Latest / Heart Health, Reimagined with Dr. Mona Shah, MD / 7 Blood Tests That Could Save Your Life (Your Doctor Probably Isn't Ordering Them)

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7 Blood Tests That Could Save Your Life (Your Doctor Probably Isn't Ordering Them) · Heart Health, Reimagined with Dr. Mona Shah, MD

• 0:00
  SPEAKER_00: Every week I see patients who pass their last physical with flying colors.
• 0:04
  SPEAKER_00: And when I run the seven labs I actually care about as a triple board certified holistic cardiologist, something is wrong in almost every single case.
• 0:15
  SPEAKER_00: Your doctor may have told you your labs look fine.
• 0:19
  SPEAKER_00: What they did not tell you is that the standard lipid panel has not meaningfully changed since the 1970s.
• 0:26
  SPEAKER_00: The markers that show what is actually building inside your arteries are not on it.
• 0:32
  SPEAKER_00: I spent 20 years inside conventional cardiology, seeing 25 to 30 patients a day.
• 0:38
  SPEAKER_00: I ran those same standard panels, and I left that system because I kept watching people getting a clean bill of health and then ending up in serious cardiac trouble anyway.
• 0:50
  SPEAKER_00: I'm gonna walk you through all the seven, tell you what each one actually measures, and give you the exact words to say at your next appointment to get them ordered.
• 1:00
  SPEAKER_00: APOB is a number that tells you how many particles are actively hitting your artery walls right now.
• 1:07
  SPEAKER_00: Across thousands of patients, I have seen people with completely normal LDL walking around building plaque right now.
• 1:16
  SPEAKER_00: Because LDL and APOB are measuring two different things.
• 1:20
  SPEAKER_00: LDL estimates the amount of cholesterol, APOB counts the particles that carry it, and it is the particles that push through your artery wall and start the plaque building process.
• 1:34
  SPEAKER_00: LDL is calculated from a 1972 formula.
• 1:38
  SPEAKER_00: In people with high triglycerides or insulin resistance, that calculation runs wrong in the direction that makes you feel safer than you are.
• 1:47
  SPEAKER_00: APOB is a direct count that matters.
• 1:50
  SPEAKER_00: Your doctor is probably ordering the estimate.
• 1:53
  SPEAKER_00: APOB is the actual count.
• 1:55
  SPEAKER_00: Have you ever had an APOB ordered, not just an LDL?
• 1:59
  SPEAKER_00: If your LDL was in range at your last appointment, do you know what your particle count actually was?
• 2:06
  SPEAKER_00: At your next appointment, ask for APOB to be added to your lipid panel.
• 2:12
  SPEAKER_00: The next number is genetic, never changes with diet or exercise.
• 2:16
  SPEAKER_00: And most people have never heard of it.
• 2:19
  SPEAKER_00: LPA, which stands for lipoprotein little A.
• 2:22
  SPEAKER_00: It's a genetic marker that drives plaque formation completely independently of your lifestyle.
• 2:28
  SPEAKER_00: I check this on every new patient because if it is elevated and nobody has ever told you you are managing a risk you don't even know you have.
• 2:36
  SPEAKER_00: I know this one personally.
• 2:38
  SPEAKER_00: I'm vegetarian, I'm at an ideal body weight, I exercise.
• 2:42
  SPEAKER_00: Every external measure of my cardiovascular risk looks low.
• 2:46
  SPEAKER_00: However, I have elevated lipoprotein A.
• 2:49
  SPEAKER_00: I found soft plaque on my own scan because of it.
• 2:52
  SPEAKER_00: Testing for the right things helped me find it before it became something worse.
• 2:57
  SPEAKER_00: LPA doesn't respond to diet.
• 2:59
  SPEAKER_00: It doesn't respond to exercise.
• 3:01
  SPEAKER_00: Most medications don't touch it.
• 3:03
  SPEAKER_00: If it's elevated, you have a baseline genetic risk that operates on its own track, regardless of everything else you're doing right.
