Life Extension Magazine®

Doctor using stethoscope and blood test for cardiovascular risks

Blood Tests to Better Predict Cardiovascular Risk

Doctors rely on basic lipid profiles to determine heart attack risk, but more precise blood tests can better pinpoint cardiovascular vulnerability.

Scientifically reviewed by: Dr. Gary Gonzalez, MD, in August 2023. Written by: Michael Downey.

Blood tests routinely ordered by mainstream doctors do not provide information needed to fully assess cardiovascular risk.

More detailed tests can pinpoint cardiac risks—and perhaps save your life.

This article describes blood tests to evaluate vascular health status before one develops symptoms of a heart attack or ischemic stroke.

Doctors Fail to Test Critical Factors

Most cardiovascular disease is hidden until chest pain (angina) or a stroke manifest.

Standard blood tests for total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) provide a partial picture of cardiovascular risk.

Missing from most cardiac tests is the number of small LDL particles circulating in your blood.

Small LDL cholesterol can be serious because the smaller particle size enables it to penetrate the arterial wall and start the process of plaque formation.

Small LDL is also more susceptible to oxidative damage.1

Knowing your LDL particle count provides crucial information beyond total cholesterol and LDL.

A blood test called the NMR LipoProfile® provides this information using nuclear magnetic resonance (NMR) spectroscopy to directly measure particle size and particle count.

NMR LipoProfile®

Blue heart with heart rate line behind

The NMR LipoProfile® blood test measures:

  • LDL-P—this is the count of LDL particles, and
  • Small LDL—this is the count of small LDL particles.

If either of these is high, it is an indicator of an elevated risk of an atherosclerotic disease.

The NMR LipoProfile® determines the size of the LDL particles in your blood. Larger and more buoyant LDL particles do not pose the same risk as small LDL.

The NMR LipoProfile® test also provides a measure of HDL-P. This is the particle count for HDL, the "good" cholesterol. You want this number to be high.

Another test included in this panel is the LP-IR score, which you want to be low. This is a marker for insulin resistance—the higher the number, the greater the probability of developing diabetic-related disorders.

Knowing this may allow you to take corrective action before type II diabetes manifests and with it, the much greater risk of cardiovascular disease.

Some researchers have found that insulin resistance is associated with an increased risk for cancer.2,3

But how can you confidently interpret your numbers?

Included with the results of the NMR LipoProfile® test is a chart that helps identify your particular risks for coronary heart disease.

Results from an NMR LipoProfile® blood test arm you with a more comprehensive picture that you can discuss with your doctor.

Oxidized LDL Test

Oxidized LDL cholesterol is more dangerous than non-oxidized cholesterol. Small cholesterol particles are notorious for oxidizing faster.

Oxidized LDL particles penetrate arterial walls (endothelium) and start a cascade of inflammatory events that lead to the formation and buildup of foam cells and plaque. (Foam cells are immune cells engorged with fatty LDL.)

These structural changes account, in part, for atherosclerotic disease and risk of heart attack, stroke, and other cardiovascular disease.4

There are tests available that measure oxidized LDL and its related markers of inflammation to provide a better idea of what is happening inside your arteries.

Assessing Vascular Inflammation

The MPO blood test is important for individuals who have a family history of cardiovascular disease or who make poor lifestyle choices.

When white blood cells attack the arterial wall, they release an enzyme called myeloperoxidase or MPO.

This process is dangerous when it occurs in response to oxidized LDL cholesterol. It creates foam cells that contribute to atherosclerotic plaque and narrowing of arteries.

MPO amplifies inflammation and causes problems that increase arterial plaque. Often, the plaque that MPO boosts is of the worst type—soft, vulnerable plaque that is prone to rupture.5,6

Making matters worse, MPO itself can also oxidize LDL cholesterol, further promoting plaque.7 It can even oxidize HDL cholesterol—the "good" type of cholesterol—which renders HDL dysfunctional.

