6 ms·

Before getting a CAC scan, I'd probably do these tests first: * ApoB - about 20% of people with normal cholesterol results will have abnormal ApoB, and be at r

Before getting a CAC scan, I'd probably do these tests first: * ApoB - about 20% of people with normal cholesterol results will have abnormal ApoB, and be at risk of heart disease. * Lp(a) - the strongest hereditary risk factor for heart disease. * hs-CRP - inflammation roughly doubles your risk of heart disease * HbA1c - insulin resistance is a risk factor for just about everything. * eGFR - estimates the volume of liquid your kidneys can filter, and is an input to the latest heart disease risk models (PREVENT). Easy to order online: https://www.empirical.health/product/comprehensive-health-panel https://www.empirical.health/product/comprehensive-health-pa... CAC is great for detecting calcified plaque in your coronary arteries. But before you have calcified plaque, the above risk factors tell you about the buildup of soft plaque. And 4 out of 5 of them are modifiable through lifestyle, exercise, and medication.

apothegm 1y ago
CAC is the right test for people who already have identified that they have major risk factors such as metabolic syndrome/T2D, high cholesterol, etc. It identifies whether heart disease has already advanced enough that the risk factor has become a risk. Some of the tests you list (like A1C) are baseline things everyone should get checked every year. Agreed that the others could provide value for those who want to know more about their risk level; however, it’s uncommon for those tests to turn up positives without one of the baselines having already raised at least a yellow flag. None of the tests you listed will tell you whether you have any soft plaque buildup. They just tell you more about your risk factors. However, there are ultrasound tests that can detect increased blood pressure in major arteries, which IIRC does reflect soft plaque buildup.
- CalChris 1y ago
  Lp(a) is a once in your lifetime test and also not very expensive.
  - dr_ 1y ago
    Sometimes free as well. Certain CROs offer free screening: https://cardiometabolicscreening.careaccess.com/en?_gl=1*1duvvfk*_ga*MjA4NDkwODc0MC4xNzUzNjM0MzE1 https://cardiometabolicscreening.careaccess.com/en?_gl=1*1du...
    - CalChris 1y ago
      The test cost me $35.20 and I found out that I have sky high Lp(a), 218 nmol/L. I already take a statin and my cholesterol is well under control (LDL 83). But as has been pointed out, Lp(a) doesn't respond to statins. I'm getting a calcium score done (probably won't be covered but we'll see). I'm prescribed a baby aspirin for the Lp(a). The AHA no longer recommends baby aspirin to the general population but 218 takes me out of the general population. The thinking is that Lp(a) clots and baby aspirin counteracts that.
      - deleted 1y ago
        [deleted]
      - LorenPechtel 1y ago
        Yeah. I've got that evil gene. Presumably took out my uncle at 55. But I'm much more active and my heart still works properly.
- JeremyNT 1y ago
  I've had high-ish LDL for ages and diet alone couldn't knock it all the way down. It's only the CAC score that provided me with peace of mind that I didn't need to reach for statins. The way I view this is that, if you can get more information, why wouldn't you? Cost of course, and I understand why insurance might not cover the procedure, but anybody of a certain age with any risk factors who is in a position to afford it benefits from doing so.
  - fivestones 1y ago
    The problem we’ve found is that when you get more information, you are more likely to find things that look off somewhere, which may have no real bearing on your actual health but definitely can cause you to have a worse quality of life—whether because of stress or subsequent more invasive tests or just the time and energy it costs you. This is why there are tests which previously were recommended to a wide range of people on a regular basis which are now only recommended in more limited settings. PSA is a good example of this. The question to ask is, is doing this test likely to improve my life, or not? And while you probably can’t know the answer for a specific test in your specific case without trying, you can often know the probability that it will improve your life based on statistical analysis of other people who have gotten that test and how it went for them.
  - 31carmichael 1y ago
    I have a CAC score of zero (no calcified plaque) and I take both a statin and ezetimibe to lower my LDL and ApoB. I disagree with your assessment that your CAC score along means that I statin wouldn't lower your risk.
- hombre_fatal 1y ago
