Some of the most common questions I help my clients navigate involve blood work, including what cardiac panel labs they should have checked and what the test results mean. I get it—lab results contain a lot of information, and it can feel overwhelming to discern your numbers. 

Below, we will review which blood tests are best for detecting heart problems and what they mean. The goal is to help you become an active participant in your care.

For an even more comprehensive look, enroll in my self-paced “How to Read Your Blood Tests for Optimal Heart Health” blood test course.

The Role of Lab Tests in Assessing Heart Health

Your cardiac labs measure key biomarkers that indicate inflammation, cholesterol levels, blood sugar control, and overall heart function. These tests provide important information about things like your risk for heart disease and future cardiac events. 

To get a full picture of your heart health, it’s important to ask for additional tests beyond the standard panel because these often miss critical markers or cardiovascular risk. Understanding these additional markers allows you to take proactive steps toward optimizing your heart health through science-based nutrition, lifestyle changes, and medical interventions.

For example, I have a 35-year-old male client who came to me after having a heart attack and didn’t understand why. His cardiologist just looked at his lipid panel and put him on a statin. When we met, I encouraged him to get further testing, which showed elevations in hs-CRP, Lp(a), and homocysteine. We started tackling these through a nutrient-sufficient, anti-inflammatory diet tailored to his needs. 

In 6 months, his hs-CRP went from 6.2mg/dL to 0.6mg/dL (normal <1.0mg/dL), homocysteine went from 15umol/L to 7umol/L (normal <10umol/L), apoB 93mg/dL to 62mg/dL (normal <90mg/dL), and HgA1c 5.7% to 5.3% (normal <5.7%, optimal <5.4%). We know that his Lp(a) could have contributed to this plaque progression so we are targeting apoB to be stricter than the general population. 

Let’s take a closer look at these important cardiac panel blood tests. 

Essential Cardiac Panel Blood Tests for Heart Health

Comprehensive Metabolic Panel (CMP)

A CMP measures 14 different substances in your blood to evaluate your body’s chemical balance and metabolism, as well as your heart health. It also offers insight into electrolyte balance and the function of your liver, kidneys, and thyroid. 

Electrolyte Imbalances and Heart Rhythm Issues

Electrolytes—particularly potassium and calcium—play a vital role in heart function because they help regulate electrical impulses that control your heartbeat.

• Low or high potassium can lead to irregular heart rhythms (arrhythmias) and even life-threatening cardiac events.
• Calcium imbalances may also contribute to arrhythmias and impact vascular health.
• Monitoring electrolyte levels through a CMP can help detect imbalances before they lead to complications.

Blood Sugar, Insulin Resistance, and Heart Disease Risk

A CMP measures fasting (non-eating) blood glucose, which provides insight into blood sugar control. However, to get a clearer picture of insulin resistance and long-term heart disease risk, consider these:

• Hemoglobin A1c (HgA1c): Measures average blood sugar levels over the past 2-3 months, helping to detect prediabetes or diabetes.
• Fasting Insulin: Elevated insulin levels indicate early insulin resistance, which is a precursor to type 2 diabetes and increased heart disease risk.
• HOMA-IR (Homeostatic Model Assessment of Insulin Resistance): A calculation that evaluates how efficiently the body regulates blood sugar and insulin. A high HOMA-IR suggests insulin resistance, which contributes to atherosclerosis (the buildup of fatty plaques in blood vessels which can lead to a heart attack or a stroke), high blood pressure, and metabolic dysfunction.
• LP-IR (Lipoprotein Insulin Resistance): This measures insulin resistance based on the distribution and amounts of lipoprotein particles in your blood. A higher LP-IR indicates a higher degree of insulin resistance in the body.

Since diabetes doubles the risk of heart disease, identifying insulin resistance early through these markers allows for proactive intervention with dietary and lifestyle changes.

Inflammatory Markers and Heart Disease

Research suggests that inflammation within the walls of your arteries can lead to plaque formation. This can increase your risk of heart disease.

The following can be used in a cardiac panel to identify increased inflammation so you have a better understanding of your risks.

High-Sensitivity C-Reactive Protein

CRP is a protein made by your liver. It’s made at higher levels when your body is stressed from an infection, injury, or another inflammatory process. A high level of hs-CRP in blood has been linked to underlying inflammation and a higher risk of atherosclerosis. 

What’s optimal? hs-CRP levels below 1.0 mg/L indicate low inflammation, while levels above 3.0 mg/L suggest a higher risk for cardiovascular disease.

hs-CRP is a nonspecific marker and is more sensitive to detecting low-grade inflammation. CRP, on the other hand, can be influenced by recent infections. Both should be evaluated alongside other heart health indicators for a more comprehensive picture. 

Lp-PLA2 (Lipoprotein-associated phospholipase A2)

Lp-PLA2 is an enzyme that appears to promote inflammation and plaque formation on your artery walls. Research suggests that having high CRP and Lp-PLA2 levels can increase your risk of ischemic stroke. The target value for Lp-PLA2 is <225 nmol/min/mL.

Lipid Profile: Understanding Your Cholesterol

A lipid profile with the tests below can help determine your risk of heart and blood vessel disease.

