Author: Dr. Bonnie Brock, NMD, RD, MPH
Patients are coming to realize that a basic cholesterol panel hasn’t told the whole story when it comes to heart health. Heart health and atherosclerosis are not single-number diagnoses. They are processes unfolding over time, influenced by inflammation, lipoprotein burden, insulin resistance, hormones, genetics, and lifestyle. My job as a naturopathic medical doctor and registered dietitian is to evaluate all parameters and connect the dots in a way that is actionable and empowering.
Below is how I typically assess cardiovascular risk and arterial health in a more comprehensive, clinically useful way.
Advanced Blood Markers: Looking Beyond Total Cholesterol
A standard lipid panel can be misleading. I often see patients with “normal” LDL cholesterol who still have significant atherosclerotic risk. That’s why I rely on advanced cardiometabolic testing, such as panels from Cleveland HeartLab, which offer a deeper look into lipoprotein physiology and inflammation.
Key labs I focus on:
Apolipoprotein B (ApoB)
ApoB measures the number of atherogenic particles circulating in the blood. Every LDL, VLDL, IDL, and Lp(a) particle carries exactly one ApoB molecule. In plain language, ApoB tells me how many “cholesterol delivery trucks” are on the road. A high ApoB means more opportunities for cholesterol to penetrate the arterial wall, even if LDL-C appears acceptable.
Lipoprotein(a), or Lp(a)
Lp(a) is a genetically driven lipoprotein that increases cardiovascular risk independently of lifestyle. It is particularly associated with premature heart disease and aortic valve disease. This is a test I believe everyone should have checked at least once in their lifetime, because you cannot infer it from standard labs and it provides insight into individual cardiovascular risk.
Inflammatory and metabolic markers
Depending on the patient, I may also evaluate hs-CRP, fasting insulin, HbA1c, triglyceride-to-HDL ratio, and sometimes oxidized LDL. These help me understand whether the arterial environment is calm or inflamed, insulin-sensitive or insulin-resistant.
Coronary Artery Calcium (CAC) Score: Seeing the Plaque
Blood markers tell me risk. Imaging tells me reality.
A coronary calcium score is a low-radiation CT scan that detects calcified plaque in the coronary arteries. Calcium is a marker of more mature, established atherosclerosis. The score gives us a numeric snapshot of lifetime plaque burden.
What I like about the CAC score is its clarity:
- A score of zero is reassuring and often allows for a more conservative approach.
- A higher score confirms that atherosclerosis is present and shifts the conversation toward more aggressive prevention.
This test does not predict soft plaque or inflammation directly, but it is one of the strongest predictors we have of future cardiovascular events. It moves the discussion from “theoretical risk” to “what’s actually there.”
Carotid Artery Testing: Early Structural Changes
A carotid artery ultrasound evaluates the arteries in the neck that supply blood to the brain. Specifically, it measures carotid intima-media thickness (CIMT) and can identify plaque formation before it becomes calcified.
This test is especially helpful for:
- Patients with strong family histories of cardiovascular disease
- Women, who may develop vascular disease differently than men
- Individuals with metabolic syndrome or long-standing inflammation
Carotid imaging gives us insight into early arterial changes and endothelial health, often before symptoms ever appear.
Bringing It All Together
Heart disease is not caused by a single bad lab value, and it’s not solved by a single intervention. In my practice, I combine advanced labs, targeted imaging, and individualized lifestyle and nutrition strategies to assess both risk and reality.
The goal isn’t fear. The goal is foresight.
When we understand particle number, genetic risk, inflammation, and actual arterial health, we can intervene earlier, more precisely, and often more gently. And that is where true preventive medicine lives.