  No, CAC only tests for end stage calcified plaque which is how your body tries to transform soft plaque. It's soft plaque that first lines your arteries and is capable of rupturing. You might be infested with soft plaque, but if none of it has calcified yet (which can take decades) then you'll have a CAC score of zero. Using CAC store to gauge risk is like waiting until you have end stage symptoms of any disease before you consider yourself at risk. The ship has already sailed and you should have instead focused on prevention for decades. The sibling comment is a great example of the misinformation here. They have high cholesterol but a CAC score of zero gave them the peace of mind to not use statins.
coldcode 1y ago
My cardiologist did all of these except the eGFR. My calcium score was fairly high, but not high enough to be concerning since my cholesterol is controlled and my diet and exercise regime are good now. Until the CAC was done, I had no idea if I had any or not. It's better to deal with cholesterol earlier than I did.
- _zagj 1y ago
  > My cardiologist did all of these except the eGFR eGFR is typically inferred from serum creatinine (not creatine!), which is part of both a comprehensive and basic metabolic panel (CMP/BMP), which your GP usually orders, along with a CBC, and perhaps an HbA1c.
OutOfHere 1y ago
Unfortunately there is no approved oral medicine to lower Lp(a) that I am aware of. (I mean given a normal LDL.) Statins don't lower it afaik. An oral medicine named muvalaplin is being tested for it.
- throwaway7783 1y ago
  There are some in trials. I'm part of one by Eli Lily. Lp(a) sucks, is genetic and so far there was no medication.
  - dr_ 1y ago
    The best way to get tested may be in conjunction with a trial. This was can potentially enroll.
- _zagj 1y ago
  Oddly enough, there's evidence that saturated fat intake inversely affects Lp(a) levels: https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/
  - OutOfHere 1y ago
    It doesn't help if LDL gets raised due to the SFAs, as LDL is an independent risk factor.
    - _zagj 1y ago
      I was just noting the oddness of Lp(a) responding inversely to SFA intake (the reverse of LDL), which also contradicts the conventional wisdom that Lp(a) isn't amenable to lifestyle interventions. You could theoretically increase SFA to target Lp(a) while still using lipid-altering drugs to target LDL.
- d4704 1y ago
  I’ve read that (injection currently, not oral) ‘PCSK9 inhibitors’ may help lower Lp(a) where few other things do today. https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhibitors https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...
rsanek 1y ago
I'd add in the LDL subcomponent assay as well -- LDL pattern, particle number, peak size, etc. you can get those and all the ones you mentioned for relatively cheap https://www.walkinlab.com/products/view/cardio-iq-advanced-lipid-panel-with-inflammation-blood-test?srsltid=AfmBOoq1zfZCriYiFlr6a3LaAv9l7SBQuAFr4O8uhIVOD67l23uLwGwW https://www.walkinlab.com/products/view/cardio-iq-advanced-l...
- brandonb 1y ago
  The latest evidence is that if you have ApoB and Lp(a), then particle sizes don't add any more information. This is the most recent research (published July 2025): https://academic.oup.com/eurheartj/article-abstract/46/27/2702/8125560 https://academic.oup.com/eurheartj/article-abstract/46/27/27...
CalRobert 1y ago
Anyone know of an equivalent in Europe? Dutch doctors always ignore me and say to come back after I’m dead. (But will happily tell me to take Tylenol)
- beacon294 1y ago
  Switch doctors? Ask on dutch social networks I think? Some stuff will also not be approved/covered.
Theodores 1y ago
Fascinating how these tests are something that is an option in America with people getting them. In the UK we have the NHS and, although private healthcare is available, the NHS are gatekeepers with long waiting lists to see the doctor. In UK culture you are just not going to 'waste NHS time' by asking for the tests that could inform you on what lifestyle choices you might need to make in order to head off chronic non-communicable diseases. You have to get a chronic disease, then the doctor will interpret the test results and not let you know what the numbers are, just what medication to take, optionally with lifestyle changes. As a consequence, nobody in the UK knows what their cholesterol levels and whatnot are, yet, in the USA, plenty of people know these numbers. Do healthcare providers actively upsell testing in the USA?
- djeastm 1y ago
