What blood tests to ask your physician for

Your doctor orders a lipid panel. Total cholesterol, LDL, HDL, triglycerides. Maybe fasting glucose if you're lucky.

The results come back "normal." Your doctor says you're fine.

But you don't feel fine. You're tired, carrying extra weight around your midsection, dealing with brain fog. You know something's wrong.

Here's the problem: standard lab panels miss 90% of cardiovascular dysfunction.

They don't measure inflammation. They don't measure oxidative stress. They don't measure insulin resistance or arterial damage. They don't tell you if your LDL particles are large and fluffy (safe) or small and dense (dangerous).

If you want to actually assess cardiovascular health and prevent heart disease, you need better testing.

Here's what to order, how to order it, and what the results actually mean.

Why Standard Testing Fails

Standard lipid panels were designed in the 1960s based on the flawed cholesterol hypothesis.

They measure:

• Total cholesterol (meaningless for risk prediction)
• LDL cholesterol (measures concentration, not particle number or size)
• HDL cholesterol (useful, but incomplete)
• Triglycerides (useful, but one marker among many)

What they don't measure:

• Inflammation (the actual driver of heart disease)
• Oxidative stress (what damages LDL and arterial walls)
• Insulin resistance (major cardiovascular risk factor)
• LDL particle number and size (what actually matters)
• Arterial damage markers
• Metabolic dysfunction

Heart disease is driven by inflammation and oxidative damage, not cholesterol levels. Standard testing completely misses this.

The Three-Tier Approach

I use a three-tier system for cardiovascular testing:

Baseline: Essential markers everyone should test annually

Intermediate: More detailed assessment if baseline shows issues or you have risk factors

Deep Dive: Comprehensive evaluation for complex cases, autoimmune conditions, or when standard treatment has failed

Baseline Panel (Everyone Needs This)

This is the minimum to actually assess cardiovascular health.

Basic Blood Work (Foundation)

CMP (Comprehensive Metabolic Panel):

• Electrolytes (sodium, potassium, chloride, CO2)
• Kidney function (BUN, creatinine, eGFR)
• Liver enzymes (AST, ALT, alkaline phosphatase, bilirubin)
• Glucose
• Calcium

CBC (Complete Blood Count):

• Red blood cells, white blood cells, platelets
• Hemoglobin, hematocrit
• Identifies anemia, infection, clotting issues

Why this matters: Kidney dysfunction, liver dysfunction, and anemia all increase cardiovascular risk. These are foundational markers that inform everything else.

Advanced Lipid Analysis

Standard markers:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides
• VLDL cholesterol

Advanced markers (critical):

• LDL particle number (LDL-P): How many LDL particles you have (more predictive than LDL cholesterol)
• LDL particle size: Large fluffy (Pattern A, safe) vs small dense (Pattern B, dangerous)
• ApoB (Apolipoprotein B): Measures total number of atherogenic particles (LDL, VLDL, Lp(a))
• Lp(a) - Lipoprotein(a): Genetic inflammatory LDL variant (test once—doesn't change)

Why this matters: Two people can have identical LDL cholesterol (say, 130 mg/dL) but completely different particle numbers. One might have 1,000 large fluffy particles (low risk). The other might have 2,000 small dense particles (high risk). Standard testing can't tell the difference.

Metabolic Health Panel

• Fasting glucose: Should be 70-85 mg/dL (not 100)
• Fasting insulin: Most important metabolic marker. Should be <5 iu="" ml="" above="" 10="insulin" resistance="" li="">
• HbA1c (Hemoglobin A1c): 3-month average blood sugar. Should be <5.3%.
• Fructosamine: 2-3 week average blood sugar. Useful if HbA1c unreliable.

Why this matters: Insulin resistance drives inflammation, raises triglycerides, creates small dense LDL, and damages arterial walls. Fasting insulin catches this years before fasting glucose becomes abnormal.

Inflammation Markers

• hs-CRP (high-sensitivity C-reactive protein): Marker of systemic inflammation. Should be <1.0 mg="" l="" above="" 3="" 0="high" cardiovascular="" risk="" li=""> 

Why this matters: Inflammation drives atherosclerosis. Elevated hs-CRP predicts heart attacks better than cholesterol ever did.

