Heart disease kills approximately 160,000 people per year in the UK. The NHS tests total cholesterol, HDL, LDL, and triglycerides. But the 2026 AHA/ACC guidelines, the European Society of Cardiology, and the Canadian Cardiovascular Society now recommend ApoB as a more accurate predictor of cardiovascular risk than LDL cholesterol. The NHS tests none of the advanced markers these guidelines recommend. A comprehensive panel like the TrueVitals Ultimate includes ApoB, Lp(a), homocysteine, and hs-CRP alongside 114 total biomarkers for £349.
In 2019, the European Society of Cardiology concluded that ApoB is a more accurate marker of cardiovascular risk than LDL cholesterol. In 2021, the Canadian Cardiovascular Society recommended ApoB over LDL-C as the primary metric for lipid management. In March 2026, the US followed: the 2026 AHA/ACC dyslipidemia guidelines now formally recommend ApoB measurement for adults on lipid-lowering therapy, particularly those with diabetes, hypertriglyceridaemia, or very low LDL cholesterol.
A 2025 European Heart Journal review (Sniderman et al.) summarised decades of research: in 9 of 9 studies, ApoB was a more accurate predictor of cardiovascular events than LDL cholesterol. When ApoB and LDL-C are discordant (they disagree), ApoB is the better predictor of risk. The CARDIA study found that young adults with high ApoB but normal LDL-C had a 55% higher risk of developing coronary artery calcification 25 years later. Those with high LDL-C but normal ApoB did not show increased risk.
The NHS still tests standard cholesterol only. It does not test ApoB. It does not test Lp(a). The gap between what the guidelines recommend and what the NHS offers is widening.
Every atherogenic lipoprotein particle (LDL, VLDL, IDL, Lp(a)) carries exactly one ApoB molecule. Measuring ApoB provides a direct count of the total number of particles that can penetrate your arterial walls and form plaque. Standard LDL cholesterol measures the cholesterol content inside LDL particles, which can be misleading: you can have normal cholesterol content distributed across a dangerously high number of small, dense particles. ApoB catches this. LDL-C misses it.
Who this matters most for: people with metabolic syndrome, insulin resistance, type 2 diabetes, elevated triglycerides, or abdominal obesity. In these groups, LDL-C frequently underestimates risk because particles are smaller and denser, meaning more particles for the same cholesterol content. ApoB captures this pattern accurately. Insulin resistance guide.
Lp(a) (lipoprotein little-a) is a genetically determined lipoprotein that increases the risk of heart attack, stroke, and aortic valve disease. It is elevated (above 125 nmol/L or 50 mg/dL) in approximately 20% of the global population. Levels are set by genetics and remain largely stable throughout life. You cannot meaningfully lower Lp(a) with diet, exercise, or statins (though novel therapies are in development).
Why test something you can't change? Because knowing your Lp(a) changes how aggressively you manage every other risk factor. A man with elevated Lp(a) alongside mildly elevated ApoB needs more aggressive lipid lowering than a man with the same ApoB but normal Lp(a). Lp(a) inherited in an autosomal dominant pattern means elevated levels should prompt testing of first-degree relatives. The European Atherosclerosis Society recommends testing Lp(a) once in every adult's lifetime. The NHS does not test it at all.
hs-CRP (high-sensitivity C-reactive protein) measures systemic inflammation. Chronic low-grade inflammation damages endothelial function and accelerates atherosclerosis. hs-CRP adds predictive value beyond lipid markers alone. Homocysteine is an amino acid associated with endothelial damage when elevated. High homocysteine is correctable with B vitamins (B12, folate, B6). Neither is included in the NHS standard lipid panel.
The NHS lipid panel tells you your cholesterol levels. A comprehensive panel tells you your atherogenic particle count (ApoB), your inherited cardiovascular risk (Lp(a)), your vascular inflammation (hs-CRP), your vascular damage marker (homocysteine), and the metabolic drivers (insulin resistance) that compound all of them. The difference is the difference between a snapshot and a prediction.
The TrueVitals Ultimate panel includes ApoB, Lp(a), homocysteine, hs-CRP, full lipid profile, fasting insulin, HOMA-IR, and the metabolic context that compounds cardiovascular risk. 114 biomarkers. Results in 48 hours. £349.
Insulin resistance drives small, dense LDL particles, elevates triglycerides, lowers HDL, increases ApoB particle count, and promotes chronic vascular inflammation. It is the metabolic engine behind the majority of cardiovascular events in people without familial hypercholesterolaemia. Testing cholesterol without testing fasting insulin and HOMA-IR is like measuring the smoke without checking for the fire.
A comprehensive cardiovascular assessment connects lipid markers to metabolic markers: ApoB alongside fasting insulin, Lp(a) alongside HbA1c, hs-CRP alongside HOMA-IR. The patterns between these systems reveal whether your cardiovascular risk is driven by genetics (elevated Lp(a)), metabolism (insulin resistance driving ApoB), inflammation (elevated hs-CRP compounding both), or a combination. Treatment differs for each driver. Prediabetes and insulin resistance guide.
You have a family history of heart disease, particularly premature cardiovascular events (before age 55 in men, 65 in women). Test Lp(a) once in your lifetime. If elevated, cascade screen first-degree relatives.
You're over 40 and have never had advanced lipid markers tested. Atherosclerosis begins decades before symptoms. ApoB and Lp(a) at 40 establish the baseline that determines how aggressively to manage your risk for the next 30 years. Health check at 40 (men). Health check at 40 (women).
You have insulin resistance, type 2 diabetes, or metabolic syndrome. These conditions drive small dense LDL, elevated ApoB, and elevated triglycerides. Standard cholesterol underestimates risk in this group more than any other.
You take a statin and want to know if it's working. ApoB is a better treatment target than LDL-C. The 2026 AHA/ACC guidelines recommend ApoB measurement in adults on lipid-lowering therapy.
You have erectile dysfunction. ED appears on average 3 years before a cardiovascular event. Penile arteries clog first because they're the smallest. If you have ED, your cardiovascular markers need testing. ED blood test guide.
The report analyses ApoB, Lp(a), hs-CRP, homocysteine, and full lipids alongside fasting insulin, HOMA-IR, HbA1c, thyroid markers, and liver function using AI cross-system analysis. It identifies whether your cardiovascular risk is genetic (Lp(a) driven), metabolic (insulin resistance driven), inflammatory (CRP driven), or a combination. It provides specific, evidence-based recommendations for each driver: dietary changes, statin discussion points for your GP, lifestyle modifications, and supplement recommendations where evidence supports them. A medical professional reviews every report.
114 biomarkers including ApoB, Lp(a), homocysteine, hs-CRP, full lipids, fasting insulin, and every metabolic marker that compounds cardiovascular risk. Results in 48 hours.
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