  >Do healthcare providers actively upsell testing in the USA? In my experience, normal doctors do not, but there are a lot of private businesses that make their living selling testing. Also, consider that despite a lot of people knowing their levels in the US through testing availability, health outcomes are not better. So, we know more, but don't do anything about it. I don't know what's worse.
  - mbac32768 1y ago
    They are better. Life expectancy at birth in the US is dragged down by myriad societal issues but if you survive to middle age, life expectancy begins climbing to the highest in the world.
    - Workaccount2 1y ago
      Really you just need to look at it by state to see the huge difference. There is almost a 10 year difference between the best and worst states.
  - beacon294 1y ago
    I think, politely, this perspective misses the forest for the trees (or maybe the trees for the forest). Out of the approx. 250 million adult americans, a large cross section do manage their health. While average outcome might be better in the UK, it's useless to lump the 60% (150 million) of americans who are not obese in with the 40% (100 million) who are obese. And while this is easily the most major, it is just one measure of health.
gcanyon 1y ago
Given the low side effect rate and limited overall impact, shouldn't the bar for deciding to take statins be near-zero? Like, the articles say if there's a 5% chance of a heart attack in the next 10 years there's no reason to take a statin, but if the statin changes that 5% to 4% (that's speculation on my part) then given the limited side effects it would likely be worth it, right?
- radlad 1y ago
  I know a number of people who report memory issues since starting statins. They also clearly exhibit memory issues but it's hard as an outsider to pinpoint when they started. Unfortunately, they really do need statins.
- brandonb 1y ago
  I used to work with a cardiologist who joked that "we should just add statins to the water," so you have a point. The current guidelines for prescribing statins are based on your risk of a major cardiac event in the next 10 years (forecasted using a statistical model). But given that plaque builds up in your arteries over your lifetime, there's a strong argument for using a 30-year or lifelong time horizon.
- jgalt212 1y ago
  > the low side effect rate The rate of serious side effects is quite low (e.g. brain fog), but the reported rate for muscle weakness is non-trivial.
  - dugmartin 1y ago
    It caused a lot of muscle weakness in the legs for two members of my family. The weakness went away for one of them when they stopped taking it.
- timr 1y ago
  Statins often have the side effect of raising blood sugar. So there’s a non-trivial tradeoff for a population that is usually on the edge of metabolic disease.
QuantumGood 1y ago
Since typical blood tests start at under $10, can you codify the value that the company at that link provides that makes their list price $1,490?
- brandonb 1y ago
  That panel costs $190 (and includes 85 biomarkers). FWIW, similar bundles I've seen online are priced at $400-$500. All 85 biomarkers, if purchased separately, would cost a total of $1,490. ApoB, for example, usually costs $60 if done in isolation, Lp(a) is $45, hs-CRP is $65 at Quest, etc. The bundles end up having lower pricing due to volume discounts and being able to amortize some of the cost across biomarkers.
  - QuantumGood 1y ago
    Thanks, that's good information. What is your relationship to the company, if any? I wouldn't ask, but it's common when the answer is "none" to provide that info before anyone asks. I believe eGFR (via creatinine testing) and sometimes HbA1c (if diabetes screening is ordered) are the only things listed may be part of a routine health check from a common/inexpensive blood test.
    - ljf 1y ago
      Tape on the posters name: about: Data for good. Co-Founder at Empirical Health (https://empirical.health https://empirical.health). Before: Risk Engineering at Brex
    - brandonb 1y ago
      Co-Founder of the company (it's on my profile). Yes, you're right--of the biomarkers listed, only eGFR and HbA1c are standard in a routine health check.
myth_drannon 1y ago
I imagine nothing like this is available in Canada?
pardner 1y ago
Saw your link, did your test and here's my feedback. No "share" or "download" button in the app? Sure, "apps are cool" and all that - but what about folks who want to archive or share their health data? AFAIK literally no provision to share all those nifty biomarkers with my doctor (except many, many screenshots)? Nowhere in the "how to get blood test" email instructions does it bother to mention a urine sample will also be needed. Kinda useful to know if you should not pee right before heading to the lab.

