Advanced Heart Disease Risk Blood Test

Cholesterol is an essential fat (lipid) in the body with important functions including building cell membranes and producing hormones. Cholesterol is manufactured in the liver and also comes from food. The two main components of total cholesterol are HDL (high-density lipoprotein), which is protective against heart disease, and LDL (low-density lipoprotein), which in high levels can contribute to cardiovascular disease. Your total cholesterol result on its own is of limited value—understanding the breakdown into HDL and LDL is more important for assessing cardiovascular risk.

LDL cholesterol (low-density lipoprotein) is a molecule made of lipids and proteins which transports cholesterol, triglycerides, and other fats to various tissues throughout the body. Too much LDL cholesterol, commonly called 'bad cholesterol', can cause fatty deposits to accumulate inside artery walls, potentially leading to atherosclerosis and heart disease.

HDL cholesterol (high-density lipoprotein) is a molecule that removes cholesterol from the bloodstream and transports it to the liver where it is broken down and removed from the body in bile. HDL cholesterol is commonly known as 'good cholesterol' because higher levels are protective against heart disease.

Non-HDL cholesterol is calculated by subtracting your HDL cholesterol from your total cholesterol. It includes all the non-protective and potentially harmful cholesterol in your blood, including LDL, VLDL (very low-density lipoproteins), and other lipoproteins thought to be even more harmful than LDL. As such, non-HDL cholesterol is considered a better marker for cardiovascular risk than total cholesterol or LDL alone. The recommended level is below 4 mmol/L.

The cholesterol:HDL ratio is calculated by dividing your total cholesterol value by your HDL cholesterol level. It is used as a measure of cardiovascular risk because it gives good insight into the proportion of your total cholesterol which is protective (HDL). Heart disease risk tools use this ratio to calculate your risk of having a heart attack. A lower ratio is better.

Triglycerides are a type of fat (lipid) that circulates in the blood. After you eat, your body converts excess calories—whether from fat or carbohydrates—into triglycerides, which are then transported to cells to be stored as fat. Your body releases triglycerides when required for energy. High triglyceride levels are associated with increased cardiovascular risk.

Apolipoprotein A1 (ApoA1) is the main protein found in high-density lipoprotein (HDL) cholesterol. The higher your ApoA1 result, the more HDL cholesterol particles you have. HDL cholesterol helps clear cholesterol from the blood by removing cholesterol from organs and tissues to be broken down by the liver. A low ApoA1 level, especially with a raised ApoB result, is associated with an increased risk of cardiovascular disease.

Apolipoprotein B (ApoB) is the main protein found in lipoproteins such as low-density lipoprotein (LDL) cholesterol and ultra-low-density lipoproteins. Each of these lipoproteins contains one ApoB particle. So, your ApoB levels can tell you the number of these lipoproteins in the blood, which is why ApoB is considered a better predictor of heart disease risk than LDL cholesterol measurements alone. Too much ApoB is linked to conditions like atherosclerosis, heart attacks, and strokes.

Lipoprotein(a), or Lp(a), is a type of lipoprotein made by the liver. Lp(a) is very similar to LDL cholesterol but is more "sticky" as it also contains a protein called Apo(a). Lp(a) is thought to play an important role in the blood's clotting system, but raised levels are linked to a higher risk of cardiovascular disease, including heart attacks and strokes. The amount of Lp(a) in your blood is determined by your genes and not affected by your age, sex, or lifestyle factors.

The enzyme lipoprotein-associated phospholipase A2 (Lp-PLA2) plays a role in the inflammation of blood vessels, promoting the build up of plaque in the coronary arteries. Lp-PLA2 is a risk marker for cardiovascular disease and because it is produced in the plaque itself, Lp-PLA2 is thought to be more sensitive at assessing cardiovascular disease risk than traditional inflammatory markers, such as CRP.

High-sensitivity CRP (hs-CRP) is an inflammation marker used to detect low-level inflammation thought to damage blood vessels, which can lead to heart attack or stroke. When you suffer a serious injury or infection you experience significant inflammation around the site of injury—any injury like this will cause your hs-CRP to rise. hs-CRP is an important marker for assessing cardiovascular risk beyond traditional cholesterol measurements.