C-Reactive Protein (CRP)

High sensitivity C-reactive protein (CRP) detects changes in inflammatory levels throughout the body.

CRP rises quickly after an inflammatory attack but should soon return to normal levels. When CRP remains high, however, it is an indication of chronic inflammation.

Elevated CRP levels indicate risk of heart attack, stroke, and death from cardiovascular disease – even in apparently healthy people.8

A study of over 50,000 individuals found that the higher the CRP levels, the greater the risk of cardiovascular disease and heart attack.9

And in addition to being a marker, CRP itself may contribute directly to cardiovascular and diabetes risk.8,10 Elevated CRP levels have also been linked to cancer risk.11,12

What you need to know

Blood vials for testing cardiovascular health

Blood Tests for Cardiovascular Health

  • More detailed, more informative blood tests can pinpoint cardiac risk much better than the standard tests routinely ordered.
  • Standard lipid tests give an incomplete picture, missing key cardiovascular disease markers.
  • Stroke and heart disease remain the leading causes of disability and death. Most are preventable when risk factors, including hypertension are controlled.

Apolipoprotein B

Apolipoprotein B (ApoB) is a primary protein constituent of all non-HDL cholesterol particles.

When apolipoprotein-B-containing particles penetrate the inner arterial wall (endothelium), they spark the initiation and progression of atherosclerosis, setting the stage for eventual blockage of blood flow.13-15

Apolipoprotein B proteins are now "widely accepted as the most important causal agents of atherosclerotic cardiovascular disease."13

A study found that even when total cholesterol and HDL are within healthy ranges, high levels of apolipoprotein B can increase coronary heart disease risk by about 60%.

When total cholesterol and HDL are in unhealthy ranges, high levels of apolipoprotein B can boost coronary heart disease risk by a frightening 160%.16

A review of 27 studies found that lowering apolipoprotein levels resulted in a reduction in existing arterial plaque.17

The apolipoprotein B blood test is an often-overlooked indicator of cardiovascular risk.

Other Heart-Disease-Related Blood Tests

Several other blood tests can help round out an evaluation of your risk for cardiovascular disease.

Lab technician writing down test results


Elevated levels of homocysteine may directly damage the delicate cells that line the inside of your arteries (endothelium), resulting in vascular inflammation, blood clot formation, and greater risk of stroke.

Vitamin D 25-Hydroxy

Low levels have now been found to be associated with increased risk for cardiovascular disease.18,19

More than 70% of Americans have either deficient or insufficient blood levels of vitamin D.20

Life Extension® supporters have long been advised of the importance of maintaining an optimal vitamin D level between 50-80 ng/mL.

CBC/Chemistry Profile

This test includes a complete blood count (CBC) to indicate general and immune health. It also tests platelets for clotting status, as well as hemoglobin for oxygen-carrying capacity. The chemistry panel measures glucose, electrolytes, important liver enzymes, kidney markers, calcium, and uric acid levels.


High blood levels of glucose are a major cause of long-term health issues, from cancer to heart disease. Practically all tissues in the body are negatively impacted by high blood sugar.

A hemoglobin A1c test is a superior way to screen for glucose problems because it shows what levels have looked like over the past two to three months. The higher the level, the more severe the problem with blood glucose control.

In addition, studies have shown that high levels of hemoglobin A1c are an important predictor of risk for heart disease, even in individuals who do not have metabolic syndrome or diabetes.21

Omega-3 Index

In June 2019, the FDA affirmed a new, qualified health claim for fish oil, noting that consumption of the omega-3 fatty acids EPA and DHA may reduce the risk of high blood pressure and coronary heart disease.22

A simple, finger-stick test provides a wealth of information about omega-3 and omega-6 fatty acids’ status in your blood.

