
Ready for more insights? Find in-depth articles covering Elder Law, Estate Planning, Medicaid Planning, Incapacity Planning, Asset Protection, Advance Directives, and much more — plus resources to help you get started — on the Everything Elder Law Blog. For real-world stories from families who very happy they planned ahead, read our Google Reviews.