Arterial Damage Marker

• Homocysteine: Amino acid that directly damages arterial walls when elevated. Should be <7 mol="" l="" above="" 10="significant" risk="" li=""> 

Why this matters: High homocysteine creates lesions in arterial endothelium where plaque forms. Lowered by B vitamins (folate, B6, B12).

Hormone Panel (Critical for Cardiovascular Risk)

For Men:

• Total testosterone: Optimal >600 ng/dL. Below 300 = clinical hypogonadism. 300-500 = suboptimal.
• Free testosterone: More accurate measure of bioavailable testosterone.
• DHEA-S: Adrenal hormone, declines with age, affects cardiovascular health.
• Estradiol: Men need some estrogen (from testosterone conversion). Too high or too low = cardiovascular risk.

For Women:

• Estradiol: Primary estrogen, dramatically protective against heart disease pre-menopause.
• Progesterone: Balances estrogen, affects vascular function.
• Testosterone: Women need testosterone too (lower levels than men). Important for metabolic health.
• DHEA-S: Adrenal hormone, declines with age.

Why this matters: Low testosterone in men is strongly correlated with increased cardiovascular mortality—independent of other risk factors. Men with total testosterone below 300 ng/dL have significantly higher rates of heart attack, stroke, and all-cause mortality.

Post-menopausal women experience a dramatic spike in heart attack rates. Before menopause, women have significantly lower cardiovascular risk than men (estrogen is cardioprotective). After menopause, estrogen drops, and cardiovascular risk rapidly increases to match or exceed men's risk.

Hormones aren't just about libido or energy. They directly affect vascular function, inflammation, lipid metabolism, and insulin sensitivity.

Where to order: LabCorp or Quest can run all of these. Requires physician order or ordering service like Ulta Lab Tests or Full Script (which we can provide).

Intermediate Panel (If Baseline Shows Issues)

If your baseline panel reveals problems—high triglycerides, low HDL, elevated hs-CRP, insulin resistance, or unfavorable particle numbers—go deeper.

Extended Metabolic Panel

• Adiponectin: Anti-inflammatory hormone from fat tissue. Low levels = insulin resistance, inflammation, metabolic syndrome.
• Leptin: Satiety hormone. High levels = leptin resistance, metabolic dysfunction, inflammation.

Why this matters: Adiponectin and leptin reveal how your fat tissue is functioning metabolically. Dysfunctional fat tissue drives systemic inflammation and cardiovascular disease.

Additional Inflammation Markers

• Lp-PLA2 (lipoprotein-associated phospholipase A2): Enzyme in plaque that predicts plaque rupture and cardiovascular events.
• IL-6 (Interleukin-6): Pro-inflammatory cytokine. Elevated in chronic inflammation.
• TNF-alpha (Tumor Necrosis Factor-alpha): Pro-inflammatory cytokine. Drives insulin resistance and arterial damage.
• IL-1beta (Interleukin-1 beta): Key inflammatory mediator in atherosclerosis.

Why this matters: These cytokines are the molecular drivers of inflammation. Elevated levels indicate active inflammatory processes damaging your cardiovascular system.

Oxidative Stress Markers

• Lipid peroxides: Measure oxidative damage to fats (including LDL).
• Myeloperoxidase (MPO): Enzyme from white blood cells that oxidizes LDL and predicts plaque instability.
• F2-isoprostanes: Gold standard marker of oxidative stress. Measures free radical damage system-wide.

Why this matters: Oxidized LDL drives atherosclerosis. These markers tell you if oxidative stress is actively damaging your LDL and arterial walls.

Thyroid and Hormone Panel

• TSH, Free T3, Free T4, Reverse T3: Thyroid dysfunction affects lipid metabolism and cardiovascular health.
• Thyroid antibodies (TPO, thyroglobulin): Autoimmune thyroid disease increases cardiovascular risk.

Why this matters: Hypothyroidism raises cholesterol, triglycerides, and homocysteine. Thyroid autoimmunity creates systemic inflammation.

Where to order: LabCorp for most markers. Specialized labs like Doctor's Data or Genova Diagnostics for oxidative stress panels.

Deep Dive Panel (Comprehensive Assessment)

For complex cases, autoimmune conditions, family history of early heart disease, or when you want the most complete picture.