One study found that those with an omega-3 index of 8% or greater, compared to those with levels below 4%, were estimated to have about a 30% lower risk of death from coronary heart disease.23

Interpreting Your Results

The Wellness Specialists at Life Extension® are available seven days a week to help you understand your blood test results at no charge. But as a quick rule, the very best results would be:

  • Low LDL-P (low LDL particle count),
  • Low small LDL-P (low small LDL particle count),
  • Large LDL size (large and buoyant is the best kind of LDL),
  • Low LP-IR (lower means better insulin sensitivity),
  • Low oxidized LDL (oxidized LDL is more atherogenic),
  • Low MPO (lower MPO indicates reduced vascular inflammation),
  • Low HbA1c (high levels indicate elevated blood sugar and greater prediabetes or type II diabetes risk), and
  • Omega Index 8%-11% (some data indicate 8% and above is ideal).

What Cardiovascular-Risk Tests Do You Need?

The popular Male or Female Panel Blood Panel provides many tests described in this article including:

  • Apolipoprotein B (ApoB)
  • Hemoglobin A1c
  • Total cholesterol
  • Triglycerides
  • C-reactive protein (high sensitivity)
  • Homocysteine LDL cholesterol HDL cholesterol 25-hydroxyvitamin D
  • Complete Blood Count (CBC)/Chemistry

As you can see on page 15 of this month’s issue, the Male or Female Panels provide far more tests than are typically prescribed in medical settings.

Those at higher risk for coronary artery occlusion or ischemic stroke should consider having the NMR LipoProfile® at least one time. If results come back in safe ranges, then this test may not be needed again for many years.

When first introduced, tests that measured small LDL particles and other lipid fractions in the NMR LipoProfile® cost over $300. During the annual lab sale, you can obtain the NMNR LipoProfile® for only $74.25.

Similarly, once optimal balance of omega-3s to omega-6s and higher omega-3 index is established, the Omega-3 Index may only need to be done in response to outward changes indicative of inflammation or significant dietary alterations.

Those with prexisting atherosclerosis, or who are otherwise at high risk of cardiovascular events may consider adding oxidized LDL and/or myeloperoxidase (MPO).

Note the Blood Test Super Sale Price for the Male or Female Panel is $224, which is up to 90% lower than what large commercial labs charge for these same tests.

Results from these laboratory tests provide "reference ranges" that are helpful, but Life Extension® often recommends improvements beyond conventional guidelines to lower risk of cardiovascular diseases.


Blood vials in centrifuge

Mainstream doctors seldom order a complete panel of technologically advanced blood tests to assess risk of cardiovascular disease events.

Levels of total cholesterol, LDL, and HDL do not paint the full picture of heart disease and stroke risk. While important, they are the tip of the iceberg of potentially important information.

Advanced, more detailed blood tests can better pinpoint risk of atherosclerosis, heart attack, and stroke.

If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.

A Low-Cost, Easy Way to Have Blood Tests Done

Man having blood taken

The high cost of conventional blood testing discourages many people from availing themselves of this life-saving diagnostic, including today’s more detailed, more useful tests.

Life Extension® long ago resolved this by allowing readers to order low-cost blood tests directly and then visit a drawing station in their own area at their convenience.

Detailed results typically come back in less than a week and are emailed to you. If you have any questions, our Wellness Specialists are available to assist, seven days a week at no charge.

Once a year, we discount prices of all lab tests. This is a convenient reminder to have your annual tests performed and save up to 25% in the process.