Total Cholesterol

Your total cholesterol is the sum of all of the parts of your blood cholesterol (your LDL, HDL, and other lipid components, such as some of your triglycerides). Elevated total cholesterol may indicate a higher risk of heart disease.

LDL Cholesterol

Your LDL cholesterol (“bad cholesterol”) can contribute to plaque buildup on the walls of your arteries. This can lead to blockages which increase your risk for a heart attack or stroke.

HDL Cholesterol

Your HDL cholesterol (“good cholesterol”) can help remove LDL from your blood, keeping your arteries open and flowing with ease. Therefore, high HDL cholesterol levels may help protect your heart, to an extent. 

We used to think just having high HDL would protect us against developing high LDL However, we now know that LDL is an independent risk factor for heart disease, and having high levels can actually make it dysfunctional—especially in postmenopausal women. 

Non-HDL Cholesterol

Non-high-density lipoprotein cholesterol (non-HDL-C) is determined by subtracting your HDL cholesterol from your total cholesterol. Your non-HDL-C includes a measure of all the “bad” types of cholesterol that can lead to hardened arteries. 

Studies show that non-HDL-C fraction may be a better marker of risk than total cholesterol or LDL cholesterol. Additionally, there’s evidence that apoB is a more accurate marker of cardiovascular risk than non-HDL cholesterol.

Triglycerides

Triglycerides are a type of fat in your blood. High triglyceride levels can contribute to atherosclerosis, blood clotting, stroke risk, and heart disease risk, as they cause the narrowing of your arteries.

Note that along with a lipid profile, there are many other components we need to analyze to assess your cardiovascular risk factors—like age, family history, medical history, gut health, other medical tests, and lifestyle to develop a treatment plan.

Advanced Cardiac Testing: Beyond the Basics

An advanced lipid panel can help further assess your risk for heart disease and create a personalized treatment plan to optimize your numbers. Unfortunately, advanced panels aren’t always routine, but knowing to ask for them (which I recommend to all of my clients) can help understand how likely your cholesterol has the potential to turn into dangerous plaque. 

An advanced lipid panel is especially useful for people with diabetes, insulin resistance, or heart disease who continue to have progression of disease despite having their cholesterol in an optimal range. However, it’s an important tool for everyone, family history or not, to understand and optimize your values early. 

Key Advanced Lipid Panel Markers

Lipoprotein(a)

Lp(a) is LDL cholesterol attached to a protein called apolipoprotein (a). This is a genetic marker that signifies an increased susceptibility to arterial plaque buildup and cardiovascular events. 

Elevated levels may signal a higher likelihood of heart disease, heart failure, and aortic stenosis. So, having an awareness of this marker can help guide the intensity of your risk management plan, which will be more stringent compared to the general population. 

Did you know I have high Lp(a)? Read my personal story.

Apolipoprotein B 

Apolipoprotein B is the main protein found in your LDL cholesterol. High levels of ApoB may indicate that you’re at higher risk for plaque formation and developing heart disease. Research suggests that testing ApoB may be a better overall marker of heart disease risk than LDL alone.

LDL Particle Number (LDL-P)

Your lipid profile will measure the amount of LDL cholesterol you have in your blood, but an LDL particle number will evaluate the number of LDL particles in your blood. 

Having a high number of LDL particles can lead to the formation of fatty plaques on your artery walls, increasing your risk for heart attack and stroke. 

LDL Size

Evaluating the size of your LDL particles may be useful for determining your risk factor for heart disease. LDL particles that are generally small and dense can increase your risk of heart disease compared to having particles that are larger and less dense.

Therefore, looking beyond a simple LDL value can provide important insight into your risk.

Cardiac Panel Markers for Heart Attack & Stress Detection

When the heart is damaged or under stress, it releases specific biomarkers into the blood. These markers can doctors assess whether a person has experienced a heart attack or cardiac injury, guiding the next steps.

Some common cardiac markers include:

• Troponin: This is the most sensitive and specific marker for heart muscle damage, making it the gold standard for diagnosing heart attacks. When heart cells are injured, troponin levels rise within hours and can remain elevated for up to two weeks, providing a clear indicator of cardiac stress.
• Creatine Kinase (CK): CK is an enzyme found in the heart, muscles, and brain, and its levels increase when there is muscle damage, including damage to the heart. While CK can indicate cardiac injury, it’s less specific than troponin, as it can also increase from muscle inflammation, trauma, or intense exercise. High CK is also associated with high blood pressure and bleeding risk.
• Myoglobin: Myoglobin is a small protein that helps move oxygen in your muscle cells. Interestingly, it’s also one of the first markers to rise following a heart attack. However, because myoglobin is found in all muscles, elevated levels can also result from non-cardiac conditions like muscle injuries, making it a less specific indicator of heart damage.

Your Cardiac Panel Labs: Next Steps

According to the American Heart Association, a whopping 80% of cardiovascular diseases (including heart disease and stroke) are preventable. Being an active participant in your health means understanding your blood tests for heart health—taking action through science-based nutrition and lifestyle management. 

Knowing your numbers is the first line of defense. If you need help optimizing your cardiac blood test parameters, join my next 6-week heart optimization group program or learn more about my 1:1 services. I do a personalized lab review as an add-on service to my group program, in which I’ll take a look at all of our labs and medical tests and incorporate those into my 1:1 treatment plans. 

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