Autoimmune and Food Sensitivity Testing

• Cyrex Labs Array 5 (Multiple Autoimmune Reactivity Screen): Tests for autoimmune reactivity against 24 different tissues including cardiovascular tissue.
• US BioTek Food Sensitivity Panel: IgG and IgA antibodies to 96+ foods. Food sensitivities drive chronic inflammation.
• Cyrex Array 2 (Intestinal Permeability): Leaky gut assessment. Intestinal permeability allows inflammatory triggers into bloodstream.

Why this matters: Autoimmune conditions and food sensitivities create chronic inflammation that damages cardiovascular tissue. Many people have subclinical autoimmunity years before overt disease.

Micronutrient Testing

• SpectraCell Micronutrient Panel: Functional assessment of vitamin and mineral status at cellular level.
• Omega-3 Index: RBC membrane EPA + DHA percentage. Should be >8%. Below 4% = high cardiovascular risk.
• Vitamin D (25-OH vitamin D): Should be 50-80 ng/mL for cardiovascular protection.
• Magnesium RBC: Intracellular magnesium (more accurate than serum). Critical for heart rhythm and blood pressure.
• CoQ10: Essential for heart muscle energy. Depleted by statins and aging.

Why this matters: Nutrient deficiencies impair antioxidant systems, increase oxidative stress, and compromise cardiovascular function.

Heavy Metal Testing

• Hair mineral analysis or provoked urine test: Mercury, lead, cadmium, arsenic. Heavy metals damage arterial walls and increase cardiovascular risk.

Genetic Testing

• ApoE genotype: Determines how you metabolize fats and respond to dietary cholesterol.
• MTHFR mutation: Affects homocysteine metabolism and B vitamin needs.
• 9p21 variant: Genetic marker for early heart disease risk.

Why this matters: Genetics inform personalized interventions. Someone with ApoE4 may need different dietary recommendations than ApoE3.

Where to order: Cyrex Labs, US BioTek, SpectraCell, Doctor's Data, 23andMe (for raw genetic data), or through functional medicine labs.

How to Order These Tests

Most conventional doctors won't order advanced testing. They stick to standard panels and treat by protocol.

Options for ordering:

1. Work With a Functional Practitioner

Practitioners trained in functional medicine, Applied Kinesiology, or integrative health understand advanced testing and can order comprehensive panels.

We can order all of these tests through our practice using LabCorp, Quest, and specialty labs.

2. Use Full Script or Similar Services

Full Script allows practitioners to create accounts for patients to order labs directly. We provide Full Script access so you can order tests on your own and review results together.

3. Direct-to-Consumer Labs

• Ulta Lab Tests
• Life Extension
• Request A Test
• WellnessFX

These services allow you to order labs without a doctor's prescription in most states. Results go directly to you.

4. Ask Your Doctor for Specific Tests

Bring this list. Request the specific markers by name. If your doctor refuses, consider finding a new doctor or using option 2 or 3.

Understanding Your Results

Optimal Ranges (Not Just "Normal")

Lab "normal" ranges are based on statistical averages of sick populations. Optimal ranges are what healthy people actually need.

Advanced Lipids:

• LDL-P: <1,000 nmol/L
• ApoB: <80 mg="" dl="" li="">
• Lp(a): <30 mg="" dl="" li="">
• Triglycerides: <70 mg="" dl="" li="">
• HDL: >60 mg/dL
• Trig:HDL ratio: <2:1

Metabolic Health:

• Fasting glucose: 70-85 mg/dL
• Fasting insulin: <5 iu="" ml="" li="">
• HbA1c: <5.3%

Inflammation:

• hs-CRP: <1.0 mg="" l="" li="">
• IL-6: <5 pg="" ml="" li="">
• TNF-alpha: <6 pg="" ml="" li=""> 

Other:

• Homocysteine: <7 mol="" l="" li="">
• Vitamin D: 50-80 ng/mL
• Omega-3 Index: >8%
• Magnesium RBC: 5.0-6.5 mg/dL

Hormones (Men):

• Total testosterone: >600 ng/dL (optimal), >300 ng/dL (minimum)
• Free testosterone: 9-30 ng/dL
• Estradiol: 20-30 pg/mL
• DHEA-S: 350-500 µg/dL