  1. Ivanova EA, Myasoedova VA, Melnichenko AA, et al. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev. 2017;2017:1273042.
  2. Arcidiacono B, Iiritano S, Nocera A, et al. Insulin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp Diabetes Res. 2012;2012:789174.
  3. Scully T, Ettela A, LeRoith D, et al. Obesity, Type 2 Diabetes, and Cancer Risk. Front Oncol. 2020;10:615375.
  4. Leiva E, Wehinger S, Guzmán L, et al. Role of oxidized LDL in atherosclerosis. Hypercholesterolemia. 2015:55-78.
  5. Senders ML, Mulder WJM. Targeting myeloperoxidase in inflammatory atherosclerosis. Eur Heart J. 2018 Sep 14;39(35):3311-3.
  6. Kamanna VS, Ganji SH, Kashyap ML. Myeloperoxidase and Atherosclerosis. Current Cardiovascular Risk Reports. 2013 2013/04/01;7(2):102-7.
  7. Liguori I, Russo G, Curcio F, et al. Oxidative stress, aging, and diseases. Clin Interv Aging. 2018;13:757-72.
  8. Jimenez RV, Szalai AJ. Therapeutic Lowering of C-Reactive Protein. Front Immunol. 2020;11:619564.
  9. Wang A, Liu J, Li C, et al. Cumulative Exposure to High-Sensitivity C-Reactive Protein Predicts the Risk of Cardiovascular Disease. J Am Heart Assoc. 2017 Oct 24;6(10).
  10. Cheng L, Zhuang H, Yang S, et al. Exposing the Causal Effect of C-Reactive Protein on the Risk of Type 2 Diabetes Mellitus: A Mendelian Randomization Study. Front Genet. 2018;9:657.
  11. Li Y, Zhong X, Cheng G, et al. Hs-CRP and all-cause, cardiovascular, and cancer mortality risk: A meta-analysis. Atherosclerosis. 2017 Apr;259:75-82.
  12. Wang G, Li N, Cao L, et al. [Association between the level of high sensitivity C-reactive protein and risk of breast cancer among non-diabetic females: a prospective study in Kailuan group]. Zhonghua Zhong Liu Za Zhi. 2014 Dec;36(12):944-8.
  13. Shapiro MD, Fazio S. Apolipoprotein B-containing lipoproteins and atherosclerotic cardiovascular disease. F1000Res. 2017;6:134.
  14. Ohwada T, Sakamoto T, Kanno Y, et al. Apolipoprotein B correlates with intra-plaque necrotic core volume in stable coronary artery disease. PLoS One. 2019;14(2):e0212539.
  15. Boren J, Williams KJ. The central role of arterial retention of cholesterol-rich apolipoprotein-B-containing lipoproteins in the pathogenesis of atherosclerosis: a triumph of simplicity. Curr Opin Lipidol. 2016 Oct;27(5):473-83.
  16. Lamarche B, Moorjani S, Lupien PJ, et al. Apolipoprotein A-I and B levels and the risk of ischemic heart disease during a five-year follow-up of men in the Quebec cardiovascular study. Circulation. 1996 Aug 1;94(3):273-8.
  17. Masson W, Siniawski D, Lobo M, et al. Association between LDL-C, Non HDL-C, and Apolipoprotein B Levels with Coronary Plaque Regression. Arq Bras Cardiol. 2015 Jul;105(1):11-9.
  18. Umar M, Sastry KS, Chouchane AI. Role of Vitamin D Beyond the Skeletal Function: A Review of the Molecular and Clinical Studies. Int J Mol Sci. 2018 May 30;19(6).
  19. Meehan M, Penckofer S. The Role of Vitamin D in the Aging Adult. J Aging Gerontol. 2014 Dec;2(2):60-71.
  20. Liu X, Baylin A, Levy PD. Vitamin D deficiency and insufficiency among US adults: prevalence, predictors and clinical implications. Br J Nutr. 2018 Apr;119(8):928-36.
  21. Goto A, Noda M, Matsushita Y, et al. Hemoglobin a1c levels and the risk of cardiovascular disease in people without known diabetes: a population-based cohort study in Japan. Medicine (Baltimore). 2015 May;94(17):e785.
  22. Available at: Accessed February 22, 2021.
  23. Harris WS, Del Gobbo L, Tintle NL. The Omega-3 Index and relative risk for coronary heart disease mortality: Estimation from 10 cohort studies. Atherosclerosis. 2017 Jul;262:51-4.