• 3:10
  SPEAKER_00: And because it doesn't change, you traditionally only need to check it once, or at least once.
• 3:16
  SPEAKER_00: Sometimes I'll check it again, especially if I'm putting them on a certain medication or herbs that may help it slightly.
• 3:23
  SPEAKER_00: If it's elevated and your standard panel is the only thing anyone has ever ordered, you are flying completely blind about a risk that has been there since you were born.
• 3:32
  SPEAKER_00: You can do everything right and still have a genetic factor, building plaque in your arteries that no one has ever measured.
• 3:40
  SPEAKER_00: Do you have a family history of early heart disease in a parent or a sibling?
• 3:46
  SPEAKER_00: Have you ever had a test called lipoprotein A specifically?
• 3:50
  SPEAKER_00: Not just a cholesterol panel.
• 3:52
  SPEAKER_00: Ask for your LPA level by name.
• 3:56
  SPEAKER_00: If you have a family history of early heart disease and you have never had this checked, this is the number I would go after.
• 4:03
  SPEAKER_00: The next number gets missed constantly because most doctors are only checking one piece of a three-part picture, HSCRP.
• 4:14
  SPEAKER_00: That stands for high sensitivity C reactive protein.
• 4:18
  SPEAKER_00: It is your inflammation marker, and inflammation inside your arteries is one of the main forces that turns plaque from stable to dangerous and unstable.
• 4:29
  SPEAKER_00: Inflammation in the artery wall is part of what causes plaque to become unstable.
• 4:35
  SPEAKER_00: Stable plaque is less likely to rupture.
• 4:38
  SPEAKER_00: Inflamed soft plaque is a kind that breaks off, triggers a clot, and causes a heart attack.
• 4:45
  SPEAKER_00: HSCRP tells me whether that inflammatory environment is active.
• 4:50
  SPEAKER_00: A normal LDL with an elevated HSCRP is a patient I take very seriously.
• 4:58
  SPEAKER_00: Plaque does not rupture because it is big.
• 5:01
  SPEAKER_00: It ruptures because it's inflamed.
• 5:03
  SPEAKER_00: Has any doctor ever mentioned the words CRP, C reactive protein to you in a cardiac context?
• 5:11
  SPEAKER_00: Do you have any of the common drivers of chronic inflammation, high stress, poor sleep, processed food, or excess weight around the middle?
• 5:20
  SPEAKER_00: Ask for HSCRP, high sensitivity C reactive protein, at your next blood draw.
• 5:26
  SPEAKER_00: If your inflammation is elevated, that changes the urgency of everything else on this list.
• 5:31
  SPEAKER_00: The next number is where I see the biggest disconnect between what patients think is being checked and what is actually being checked.
• 5:39
  SPEAKER_00: If this is the kind of workup you have been looking for and nobody has ever sat down with you and walked through what these numbers actually mean for your specific situation, subscribe.
• 5:50
  SPEAKER_00: Every week I go through the tests and the markers that matter for your heart that are not making into the standard appointment.
• 5:57
  SPEAKER_00: Your doctor is probably checking your blood sugar.
• 6:00
  SPEAKER_00: That is not the same thing as checking your insulin resistance.
• 6:04
  SPEAKER_00: And the difference between those two tests is years of warning time.
• 6:09
  SPEAKER_00: Your body can be struggling to manage blood sugar for years before glucose or A1C shows it.
• 6:16
  SPEAKER_00: The pancreas just keeps pumping out more and more insulin to keep those numbers in range.
• 6:21
  SPEAKER_00: Blood sugar looks fine.
• 6:23
  SPEAKER_00: Insulin is elevated, and elevated insulin drives inflammation, raises triglyceride, and accelerates plaque formation.
• 6:33
  SPEAKER_00: By the time glucose and A1C go abnormal, the damage has already been building for a long time.
• 6:39
  SPEAKER_00: The insulin resistant score catches it early enough to actually do something about it.
