The core cardiac risk blood panel
| Test | Optimal | Borderline/High | Why it matters |
|---|---|---|---|
| Total Cholesterol | <200 mg/dL | 200–239 / ≥240 | Overall lipid burden |
| LDL Cholesterol | <100 mg/dL (<70 if very high risk) | 130–159 / ≥160 | The main statin target; builds arterial plaque |
| HDL Cholesterol | >60 mg/dL | 40–60 / <40 (men) | Protective; removes cholesterol from arteries |
| Triglycerides | <150 mg/dL | 150–199 / ≥200 | Raised by carbs, alcohol, diabetes |
| Fasting Glucose | 70–100 mg/dL | 100–125 (pre-diabetes) | Diabetes doubles heart risk |
| HbA1c | <5.7% | 5.7–6.4% (pre-diabetes) | 3-month blood sugar average |
| hs-CRP | <1.0 mg/L (low risk) | 1.0–3.0 (moderate) | Vascular inflammation |
Advanced cardiac biomarkers
Lipoprotein(a) — Lp(a)
Lp(a) is a genetically determined atherogenic lipoprotein that increases heart attack and stroke risk independently of LDL. It is not reduced by statins. Optimal: <30 mg/dL. About 20% of the population has elevated Lp(a). It should be measured at least once in every adult, especially those with premature heart disease or a family history of heart attack before age 60. Newer drugs specifically targeting Lp(a) are in development.
Homocysteine
Elevated homocysteine (>15 micromol/L) is associated with increased cardiovascular risk, stroke and venous thrombosis. It rises with B12 and folate deficiency, hypothyroidism, kidney disease, and genetic MTHFR mutations. Supplementing B12 and folate lowers homocysteine but has not been proven to reduce cardiovascular events in large trials.
NT-proBNP / BNP
The heart failure markers. NT-proBNP >125 pg/mL in a patient with breathlessness strongly suggests heart failure. Used in: diagnosing heart failure, monitoring treatment, and as a prognostic marker. A completely normal NT-proBNP makes significant heart failure very unlikely.
High-sensitivity Troponin (hs-cTn)
The definitive heart attack test. A single negative hs-troponin at presentation, followed by a second negative at 1–3 hours, rules out acute MI with >99% sensitivity. Also mildly elevated in heart failure, pulmonary embolism, myocarditis and after intense exercise.
10-year cardiovascular risk calculators
Rather than treating each test result in isolation, doctors calculate your overall 10-year cardiovascular risk using validated calculators: ASCVD Pooled Cohort Equations (USA), SCORE2 (Europe), QRISK3 (UK). These combine: age, sex, smoking status, blood pressure, cholesterol, diabetes status and ethnicity to estimate your 10-year risk of heart attack or stroke. Treatment decisions (whether to start statins, aspirin, etc.) are largely based on this overall risk, not individual test values alone.
How often to test
| Test | Frequency |
|---|---|
| Fasting lipid profile | Every 5 years from age 20; annually if on statins or history of heart disease |
| Fasting glucose / HbA1c | Every 3 years if normal; annually if pre-diabetic or high-risk |
| hs-CRP | Once — guides statin decision in borderline-risk patients |
| Lp(a) | Once in a lifetime (genetically determined) |
| NT-proBNP | Only if symptoms of heart failure |
Questions to ask your doctor
- What is my 10-year cardiovascular risk?
- Should I be on a statin?
- What is my Lp(a) level?
- Is my hs-CRP elevated?
- What lifestyle changes will lower my cardiac risk most effectively?