Cardiovascular disease remains the leading cause of death worldwide. While we've made significant advances in treating heart disease, prevention remains one of our most important tools.
One of the challenges is that cardiovascular risk isn't always obvious. Someone can exercise regularly, feel relatively healthy, and have what appears to be a normal cholesterol panel while still having underlying risk factors that deserve attention.
Most people are familiar with LDL and HDL cholesterol. LDL is commonly referred to as "bad" cholesterol because elevated levels are associated with plaque buildup in the arteries. HDL is often called "good" cholesterol because it participates in transporting cholesterol away from peripheral tissues.
These numbers are important, but they don't tell us everything.
When evaluating cardiovascular and metabolic health, there are additional laboratory tests worth considering.
1. ApoB: Looking at the Number of Atherogenic Particles
Apolipoprotein B, or ApoB, is a protein found on the surface of atherogenic lipoprotein particles, including LDL, VLDL, IDL, and lipoprotein(a).
Each of these particles carries one ApoB molecule. Measuring ApoB therefore gives us an estimate of the total number of particles capable of contributing to plaque formation in the arteries.
Why does this matter?
Two people can have similar LDL cholesterol levels but very different numbers of atherogenic particles. ApoB can help identify this difference and provide additional information about cardiovascular risk.
2. Lp(a): The Genetic Risk Factor Many People Don't Know About
Lipoprotein(a), or Lp(a), is a cholesterol-containing lipoprotein that is largely determined by genetics.
Elevated Lp(a) is an independent risk factor for cardiovascular disease, including coronary artery disease and aortic valve stenosis.
One important consideration is that Lp(a) levels are generally not significantly affected by diet and exercise. Someone can have healthy lifestyle habits and otherwise favorable cholesterol numbers but still have elevated Lp(a) because of their genetics.
Because levels are largely inherited and relatively stable throughout life, measuring Lp(a) at least once in adulthood is recommended by many cardiovascular guidelines and expert groups.
Knowing your level can help guide how aggressively other modifiable risk factors should be addressed.
3. Fasting Insulin: Looking Beyond Blood Sugar
Insulin is a hormone produced by the pancreas that helps regulate blood glucose.
When the body becomes less responsive to insulin, the pancreas may compensate by producing more insulin to maintain relatively normal blood sugar levels. This is known as insulin resistance.
The challenge is that insulin resistance can develop before fasting glucose or hemoglobin A1c becomes abnormal.
Fasting insulin may provide additional insight into metabolic health and possible insulin resistance. Insulin resistance is associated with several cardiovascular risk factors, including high triglycerides, low HDL, elevated blood pressure, and increased risk of type 2 diabetes.
Fasting insulin is not a stand-alone diagnostic test, and results need to be interpreted in context. However, it can be a useful additional piece of information when evaluating someone's metabolic health.
Looking at the Bigger Picture
ApoB, Lp(a), and fasting insulin each provide different information:
ApoB helps us understand the number of atherogenic particles.
Lp(a) helps identify an inherited cardiovascular risk factor.
Fasting insulin can provide insight into insulin resistance and metabolic health.
None of these tests replaces a standard lipid panel or a comprehensive cardiovascular risk assessment. Blood pressure, smoking history, family history, diabetes, kidney function, and other factors also matter.
The goal isn't simply to order more laboratory tests. It's to understand what the results mean and use that information to make informed decisions about prevention.
At Hearthstone Family Care, I believe in taking the time to look beyond the obvious and consider the whole picture. Sometimes identifying risk earlier gives us an opportunity to make meaningful changes before disease develops.
Your cholesterol numbers are important. But they may not tell the whole story.