Your Cholesterol is “Normal.” So Why Are We Still Worried About Heart Disease?

Key Takeaways

• The Problem: Standard cholesterol tests (LDL/HDL) often miss early warning signs of heart disease.

• The Missing Markers: To see true risk, you must check ApoB (particle count), hs-CRP (inflammation), and Fasting Insulin (metabolic stress).

• The Solution: Normal labs don’t always mean “healthy.” Advanced functional testing can detect cardiovascular risk years before a standard physical.

February is American Heart Month. You are going to see a lot of red ribbons and generic advice about “eating less salt” and “going for a jog.”

But in my practice, I see a different story.

I see patients who go to their annual physical, get a basic cholesterol panel, and are told, “Everything looks great!” Then, they go home and continue to feel fatigued, inflamed, or simply uneasy about their long-term risks.

The reality is that standard cholesterol testing (Total Cholesterol and LDL) was developed decades ago. It gives us a rough estimate of your risk, but it misses the nuance. It’s like counting the cars on the highway without checking to see if any of them are on fire.

If you really want to know your cardiovascular risk, we need to look deeper. Here are the three markers I run on my patients that standard physicals often skip.

1. ApoB (Apolipoprotein B)

You’ve heard of LDL (the “bad” cholesterol). But LDL-C just measures the weight of the cholesterol in your blood.

ApoB measures the actual number of particles capable of causing plaque buildup.

Think of it this way: You can have “normal” LDL but a sky-high number of small, dense particles that are aggressively damaging your arteries. If we only look at LDL, we miss the real culprit. ApoB is widely considered by modern lipidologists to be a far superior predictor of heart disease than LDL alone.

2. hs-CRP (High-Sensitivity C-Reactive Protein)

Cholesterol is just one half of the equation. The other half is inflammation.

Cholesterol generally doesn’t stick to smooth, healthy artery walls. It sticks to damage. hs-CRP measures systemic inflammation in your body. If your arteries are inflamed (like a scratch on the inside of a pipe), cholesterol gets trapped there to “patch” the damage. That patch becomes plaque.

If your cholesterol is low but your hs-CRP is high, you are still at risk. We need to cool the inflammation down.

3. Fasting Insulin (Not just Glucose)

Most doctors check your Fasting Glucose or A1c. These tell us what your blood sugar is doing right now.

Fasting Insulin tells us how hard your pancreas is working to keep that number down.

Insulin resistance is a primary driver of heart disease. High insulin levels stiffen arteries and increase blood pressure long before your blood sugar ever registers as “Diabetic.” By the time your Glucose is high, the damage has been happening for years. We want to catch it while it’s just an insulin problem.

Stop Guessing with Your Heart

If you are relying on a lab panel from 1995 to predict your health in 2026, you aren’t getting the full picture.

Knowing these numbers doesn’t just predict risk—it gives us a roadmap to fix it. Whether through nutrition, targeted supplementation, or medication, we can change these numbers. But only if we measure them.

Ready to see what’s really going on? Book a Discovery Call to learn more about our Comprehensive Lab Panels.