Cardiovascular biomarkers
Lipids, inflammation, and vascular risk markers interpreted together rather than in isolation.
Key takeaways
- ApoB beats LDL cholesterol as a risk marker because particle number is what contacts the arterial wall.
- Lp(a) is largely genetic, elevated in roughly 10 to 20 percent of people, and should be measured once.
- hsCRP and IL-6 describe inflammatory load, which drives events independently of lipids.
- Blood pressure remains one of the strongest modifiable predictors at any age.
Blood Pressure. One of the strongest independent predictors of long term health at any age. Even a reading in the 120 to 130 over 75 to 80 range carries meaningfully more lifetime cardiovascular risk than tighter control. Standard: under 130/80 mmHg. Optimal: under 120/75 mmHg. Moved by: sodium reduction, potassium intake, weight management, aerobic exercise, alcohol reduction.
Lipid Panel (Total, LDL, HDL, Triglycerides). Standard cardiovascular risk starting point. Should be interpreted alongside ApoB for accurate particle assessment. Standard: LDL under 130 mg/dL, TG under 150. Optimal: LDL-C under 70, triglycerides under 80, HDL above 60 (men), above 70 (women). Moved by: dietary fat quality, exercise, omega-3s.
ApoB. Measures the number of atherogenic lipoprotein particles. A better cardiovascular risk marker than LDL cholesterol alone because particle number determines arterial wall exposure. Standard: under 130 mg/dL. Optimal: under 80 mg/dL, under 60 in elevated risk individuals. Moved by: diet, statins, PCSK9 inhibitors, GLP-1 therapy.
Lp(a). Largely genetic, an independent cardiovascular risk factor that does not respond to statins or diet. Affects roughly 1 in 5 people. Rarely included in standard panels. Standard: under 75 nmol/L. Optimal: under 30 mg/dL. Moved by: cannot be significantly changed through lifestyle, manage other cardiovascular risk factors aggressively.
hsCRP (High-Sensitivity CRP). Measures systemic low grade inflammation. One of the most reliable predictors of cardiovascular events and accelerated aging. Standard: under 10 mg/L. Optimal: under 1.0 mg/L, under 0.5 mg/L as the tightest longevity target. Moved by: omega-3s, sleep quality, gut health, weight management, dietary changes.
IL-6 (Interleukin-6). A pro-inflammatory marker produced in response to tissue damage, infection, and metabolic stress. Chronically elevated levels are associated with accelerated aging, cardiovascular disease, insulin resistance, and muscle loss. More upstream than hsCRP, it actually drives CRP production. Standard: under 7 pg/mL. Optimal: under 1.5 pg/mL. Moved by: omega-3s, resistance training, sleep quality, weight management, dietary anti-inflammatories.
Homocysteine. Elevated levels are associated with cardiovascular disease, stroke, and cognitive decline. Rises when B12, folate, and B6 are insufficient for methylation. Standard: under 15 umol/L. Optimal: under 7 umol/L. Moved by: methylfolate, methylcobalamin B12, B6, TMG.
Cystatin C. A more sensitive kidney function marker than creatinine, detects early decline before creatinine rises. Also an independent cardiovascular risk marker. Standard: 0.51 to 0.98 mg/L. Optimal: under 0.8 mg/L. Moved by: hydration, blood pressure management, addressing underlying metabolic dysfunction.
What this means for you
If you have never had ApoB and Lp(a) measured, those two results will tell you more about cardiovascular risk than another standard lipid panel.