Hormones (Women, pre-menopausal):

• Estradiol: 50-300 pg/mL (varies by cycle phase)
• Progesterone: 5-20 ng/mL (luteal phase)
• Testosterone: 15-70 ng/dL
• DHEA-S: 65-380 µg/dL

What to Do With Results

Testing without action is pointless. Here's how to use your results:

If Inflammation Is Elevated

• Remove inflammatory foods (seed oils, sugar, grains)
• Increase omega-3s (fatty fish, fish oil)
• Test for food sensitivities (US BioTek panel)
• Heal gut (remove irritants, bone broth, probiotics)
• Manage stress

If Oxidative Stress Is High

• Increase antioxidants (colorful vegetables, berries, herbs)
• Remove seed oils (primary source of oxidation)
• Supplement: CoQ10, vitamin C, vitamin E, selenium
• Stabilize blood sugar (reduce oxidative stress)

If Insulin Resistant

• Remove sugar and refined carbs
• Eat protein and fat at every meal
• Exercise (especially resistance training)
• Consider intermittent fasting
• Supplement: magnesium, chromium, berberine

If Homocysteine Is Elevated

• Supplement: methylated B vitamins (B6, B12, folate)
• Increase leafy greens
• Test for MTHFR mutation

If Nutrient Deficiencies Found

• Supplement strategically based on specific deficiencies
• Improve diet quality
• Address gut health (poor absorption often root cause)

If Hormones Suboptimal

For Men with Low Testosterone:

1. Address root causes: improve sleep (7-9 hours), strength train, reduce body fat, manage stress, supplement zinc/magnesium/vitamin D
2. Remove endocrine disruptors (BPA plastics, pesticides, xenoestrogens)
3. Consider testosterone replacement therapy (TRT) if lifestyle interventions insufficient and levels remain below 300-400 ng/dL
4. Monitor estradiol and DHT with TRT to prevent imbalances

For Post-Menopausal Women:

1. Consider bioidentical hormone replacement therapy (BHRT) - estradiol and progesterone
2. Work with practitioner experienced in BHRT (dosing matters, synthetic hormones different from bioidentical)
3. Timing matters: BHRT most beneficial when started within 10 years of menopause
4. Support hormone metabolism: cruciferous vegetables, fiber, liver support, gut health

Note: Hormone replacement is complex and controversial. Work with a knowledgeable practitioner. Cardiovascular benefits are clear when done properly with bioidentical hormones.

For comprehensive nutrition strategies, visit the Fuel Your Body pillar page.

For stress management and lifestyle optimization, visit the Regulate Your System pillar page.

The Bottom Line

Standard lipid panels miss 90% of cardiovascular dysfunction.

If you want to actually assess heart health and prevent disease, you need:

Baseline (everyone):

• Basic blood work (CMP, CBC)
• Advanced lipid analysis (particle number and size, ApoB, Lp(a))
• Metabolic panel (fasting insulin, glucose, HbA1c)
• Inflammation (hs-CRP)
• Arterial damage (homocysteine)
• Hormone panel (testosterone for men, estrogen/progesterone for women)

Intermediate (if baseline shows issues):

• Extended metabolic markers (adiponectin, leptin)
• Additional inflammation markers (Lp-PLA2, IL-6, TNF-alpha, IL-1beta)
• Oxidative stress (lipid peroxides, MPO, F2-isoprostanes)
• Thyroid panel

Deep Dive (comprehensive):

• Autoimmune screening (Cyrex Arrays)
• Food sensitivity testing (US BioTek)
• Micronutrient analysis (SpectraCell)
• Heavy metals
• Genetic testing

You can order these through functional practitioners, Full Script, or direct-to-consumer labs.

Cholesterol doesn't cause heart disease. Inflammation, oxidative stress, and metabolic dysfunction do.

Test what actually matters. Get the data. Fix the root causes.

That's how you prevent cardiovascular disease.

Ready to order comprehensive cardiovascular testing? Dr. JJ Gregor provides advanced lab testing through LabCorp, Full Script, and specialty labs at his Frisco, Texas practice. Schedule a consultation to determine which testing tier is right for you and develop a personalized plan based on your results.