apothegm 1y ago

CAC is the right test for people who already have identified that they have major risk factors such as metabolic syndrome/T2D, high cholesterol, etc. It identifies whether heart disease has already advanced enough that the risk factor has become a risk. Some of the tests you list (like A1C) are baseline things everyone should get checked every year. Agreed that the others could provide value for those who want to know more about their risk level; however, it’s uncommon for those tests to turn up positives without one of the baselines having already raised at least a yellow flag. None of the tests you listed will tell you whether you have any soft plaque buildup. They just tell you more about your risk factors. However, there are ultrasound tests that can detect increased blood pressure in major arteries, which IIRC does reflect soft plaque buildup.

CalChris 1y ago
Lp(a) is a once in your lifetime test and also not very expensive.
- dr_ 1y ago
  Sometimes free as well. Certain CROs offer free screening: https://cardiometabolicscreening.careaccess.com/en?_gl=1*1duvvfk*_ga*MjA4NDkwODc0MC4xNzUzNjM0MzE1 https://cardiometabolicscreening.careaccess.com/en?_gl=1*1du...
  - CalChris 1y ago
    The test cost me $35.20 and I found out that I have sky high Lp(a), 218 nmol/L. I already take a statin and my cholesterol is well under control (LDL 83). But as has been pointed out, Lp(a) doesn't respond to statins. I'm getting a calcium score done (probably won't be covered but we'll see). I'm prescribed a baby aspirin for the Lp(a). The AHA no longer recommends baby aspirin to the general population but 218 takes me out of the general population. The thinking is that Lp(a) clots and baby aspirin counteracts that.
    - deleted 1y ago
      [deleted]
    - LorenPechtel 1y ago
      Yeah. I've got that evil gene. Presumably took out my uncle at 55. But I'm much more active and my heart still works properly.
JeremyNT 1y ago
I've had high-ish LDL for ages and diet alone couldn't knock it all the way down. It's only the CAC score that provided me with peace of mind that I didn't need to reach for statins. The way I view this is that, if you can get more information, why wouldn't you? Cost of course, and I understand why insurance might not cover the procedure, but anybody of a certain age with any risk factors who is in a position to afford it benefits from doing so.
- fivestones 1y ago
  The problem we’ve found is that when you get more information, you are more likely to find things that look off somewhere, which may have no real bearing on your actual health but definitely can cause you to have a worse quality of life—whether because of stress or subsequent more invasive tests or just the time and energy it costs you. This is why there are tests which previously were recommended to a wide range of people on a regular basis which are now only recommended in more limited settings. PSA is a good example of this. The question to ask is, is doing this test likely to improve my life, or not? And while you probably can’t know the answer for a specific test in your specific case without trying, you can often know the probability that it will improve your life based on statistical analysis of other people who have gotten that test and how it went for them.
- 31carmichael 1y ago
  I have a CAC score of zero (no calcified plaque) and I take both a statin and ezetimibe to lower my LDL and ApoB. I disagree with your assessment that your CAC score along means that I statin wouldn't lower your risk.
hombre_fatal 1y ago
No, CAC only tests for end stage calcified plaque which is how your body tries to transform soft plaque. It's soft plaque that first lines your arteries and is capable of rupturing. You might be infested with soft plaque, but if none of it has calcified yet (which can take decades) then you'll have a CAC score of zero. Using CAC store to gauge risk is like waiting until you have end stage symptoms of any disease before you consider yourself at risk. The ship has already sailed and you should have instead focused on prevention for decades. The sibling comment is a great example of the misinformation here. They have high cholesterol but a CAC score of zero gave them the peace of mind to not use statins.

coldcode 1y ago

My cardiologist did all of these except the eGFR. My calcium score was fairly high, but not high enough to be concerning since my cholesterol is controlled and my diet and exercise regime are good now. Until the CAC was done, I had no idea if I had any or not. It's better to deal with cholesterol earlier than I did.

