While heart disease is the #1 killer, the good news is that excellent biomarkers exist that can predict heart disease decades in advance. Only half of the top 6 heart health biomarkers are covered by insurance, but they can be obtained for <$200.
The best biomarkers for heart disease are ApoB, Lp(a), blood pressure, hs-CRP, HbA1c, and eGFR. Each of these are an independent risk factor for heart disease, and each of them are actionable.
The six strongest lab tests for heart disease: ApoB, Lp(a), blood pressure, hs-CRP, HbA1c, and eGFR.
ApoB: a more accurate LDL cholesterol
Apolipoprotein B (ApoB) is the single best blood biomarker for predicting your risk of a heart attack. Unlike the traditional LDL cholesterol test—which measures the amount of cholesterol floating in your blood—ApoB directly counts the number of atherogenic (artery-clogging) particles. Each LDL, VLDL, and IDL particle carries exactly one ApoB molecule, so ApoB gives a true count of particles capable of causing plaque. Several major studies in 2023 and 2025 have confirmed that ApoB consistently outperforms LDL in predicting who develops heart disease.
ApoB is not usually covered by insurance, but the test is available nationwide through major labs.
Lp(a): the strongest hereditary risk factor for heart disease
Lipoprotein(a), or Lp(a), is the largest inherited risk factor for heart disease. Lp(a) is an LDL particle with an extra apoprotein (a) “tail” that camoflauges it from your liver. This makes Lp(a) up to 6 times more atherogenic than standard LDL. Your Lp(a) level is set mostly by genetics at birth, and remains stable throughout life—so a single measurement is usually enough to know your inherited risk.
Experts like Dr. Alan Sniderman and organizations such as the European Society of Cardiology now recommend that everyone gets Lp(a) measured at least once. Clinical trials have repeatedly shown that high Lp(a) is a major driver of early heart disease. While there’s not yet an FDA-approved drug to lower Lp(a), new therapies are being studied in late-stage trials and should be available soon.
ApoB and Lp(a) now outweigh cholesterol, triglycerides, and particle sizes. Source: European Heart Journal, 2025
Blood pressure
Blood pressure screening is standard across nearly all routine healthcare visits. Unlike many other heart biomarkers, blood pressure is almost always covered by insurance and can even be measured at home.
Blood pressure is affected by a combination of genetics, salt (sodium) and potassium intake, exercise, stress, and certain medications. The good news: it’s highly modifiable—lowering blood pressure, even a little, leads to a substantial reduction in your lifetime risk.
The latest models of Apple Watch, Samsung, and Whoop have new FDA-cleared features that can sometimes alert you to hypertension. It’s most common that you would measure blood pressure with a conventional cuff.
Inflammation (hs-CRP)
High-sensitivity C-reactive protein (hs-CRP) is a marker of chronic inflammation. Recent research shows that inflammation is a larger risk factor than cholesterol in predicting heart attacks. The good news is that inflammation can be reduced both by diet (for example, antioxidants) and medications (statins reduce both ApoB and hs-CRP).
HbA1c: metabolic health
Hemoglobin A1c (HbA1c) roughly measures your average blood sugar level over the past two to three months. An HbA1c of 5.7-6.4 indicates pre-diabetes. An HbA1c over 6.5 indicates diabetes. Lowering your HbA1c through diet, exercise, or medication can dramatically reduce your risk of cardiovascular complications.
eGFR: kidney function
Estimated glomerular filtration rate (eGFR) measures how well your kidneys are filtering waste. Chronic kidney disease is a “force multiplier” for heart risk—when your kidney function goes down, heart disease and mortality risks go up. Even mild drops in eGFR are associated with higher rates of heart attacks and strokes.
How to use these biomarkers to calculate your risk of heart disease
Risk calculators such as the ACC/AHA ASCVD Risk Estimator and newer risk models like PREVENT use these biomarkers to give you a personalized estimate of your 10-year, 30-year, or lifetime risk of having a heart attack or stroke. These calculators help turn your biomarkers into actionable recommendations, including whether you’d benefit from lifestyle changes or preventive medications.
How to get all of the top biomarkers for heart disease in one lab test
Most standard cholesterol and “physical” blood panels do not include ApoB or Lp(a). However, several advanced panels now bundle all six critical biomarkers (ApoB, Lp(a), blood pressure, hs-CRP, HbA1c, and eGFR) into a single test, available through direct-to-consumer labs and select clinics. For about $190, you can get all of these biomarkers as part of Empirical Health’s comprehensive health panel, which also includes a video visit with a doctor.
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