These biomarkers can signal serious heart concerns, but you may not be tested for them at your regular check-up.
To live a long life free of major health concerns, supporting your cardiovascular health is essential.
In fact, individuals with good cardiovascular health had a life expectancy at age 50 that was, on average, 8.9 years longer than those with poor cardiovascular health, according to a 2023 study published in Circulation. Maintaining “ideal” cardiovascular health is also linked with a lower risk of premature mortality, both in the general population and in people with cardiometabolic disease, per a study of more than 341,000 participants.
Receiving a regular check-up from your healthcare provider is an easy way to stay on top of your heart health. Every one to five years, your provider will likely order a lipid panel, assessing your levels of total cholesterol, LDL (low-density lipoprotein) cholesterol, HDL (high-density lipoprotein) cholesterol, and triglycerides in your blood, says Stephen Kopecky, M.D., a cardiologist specializing in cardiovascular disease prevention and the director of the Statin Intolerance Clinic at the Mayo Clinic. This test can determine your risk of plaque build-up that can ultimately narrow or block your arteries and cause serious health complications, according to the Mayo Clinic.
However, these aren't the only biomarkers that can clue you in on your cardiovascular health and, in turn, your longevity. Ahead, other noteworthy substances your doctor may want to assess at your next appointment.
Lipoprotein (a)
Cholesterol uses lipoproteins — made of fat and protein — to travel through the blood, and while LDL and HDL are the most commonly known, there’s also lipoprotein (a). Just like LDL cholesterol, Lp(a) cholesterol can build up as plaque in your blood vessels, reducing blood flow to essential organs, including the heart, according to the Centers for Disease Control and Prevention. This type of lipoprotein may also increase clotting and inflammation.
“The problem with lipoprotein (a) is that it delivers cholesterol just like LDL cholesterol does, but it also will irritate the plaque, cause it to tear or rupture, and then clot [it],” says Dr. Kopecky. “So it does the three things you don't want to have happen.” The takeaway: Having high Lp(a) levels increases your risk of suffering a heart attack or stroke, per the CDC.
Lp(a) typically isn’t tested in your usual lipid panel, and concentrations are largely genetically determined. That’s why the American College of Cardiology and American Heart Association now recommend checking this lipoprotein if you have a family history of early heart disease (read: men under the age of 55 and women under the age of 65), says Dr. Kopecky. You also won’t need to have your Lp(a) levels routinely tested throughout your lifetime, he adds. “It's like having blue eyes — you don’t get sent back to the eye doctor every year [for them to] say your eyes are blue,” he explains. “Once we know Lp(a) is high, it's high [for your life].”
Apolipoprotein B
Apolipoprotein B (aka ApoB) is the main protein found on the surface of very low-density, low-density, and intermediate-density lipoproteins, as well as lipoprotein (a). Its levels are typically assessed when triglyceride levels (which are measured on a standard lipid profile and fluctuate when you eat and digest food) are high, says Dr. Kopecky. Specifically, If triglycerides are over 200 mg/dL, the equation used to calculate LDL cholesterol becomes less accurate, so healthcare providers will instead use ApoB to assess your risk of cardiovascular issues, he explains. ApoB may also be measured in people with diabetes, as high levels have been linked with type II diabetes.
“It is the single best thing to draw for lipids to assess your risk,” says Dr. Kopecky. “If you can only do one test the rest of your life, make it ApoB.” In one recent study on more than 13,000 patients being treated with cholesterol-lowering drugs, researchers found that elevated apoB and non-HDL cholesterol levels were linked with residual risk of all-cause mortality and heart attack. What’s more, ApoB levels were shown to be a more accurate marker of all-cause mortality in these individuals than LDL cholesterol or non-HDL cholesterol levels.
That said, Dr. Kopecky recommends only folks with high triglycerides or other specific health concerns get their ApoB levels tested. “If you have an LDL that's incredibly high, say 150 or something, you don't need an ApoB — it's not going to help you [any more],” he notes.
NT-proBNP
A substance found in the brain and heart, N-terminal pro-B-type natriuretic peptide — or NT-proBNP — levels elevate when your heart isn’t pumping well or relaxing enough in between each beat, and it can signal some heart concerns, says Dr. Kopecky. “It's usually [elevated in] people that have what we call heart failure, where the heart fails to pump enough blood around to meet the body’s demand,” he explains. And research backs this up: A 2013 review suggests that NT-proBNP is a strong predictor of death during acute and chronic heart failure.
In addition to other signs of heart failure, NT-proBNP levels may be assessed if a patient comes to the doctor due to shortness of breath, but the cause isn’t quite clear, says Dr. Kopecky.
Ceramides and hs-CRP
Ceramides and high-sensitivity C-reactive protein (hs-CRP) levels may also be tested for a better understanding of cardiovascular health, says Dr. Kopecky. “hs-CRP indicates inflammation or irritation of the tissues in your arteries, which make it more likely to rupture any cholesterol plaque,” he explains. “And the ceramides are a signaling molecule for that plaque rupture.” Heart attack patients are often found to have elevated hs-CRP levels, according to the Journal of the American Heart Association.
These substances are typically tested in individuals with known risk factors or known heart disease, says Dr. Kopecky. “The benefit of the ceramides is that they're more specific than the hs-CRP, which can be elevated for other reasons like if you have a flu or an infection,” he adds.”
The takeaway
While testing your blood for these biomarkers can help better assess your cardiovascular health, they’re not always necessary, says Dr. Kopecky. “I don't want patients to get bogged down by all this little testing minutia,” he adds.” Instead, he encourages patients to have open and honest conversations with their healthcare provider and discuss their stress levels, sleeping habits and quality, diet, and activity levels before requesting every assessment. Chatting through these lifestyle factors can often highlight potential cardiovascular issues worth exploring further — without the need to draw blood.
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