_zagj 1y ago
> My cardiologist did all of these except the eGFR eGFR is typically inferred from serum creatinine (not creatine!), which is part of both a comprehensive and basic metabolic panel (CMP/BMP), which your GP usually orders, along with a CBC, and perhaps an HbA1c.

OutOfHere 1y ago

Unfortunately there is no approved oral medicine to lower Lp(a) that I am aware of. (I mean given a normal LDL.) Statins don't lower it afaik. An oral medicine named muvalaplin is being tested for it.

throwaway7783 1y ago
There are some in trials. I'm part of one by Eli Lily. Lp(a) sucks, is genetic and so far there was no medication.
- dr_ 1y ago
  The best way to get tested may be in conjunction with a trial. This was can potentially enroll.
_zagj 1y ago
Oddly enough, there's evidence that saturated fat intake inversely affects Lp(a) levels: https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/
- OutOfHere 1y ago
  It doesn't help if LDL gets raised due to the SFAs, as LDL is an independent risk factor.
  - _zagj 1y ago
    I was just noting the oddness of Lp(a) responding inversely to SFA intake (the reverse of LDL), which also contradicts the conventional wisdom that Lp(a) isn't amenable to lifestyle interventions. You could theoretically increase SFA to target Lp(a) while still using lipid-altering drugs to target LDL.
d4704 1y ago
I’ve read that (injection currently, not oral) ‘PCSK9 inhibitors’ may help lower Lp(a) where few other things do today. https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhibitors https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...

rsanek 1y ago

I'd add in the LDL subcomponent assay as well -- LDL pattern, particle number, peak size, etc. you can get those and all the ones you mentioned for relatively cheap https://www.walkinlab.com/products/view/cardio-iq-advanced-lipid-panel-with-inflammation-blood-test?srsltid=AfmBOoq1zfZCriYiFlr6a3LaAv9l7SBQuAFr4O8uhIVOD67l23uLwGwW https://www.walkinlab.com/products/view/cardio-iq-advanced-l...

brandonb 1y ago
The latest evidence is that if you have ApoB and Lp(a), then particle sizes don't add any more information. This is the most recent research (published July 2025): https://academic.oup.com/eurheartj/article-abstract/46/27/2702/8125560 https://academic.oup.com/eurheartj/article-abstract/46/27/27...

CalRobert 1y ago

Anyone know of an equivalent in Europe? Dutch doctors always ignore me and say to come back after I’m dead. (But will happily tell me to take Tylenol)

beacon294 1y ago
Switch doctors? Ask on dutch social networks I think? Some stuff will also not be approved/covered.

Theodores 1y ago

Fascinating how these tests are something that is an option in America with people getting them. In the UK we have the NHS and, although private healthcare is available, the NHS are gatekeepers with long waiting lists to see the doctor. In UK culture you are just not going to 'waste NHS time' by asking for the tests that could inform you on what lifestyle choices you might need to make in order to head off chronic non-communicable diseases. You have to get a chronic disease, then the doctor will interpret the test results and not let you know what the numbers are, just what medication to take, optionally with lifestyle changes. As a consequence, nobody in the UK knows what their cholesterol levels and whatnot are, yet, in the USA, plenty of people know these numbers. Do healthcare providers actively upsell testing in the USA?

