Your GP checks total cholesterol, LDL, HDL, and triglycerides. That is the standard lipid panel from 1988. Cardiovascular medicine has moved on. ApoB and Lp(a) are what cardiologists actually use to assess real risk. Here is why they matter and who tests them.
The standard NHS lipid panel measures how much cholesterol is inside your lipoprotein particles. Advanced testing measures the particles themselves. This distinction matters because it is the particles, not the cholesterol they carry, that penetrate artery walls and cause atherosclerosis.
| Marker | What It Measures | Clinical Value | NHS? | TrueVitals? |
|---|---|---|---|---|
| Total cholesterol | Sum of all cholesterol in your blood | Crude overview. Can be misleading. High total with high HDL is very different from high total with low HDL. | Yes | All panels |
| LDL cholesterol | Cholesterol content within LDL particles | The traditional "bad cholesterol" marker. Useful but not the best predictor of risk. Two people with the same LDL can have very different particle counts. | Yes | All panels |
| HDL cholesterol | Cholesterol content within HDL particles | The "good cholesterol." Higher is generally better. Low HDL with high triglycerides is a particularly concerning pattern. | Yes | All panels |
| Triglycerides | Fat molecules in the blood, largely diet-driven | Elevated triglycerides indicate metabolic dysfunction, insulin resistance, or excessive carbohydrate/alcohol intake. | Yes | All panels |
| ApoB | Count of all atherogenic lipoprotein particles | The single best blood marker for predicting cardiovascular events. Counts the particles that cause plaque, not just the cholesterol inside them. | No | From Advanced |
| Lp(a) | Genetically determined lipoprotein particle | Independent risk factor elevated in ~20% of people. Does not respond to diet or exercise. Only needs testing once. If high, it changes your entire risk management strategy. | No | Ultimate |
Every lipoprotein particle that can cause atherosclerosis carries exactly one ApoB molecule on its surface. That includes LDL particles, VLDL particles, IDL particles, and Lp(a) particles. By measuring ApoB, you are counting every particle that can penetrate an artery wall and contribute to plaque formation.
LDL cholesterol, by contrast, measures the total amount of cholesterol carried by LDL particles. But LDL particles vary in size. Someone with many small, dense LDL particles can have a "normal" LDL cholesterol level but a very high ApoB, meaning they have more atherogenic particles in circulation. Their cardiovascular risk is significantly higher than their LDL suggests.
This is not a niche academic distinction. Meta-analyses consistently show ApoB is a better predictor of cardiovascular events than LDL cholesterol. The European Atherosclerosis Society recommends ApoB as the primary target for lipid-lowering therapy. Peter Attia, one of the most influential voices in longevity medicine, calls ApoB "the most important thing you can measure in your blood."
And yet the NHS does not test it. Most private blood testing services do not test it. TrueVitals includes ApoB from the Advanced panel (£269).
Lipoprotein(a) is a variant of the LDL particle with an additional protein called apolipoprotein(a) attached to it. Your Lp(a) level is almost entirely genetically determined. It does not change significantly with diet, exercise, or most medications.
Approximately 20% of the population has elevated Lp(a), which independently increases the risk of heart attack, stroke, and aortic valve disease. If your Lp(a) is high, you need to manage your other modifiable risk factors (ApoB, blood pressure, insulin sensitivity, inflammation) more aggressively than someone with normal Lp(a).
The critical point is that you only need to test Lp(a) once. It is genetically fixed. But if you never test it, you will never know whether you are in the 20% who carry elevated risk. One in five people reading this page has elevated Lp(a) and does not know it.
The NHS does not test Lp(a). Most private providers do not either. TrueVitals includes it in the Ultimate panel (£349). One test. One number. Potentially the most important piece of cardiovascular information you will ever receive.
Individual cholesterol numbers are useful. The ratios between them are more useful. TrueVitals calculates these automatically in your report.
One of the best surrogate markers for insulin resistance and small dense LDL particles. A ratio above 2.0 (in mmol/L) suggests metabolic dysfunction. A ratio below 1.0 is excellent. This single ratio tells you more about metabolic and cardiovascular risk than total cholesterol alone.
Calculated as total cholesterol minus LDL minus HDL. Represents the cholesterol in triglyceride-rich remnant particles, which are independently atherogenic. Elevated remnant cholesterol adds risk on top of what LDL and ApoB show. Optimal is below 0.5 mmol/L.
A broad cardiovascular risk indicator. Below 4.0 is desirable. Below 3.5 is optimal. Above 5.0 warrants attention. This ratio captures the balance between atherogenic and protective lipoproteins.
Total cholesterol minus HDL. Captures all atherogenic cholesterol including that carried by VLDL and remnant particles. Many guidelines now prefer non-HDL over LDL as a treatment target because it correlates better with ApoB.
Cholesterol is not purely a diet issue. Understanding what influences your results helps you interpret them properly and make effective changes.
Your baseline cholesterol levels are primarily genetically determined. Some people have elevated LDL regardless of diet. Lp(a) is entirely genetic. This is why testing matters more than assuming your diet will handle everything.
Insulin resistance drives a pattern of high triglycerides, low HDL, and small dense LDL particles. This triad is more dangerous than isolated high LDL. Testing insulin and HOMA-IR alongside lipids reveals whether metabolic dysfunction is driving your cholesterol pattern.
Hypothyroidism raises LDL cholesterol by slowing hepatic clearance. Some people are prescribed statins for cholesterol that would normalise if their thyroid were treated. Testing full thyroid alongside lipids catches this.
Chronic inflammation alters lipid metabolism and increases cardiovascular risk independently of cholesterol levels. hs-CRP alongside your lipid panel shows whether inflammation is adding to your risk profile.
This is why TrueVitals tests cholesterol alongside thyroid, insulin, inflammation, and 100+ other markers. Your AI-powered report identifies whether your cholesterol pattern is being driven by genetics, metabolic dysfunction, thyroid issues, or inflammation, and gives you specific recommendations for each. See how our reports work.
A comprehensive lipid panel including total cholesterol, LDL, HDL, triglycerides, ApoB, and Lp(a). ApoB is the best single marker for predicting cardiovascular events. Lp(a) is a genetic risk factor that only needs testing once. TrueVitals includes ApoB from the Advanced panel and Lp(a) in the Ultimate panel.
No. The standard NHS lipid panel tests total cholesterol, LDL, HDL, and triglycerides. ApoB is not routinely available through NHS primary care. Some specialist lipid clinics may test it on referral. A private comprehensive blood test is the most reliable way to get ApoB tested in the UK. NHS vs private comparison.
Fasting for 8 to 12 hours gives the most accurate triglyceride reading. Total cholesterol, LDL, HDL, ApoB, and Lp(a) are not significantly affected by fasting status. If you cannot fast, your results are still clinically useful but triglycerides may be elevated.
Not necessarily. High total cholesterol with very high HDL can represent a favourable profile. High LDL with low ApoB means you have large, buoyant LDL particles which are less atherogenic. The pattern and particle count matter more than any single number. This is exactly why ApoB and the triglyceride/HDL ratio are more informative than total cholesterol alone.
Annually as part of a comprehensive health check. If you are on statins, making dietary changes, or managing cardiovascular risk, every 6 months to track response. Lp(a) only needs testing once because it is genetically determined.
ApoB and Lp(a) included alongside the standard lipid panel. Plus 100+ other markers for the complete cardiovascular and metabolic picture. From £269.
.png)