A standard cholesterol panel checks your LDL, HDL, and triglycerides. Your doctor tells you everything looks fine. You move on with your life.

But what if a standard lipid panel is missing the full picture?

We analyzed blood test data from Empirical Health members who completed advanced cardiovascular panels with markers like ApoB, Lp(a), hs-CRP, HbA1c, eGFR, and blood pressure. We found 83% of patients had at least one abnormal cardiovascular risk factor, most of which a basic cholesterol panel would have missed.

This post breaks down which heart health blood tests matter, how often they come back abnormal, why they tend to cluster together, and ways to order heart health tests online.

The 6 heart health blood tests that matter most

Cardiovascular disease isn’t caused by a single number. As Jeff Wessler of Heartbeat Health put it, heart disease happens when “circulating fats in the blood (e.g. ApoB & Lp(a)) are pushed by a driving force (i.e. blood pressure) into a vessel wall that is vulnerable (inflammation).” To understand your heart heatlh, you need to understand each independent risk factor:

Test	What the test measures	Risk threshold
ApoB	Number of atherogenic particles in your blood (a better cholesterol)	≥ 100 mg/dL
Lp(a)	Genetically-determined lipoprotein that accelerates plaque	≥ 50 mg/dL
hs-CRP	Systemic inflammation, an independent driver of heart attacks	≥ 2.0 mg/L
HbA1c	Average blood sugar over 3 months (diabetes marker)	≥ 5.7%
Blood pressure	Force on arterial walls	≥ 130/80 mmHg
eGFR	Kidney function (reduced function = higher CV risk)	< 60 mL/min

While some of these tests have funny names, they aren’t obscure research markers. All six are recognized as risk-enhancing factors in the 2018 AHA/ACC Cholesterol Guideline, the 2023 AHA PREVENT equations, and the American College of Cardiology’s 2025 guidelines. Most annual physicals only check a few of these (A1c, blood pressure, and sometimes eGFR).

What our data shows about heart health screenings

Among Empirical Health members with all six markers tested, 87% found at least one abnormal result. 52% had two or more abnormal biomarkers. Only 17% had a clean bill of health across all six heart health markers.

Left: 83% of people had at least one abnormal blood test results. Right: breakdown for each heart health test of what percentage of patients received an abnormal result.

Even in a health-conscious population (people who proactively order advanced blood tests), the majority of people have hidden risk.

In our data, Lp(a) was the heart health blood test that was most commonly abnormal, with 43% of people getting an elevated result. About 40% of people had an elevated ApoB. eGFR, which measures kidney function, was the biomarker that was normal for the greatest number of people.

Heart health biomarkers are correlated

Cardiovascular risk factors don’t occur independently. If you have one abnormal marker, you’re significantly more likely to have others.

How heart health blood test results are linked. This chart shows the percentge of people with an abnormal result for the test listed in each column, given that they had an abnormal result for the test listed in the row.

For example, among users with elevated hs-CRP, 47% also had elevated ApoB. Among those with elevated HbA1c (insulin resistance), 57% had high Lp(a).

This clustering effect is well-documented in the medical literature. It’s why the AHA’s new PREVENT risk calculator incorporates kidney function (eGFR) and metabolic markers alongside traditional lipid levels. These systems are interconnected.

A new cardiovascular disease risk calculator was needed, particularly one that includes measures of CKM syndrome, which is highly prevalent in the U.S. The new PREVENT risk calculator enables clinicians to quantify this risk and may help people receive preventive care or treatment earlier to reduce CVD risk.

— Sadiya S. Khan, MD, Associate Professor of Cardiology, Northwestern University; Chair of the AHA PREVENT equations committee (AHA Newsroom, 2023)

Why a basic cholesterol blood test isn’t enough to check heart health

Let’s go through each heart health blood test that we recommend one-by-one, to understand exactly what they measure and why they’re important screenings.

ApoB: a more accurate blood test than cholesterol

A standard lipid panel measures LDL cholesterol, which is the amount of cholesterol carried by atherogenic particles. But it doesn’t measure the number of particles themselves. This distinction matters — ApoB is more accurate than LDL cholesterol — and the two disagree more often than most people realize:

ApoB is the accurate sum of all the atherogenic particles, and that’s the most important measure you can make. When your LDL or non-HDL cholesterol are measured, you may not have an accurate idea of the risk posed to you.

— Allan Sniderman, MD, Edwards Professor of Cardiology, McGill University (CAP TODAY)

The 2024 National Lipid Association consensus statement puts it plainly:

“ApoB has been shown to be superior to LDL-C in risk assessment both before and during treatment with lipid-lowering therapy. LDL-C may be an inadequate measure when discordant from apoB levels.”

— National Lipid Association Expert Panel, Journal of Clinical Lipidology, 2024 (PMC)

Inflammation: an emerging heart health biomarker

Cholesterol tells you nothing about inflammation, which is an independent driver of cardiovascular events. The latest evidence shows that inflammation may be a stronger test of heart disease than even LDL cholesterol:

Inflammation is now a stronger predictor of heart health than even LDL cholesterol. Source: Journal of the American College of Cardiology

The American College of Cardiology now recommends that people test their inflammation for heart health, specifically using hs-CRP (high sensitivity c-reactive protein). The ACC says:

Universal screening of hsCRP in both primary and secondary prevention patients, in combination with cholesterol, represents a major clinical opportunity and is therefore recommended.

• American College of Cardiology scientific statement

If you’re not measuring CRP, you have no idea that your patient even has this problem.

— Paul M. Ridker, MD, Director, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital (TCTMD)

We can’t treat what we don’t look for, and that’s why we as cardiologists and our primary care colleagues need to be more attuned to the role of inflammation in cardiovascular risk.

— Jared A. Spitz, MD, Inova Health System (ACC.org, 2025)

Lp(a): hereditary risk of heart disease

Lipoprotein(a), or Lp(a), is a type of cholesterol particle that is almost entirely determined by your genes. Each Lp(a) particle is 6.6x more likely to cause hart disease than a “standard” cholesterol particle. A recent study shows that only 0.2% of people get their Lp(a) tested, but the American College of Cardiology recommends an Lp(a) test at least once in your lifetime.

Blood pressure: not a blood test, but measurable at-home

Your doctor almost certainly has measured your blood pressure in the office. Modern medical guidelines recommend measuring your blood pressure at home, taking the average of many measurements. Our data indicates blood pressure varies day-to-day by up to 20 mmgHg.

eGFR and HbA1c: the effect of kidneys and liver on heart heatlh

eGFR (estimated Glomerular Filtration Rate) is a blood test that measures how well your kidneys are filtering waste from your blood. Declining kidney function is an important risk factor for heart disease. People with reduced eGFR face significantly higher cardiovascular risk, even if their cholesterol is normal.

HbA1c (Hemoglobin A1c) is a marker that reflects your average blood sugar levels over the past 2-3 months. Elevated HbA1c means you have prediabetes or diabetes, both of which greatly increase the risk of heart attack and stroke. Even mildly elevated HbA1c can quietly increase cardiovascular risk, making it important to check regularly. Most doctors check HbA1c.

Which heart health blood tests should you check? And how to order online.

While a basic cholesterol test is better than nothing, it’s not enough. Our data shows that the majority of people carry at least one cardiovascular risk factor that only shows up on advanced testing. Based on the clinical evidence and our data, a comprehensive cardiovascular screening should include six key tests: ApoB, Lp(a), hs-CRP, HbA1c, blood pressure, and eGFR.

The good news: all of these tests are widely available, relatively inexpensive, and can be ordered through your doctor or through services like Empirical Health’s advanced heart health test.