djeastm 1y ago
>Do healthcare providers actively upsell testing in the USA? In my experience, normal doctors do not, but there are a lot of private businesses that make their living selling testing. Also, consider that despite a lot of people knowing their levels in the US through testing availability, health outcomes are not better. So, we know more, but don't do anything about it. I don't know what's worse.
- mbac32768 1y ago
  They are better. Life expectancy at birth in the US is dragged down by myriad societal issues but if you survive to middle age, life expectancy begins climbing to the highest in the world.
  - Workaccount2 1y ago
    Really you just need to look at it by state to see the huge difference. There is almost a 10 year difference between the best and worst states.
- beacon294 1y ago
  I think, politely, this perspective misses the forest for the trees (or maybe the trees for the forest). Out of the approx. 250 million adult americans, a large cross section do manage their health. While average outcome might be better in the UK, it's useless to lump the 60% (150 million) of americans who are not obese in with the 40% (100 million) who are obese. And while this is easily the most major, it is just one measure of health.

gcanyon 1y ago

Given the low side effect rate and limited overall impact, shouldn't the bar for deciding to take statins be near-zero? Like, the articles say if there's a 5% chance of a heart attack in the next 10 years there's no reason to take a statin, but if the statin changes that 5% to 4% (that's speculation on my part) then given the limited side effects it would likely be worth it, right?

radlad 1y ago
I know a number of people who report memory issues since starting statins. They also clearly exhibit memory issues but it's hard as an outsider to pinpoint when they started. Unfortunately, they really do need statins.
brandonb 1y ago
I used to work with a cardiologist who joked that "we should just add statins to the water," so you have a point. The current guidelines for prescribing statins are based on your risk of a major cardiac event in the next 10 years (forecasted using a statistical model). But given that plaque builds up in your arteries over your lifetime, there's a strong argument for using a 30-year or lifelong time horizon.
jgalt212 1y ago
> the low side effect rate The rate of serious side effects is quite low (e.g. brain fog), but the reported rate for muscle weakness is non-trivial.
- dugmartin 1y ago
  It caused a lot of muscle weakness in the legs for two members of my family. The weakness went away for one of them when they stopped taking it.
timr 1y ago
Statins often have the side effect of raising blood sugar. So there’s a non-trivial tradeoff for a population that is usually on the edge of metabolic disease.

QuantumGood 1y ago

Since typical blood tests start at under $10, can you codify the value that the company at that link provides that makes their list price $1,490?

brandonb 1y ago
That panel costs $190 (and includes 85 biomarkers). FWIW, similar bundles I've seen online are priced at $400-$500. All 85 biomarkers, if purchased separately, would cost a total of $1,490. ApoB, for example, usually costs $60 if done in isolation, Lp(a) is $45, hs-CRP is $65 at Quest, etc. The bundles end up having lower pricing due to volume discounts and being able to amortize some of the cost across biomarkers.
- QuantumGood 1y ago
  Thanks, that's good information. What is your relationship to the company, if any? I wouldn't ask, but it's common when the answer is "none" to provide that info before anyone asks. I believe eGFR (via creatinine testing) and sometimes HbA1c (if diabetes screening is ordered) are the only things listed may be part of a routine health check from a common/inexpensive blood test.
  - ljf 1y ago
    Tape on the posters name: about: Data for good. Co-Founder at Empirical Health (https://empirical.health https://empirical.health). Before: Risk Engineering at Brex
  - brandonb 1y ago
    Co-Founder of the company (it's on my profile). Yes, you're right--of the biomarkers listed, only eGFR and HbA1c are standard in a routine health check.

myth_drannon 1y ago

I imagine nothing like this is available in Canada?

pardner 1y ago

Saw your link, did your test and here's my feedback. No "share" or "download" button in the app? Sure, "apps are cool" and all that - but what about folks who want to archive or share their health data? AFAIK literally no provision to share all those nifty biomarkers with my doctor (except many, many screenshots)? Nowhere in the "how to get blood test" email instructions does it bother to mention a urine sample will also be needed. Kinda useful to know if you should not pee right before heading to the lab.