By Dr. Kelly Wilhelms | Thoughts on Innovation
Heart health plays an important role in helping us stay active, enjoy life, and continue doing the things we love. And while most of us are familiar with having our cholesterol checked, today’s science tells us that a standard cholesterol panel may not always provide the complete picture of cardiovascular risk.
A traditional lipid panel typically measures total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. These remain important measures of cardiovascular health. In fact, updated 2026 guidelines from the American College of Cardiology and American Heart Association continue to emphasize LDL-C as an important target for preventing atherosclerotic cardiovascular disease (ASCVD).
But additional blood tests can help clinicians better understand an individual’s risk. Two markers receiving increased attention from leading cardiovascular and medical organizations such as the American Heart Association (AHA) and the American College of Cardiology (ACC) are apolipoprotein B (apoB) and lipoprotein(a), or Lp(a).
Looking Beyond LDL Cholesterol
LDL-C measures the amount of cholesterol carried within LDL particles. ApoB provides different information that can be used as an estimate of the number of atherogenic, or plaque-forming, lipoprotein particles circulating in the blood.
Every plaque-forming lipoprotein particle, including LDL and other cholesterol-carrying particles, contains one apoB molecule. As a result, measuring apoB can provide insight into the number of potentially harmful particles rather than simply the amount of cholesterol they carry.
That distinction matters. Two people with similar LDL-C levels may have different numbers of apoB particles and, therefore, different levels of cardiovascular risk. This misalignment can occur particularly in people with elevated triglycerides, diabetes, or other cardiometabolic risk factors.
ApoB testing may also be informative for people with cardiovascular-kidney-metabolic syndrome or known cardiovascular disease, including individuals whose LDL-C and non-HDL-C levels have already reached recommended goals.
New guidelines released by the American College of Cardiology (ACC) and the American Heart Association (AHA) earlier this year, recognize apoB testing as a useful tool for refining cardiovascular risk in selected patients.
Lp(a): A Risk Factor You May Inherit
Another important blood marker is Lp(a). Unlike many cardiovascular risk factors, Lp(a) levels are largely determined by genetics and generally remain relatively stable throughout adulthood.
Elevated Lp(a) is a risk factor that directly increases the chance for ASCVD, including heart attack and stroke. Because someone can have elevated Lp(a), even when the results of a traditional cholesterol panel appear reassuring, the new guidelines by the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that all adults have their Lp(a) measured at least once in their lifetime.
Unfortunately, lifestyle changes typically have little effect on Lp(a) levels. Knowing whether this marker is elevated can help patients and their health care providers focus more closely on complementary risk factors they can change, such as LDL-C, blood pressure, diabetes, tobacco use and physical activity.
Other Numbers Worth Knowing
ApoB and Lp(a) don’t replace the standard lipid panel. Instead, they complement routine testing to create a more complete assessment of cardiovascular health. A standard lipid panel can calculate LDL-C, HDL-C, total cholesterol, and triglycerides. It can also be used to calculate non-HDL cholesterol, which reflects the types of cholesterol most likely to contribute to plaque buildup in the arteries. In select patients, clinicians may also consider testing high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation that can help refine cardiovascular risk.
Blood pressure, blood glucose or hemoglobin A1C, kidney health, family history, smoking status, and other clinical factors are also important pieces of the cardiovascular risk assessment. No single laboratory value should be interpreted in isolation. Together, these tests can help patients and their health care providers better understand cardiovascular risk and make more informed decisions about prevention and care
This can be particularly important for women, whose cardiovascular risk may also be influenced by factors such as pregnancy-related conditions and menopause. The latest cardiovascular guidance recognizes reproductive factors including preeclampsia, gestational diabetes, and early menopause as potential risk enhancers that clinicians should consider when evaluating an individual’s overall risk.
Knowledge Can Lead to Earlier Action
The goal of cardiovascular testing isn’t simply to collect more numbers – it’s to identify risk early enough to do something meaningful about it. Patients who are interested in apoB or Lp(a) testing can speak with their health care provider about whether it is appropriate for them. ApoB testing is also available without a doctor’s order through Sonora Quest’s My Lab Request™.
Lab test results are most valuable when considered within the context of your complete health history. Results that are outside the expected range should be discussed with your physician or a specialist who can assess your overall cardiovascular risk and determine whether lifestyle changes, additional testing, or treatment may be appropriate. Even results within expected ranges can be useful for establishing a baseline and beginning a conversation about cardiovascular health.
When it comes to protecting your heart, knowing your numbers is an important first step. Understanding what those numbers mean and working with your health care team to act on them can help turn a simple blood test into a powerful tool for prevention.
Editor’s Note: Dr. Kelly Wilhelms is the scientific director at Sonora Quest Laboratories