• 6:46
  SPEAKER_00: Normal blood sugar does not mean your metabolism is not hurting your heart.
• 6:51
  SPEAKER_00: It means the damage has not become severe enough yet to show up on the test your doctor ordered.
• 6:57
  SPEAKER_00: Whether your insulin picture is part of your cardiovascular risk depends on what your fasting insulin actually looks like.
• 7:05
  SPEAKER_00: And that requires ordering the right test.
• 7:07
  SPEAKER_00: Has your doctor ever checked your fasting insulin specifically or an insulin-resistant score?
• 7:13
  SPEAKER_00: Not just your blood sugar or A1C.
• 7:16
  SPEAKER_00: Do you carry extra weight around your midsection, experience afternoon energy crashes, or feel hungry shortly after eating?
• 7:23
  SPEAKER_00: Ask your doctor to add a fast line insulin level or an insulin-resistant score to your next metabolic panel.
• 7:30
  SPEAKER_00: That number gives you a window into your insulin resistance that glucose and A1C cannot provide.
• 7:37
  SPEAKER_00: Ask for it by name.
• 7:39
  SPEAKER_00: The next number I check tells me whether your cholesterol particles are the kind that build up plaque aggressively or the kind that cause relatively less damage.
• 7:49
  SPEAKER_00: Most people know their LDL.
• 7:51
  SPEAKER_00: Almost nobody pays attention to their triglycerides.
• 7:54
  SPEAKER_00: And yet, triglycerides are often one of the earliest clues that your metabolism and metabolic health is going in the wrong direction.
• 8:03
  SPEAKER_00: I see this all the time.
• 8:04
  SPEAKER_00: A patient comes in with an LDL that doesn't look terrible and assumes everything is fine.
• 8:10
  SPEAKER_00: Then I look at the triglycerides and immediately know we are dealing with insulin resistance and metabolic dysfunction, or both.
• 8:18
  SPEAKER_00: Triglycerides are the form of fat your body uses to store excess calories.
• 8:24
  SPEAKER_00: When they start climbing, it is often a sign that your body is struggling to process carbohydrates and sugars efficiently, and you become more insulin resistant.
• 8:34
  SPEAKER_00: Long before blood sugar becomes abnormal, triglycerides frequently start sending warning signals.
• 8:41
  SPEAKER_00: Elevated triglycerides are associated with increased cardiovascular risk, increased inflammation, and a greater likelihood of developing diabetes over time.
• 8:52
  SPEAKER_00: And one of the biggest problems is that many labs label triglycerides under 150 as normal, even though I often start paying attention long before that.
• 9:03
  SPEAKER_00: Your triglycerides are not just a cholesterol number, they are a window into your metabolic health.
• 9:09
  SPEAKER_00: If your triglycerides are elevated, I immediately start looking more closely at insulin resistance, nutrition, exercise habits, sleep quality, and other drivers that may be contributing to plaque formation.
• 9:23
  SPEAKER_00: Have you ever looked at your triglycerides?
• 9:25
  SPEAKER_00: Or do you only focus on your LDL?
• 9:28
  SPEAKER_00: Have your triglycerides been gradually increasing over the last several years, even if they're technically in the normal range?
• 9:39
  SPEAKER_00: Do you have elevated triglycerides along with extra weight around your midsection, low HTL, or a family history of diabetes?
• 9:48
  SPEAKER_00: Ask your doctor what your triglyceride level actually is, not whether it is normal.
• 9:54
  SPEAKER_00: For many patients, triglycerides can be one of the earliest warning signs that metabolic health is beginning to impact cardiovascular risk.
• 10:02
  SPEAKER_00: The next number is one that almost nobody checks, and that I have started thinking of as a missing piece in a lot of cardiovascular pictures that do not add up.
• 10:13
  SPEAKER_00: Homocysteine is an amino acid that, when elevated, can damage the inner lining of your arteries, promote inflammation, oxidative stress, contribute to abnormal clotting, and impair blood vessel function.
