Best Tests for Heart Health

Cardiovascular disease (CVD) accounts for roughly 1 in 3 deaths globally, according to WHO data. Yet much of this burden is preventable when risk is identified early. Standard cholesterol panels miss a substantial fraction of at-risk individuals. Modern testing — combining advanced lipid markers, inflammatory biomarkers, and cardiac imaging — can detect cardiovascular risk decades before a heart attack or stroke.

Advanced Lipid Testing

A standard lipid panel measures total cholesterol, LDL-C, HDL-C, and triglycerides. While useful, these metrics have significant limitations. LDL-C measures the cholesterol mass carried in LDL particles, but it is the number of particles — not the cholesterol content — that drives atherosclerosis. Two people with identical LDL-C can have vastly different particle counts.

• •ApoB — One ApoB molecule sits on every atherogenic particle (LDL, VLDL, IDL, Lp(a)). ApoB directly counts these particles. The European Atherosclerosis Society consensus statement recommends ApoB as a primary treatment target.
• •Lp(a) — A genetically determined lipoprotein that increases risk of heart attack, stroke, and aortic valve stenosis. Roughly 20% of the global population has elevated Lp(a). It should be measured at least once in every adult's lifetime (European Heart Journal, 2022).
• •LDL particle number (LDL-P) — An alternative to ApoB that specifically counts LDL particles. Available via NMR LipoProfile testing.
• •Triglyceride-to-HDL ratio — A simple ratio from standard labs. A ratio above 3.0 suggests insulin resistance and small-dense LDL predominance.

Inflammatory & Metabolic Markers

• •hsCRP — High-sensitivity C-reactive protein measures systemic inflammation. The JUPITER trial (NEJM, 2008) demonstrated that elevated hsCRP, even with normal LDL, identifies individuals who benefit from statin therapy.
• •Homocysteine — Elevated levels are associated with increased cardiovascular risk and may indicate folate or B12 deficiency.
• •Fasting insulin — Hyperinsulinemia is an early driver of endothelial dysfunction and atherosclerosis, often present years before diabetes develops.
• •Uric acid — Emerging evidence links elevated uric acid to hypertension and cardiovascular events beyond its role in gout.

Cardiac Imaging

Blood tests reveal circulating risk factors, but imaging shows what is actually happening in your arteries. The two most valuable cardiac imaging tests for asymptomatic adults are the coronary artery calcium (CAC) score and CT angiography.

• •Coronary Artery Calcium (CAC) Score — A non-contrast CT scan that quantifies calcified plaque in the coronary arteries. A score of 0 indicates very low 10-year event risk. The MESA study (Journal of the American College of Cardiology, 2014) showed that CAC adds significant predictive value beyond traditional risk factors. Cost: $75–$200, no insurance needed at many imaging centers.
• •CT Angiography (CTA) with AI Analysis — Cleerly uses AI to analyze coronary CTA scans, detecting and characterizing both calcified and non-calcified (soft) plaque. Soft plaque is the type most prone to rupture and cause heart attacks. This test provides the most detailed non-invasive view of coronary artery disease.
• •Carotid Intima-Media Thickness (CIMT) — Ultrasound measurement of the carotid artery wall thickness. Increased CIMT is associated with elevated stroke and MI risk, though its incremental value over CAC is debated.

Building Your Cardiac Testing Plan

For most adults, start with an advanced lipid panel (including ApoB and Lp(a)), hsCRP, and fasting insulin. If any markers are elevated — or if you have a family history of premature heart disease — add a CAC score. If the CAC is elevated or if soft plaque detection is a priority, consider CT angiography with Cleerly. This layered approach gives you actionable data at each step without unnecessary testing.