Cardiovascular Disease Risk Tests

Aetna covers hs‑CRP only for patients with 2+ major CHD risk factors, LDL 100–130 mg/dL, and intermediate 10‑year CHD risk (10–20% by Framingham), apoB testing to guide additional therapy in high‑risk hypercholesterolemia patients once LDL goals are reached (LDL <70 and non‑HDL <100 mg/dL with CVD/diabetes, or LDL <100 and non‑HDL <130 mg/dL with other risk factors), homocysteine testing for homocystinuria, unexplained thrombotic disorders or borderline B12 deficiency, and BNP/NT‑proBNP for evaluation of suspected heart failure; carotid IMT, noninvasive arterial elasticity/central pressure waveform tests and other uses of hs‑CRP/apoB/homocysteine are considered experimental/investigational and excluded. Key requirements: major CHD risk factors are age (men ≥45, women ≥55), current smoking, premature family history, hypertension (BP ≥140 or on meds), and low HDL (<40 mg/dL); high‑risk for apoB = diabetes, known CVD, or ≥2 CVD risk factors.

"G46."