• 10:26
  SPEAKER_00: Over time, that combination may accelerate plaque formation and increase cardiovascular risk.
• 10:32
  SPEAKER_00: I see this comeback elevated in patients whose standard panels have looked fine for years.
• 10:38
  SPEAKER_00: It shows up most in patients with family history who do not fit the standard risk profile on paper.
• 10:44
  SPEAKER_00: Low B12, low folate, and certain genetic variants are usually driving an elevated homocysteine.
• 10:52
  SPEAKER_00: Homocysteine damages the inner lining of your artery walls.
• 10:55
  SPEAKER_00: When that lining is compromised, particles get in more easily and plaque forms faster.
• 11:02
  SPEAKER_00: Elevated homocysteine may also promote abnormal clotting, contribute to arterial stiffness, and impair blood vessel function, which can make blood pressure more difficult to control.
• 11:15
  SPEAKER_00: And in many cases, it responds to targeted B vitamin supplementation and a methylated version of B12, folate, and other supplements.
• 11:25
  SPEAKER_00: That makes it exactly the kind of number I want to find early.
• 11:29
  SPEAKER_00: Elevated homocysteine is associated with heart disease, stroke, and vascular dysfunction.
• 11:34
  SPEAKER_00: Yet it often responds very well to targeted vitamin therapy and lifestyle changes.
• 11:40
  SPEAKER_00: And almost nobody is checking it.
• 11:42
  SPEAKER_00: If you have a clean standard panel and a family history that still worries you, homocysteine is one of the places I look for the explanation.
• 11:51
  SPEAKER_00: Have you ever been told you have a low B12 or low folate?
• 11:55
  SPEAKER_00: Do you have a family history of early cardiovascular disease or stroke without an obvious explanation?
• 12:02
  SPEAKER_00: Ask for your plasma homocysteine level at your next blood draw.
• 12:06
  SPEAKER_00: If it comes back elevated, ask specifically about targeted B vitamin supplementation as a first step before any stronger intervention.
• 12:14
  SPEAKER_00: High sensitivity CRP catches cardiovascular inflammation, but inflammation in the body can have many different causes.
• 12:23
  SPEAKER_00: An elevated HSCRP is often a signal and a window to other inflammatory markers that I often check.
• 12:31
  SPEAKER_00: But when it comes back elevated and the diet and lifestyle picture does not fully explain it, I start asking why are these other inflammatory numbers elevated?
• 12:40
  SPEAKER_00: Metabolic dysfunction, chronic stress, autoimmune conditions, infections, and other inflammatory processes can all contribute.
• 12:49
  SPEAKER_00: The source is different in every patient.
• 12:52
  SPEAKER_00: My job as a preventative cardiologist is not necessarily to diagnose every cause of inflammation.
• 12:59
  SPEAKER_00: My job is to recognize when inflammation is present and make sure it is not being ignored.
• 13:05
  SPEAKER_00: In some cases, that means looking more closely at metabolic health.
• 13:09
  SPEAKER_00: In others, it may mean discussing additional evaluation with your primary care physician or the appropriate specialist.
• 13:16
  SPEAKER_00: High sensitivity CRP tells me there is a fire.
• 13:20
  SPEAKER_00: The other labs behind inflammation helps me figure out where it's possibly coming from.
• 13:25
  SPEAKER_00: If your HSCRP has ever come back elevated and your doctor simply told you to change your diet and recheck it in six months, you may not have gotten the full picture.
• 13:34
  SPEAKER_00: Has an elevated HSCRP ever come back without a conversation about what might be driving it?
• 13:40
  SPEAKER_00: Do you have ongoing symptoms, autoimmune conditions, chronic stress, or other health concerns that may be contributing to inflammation?
• 13:48
  SPEAKER_00: If your HSCRP is elevated, ask your doctor what the next step is for identifying the source of that inflammation.
• 13:56
  SPEAKER_00: You came into this video with the labs your doctor ordered.
• 14:00
  SPEAKER_00: You are leaving with the ones that actually tell the full cardiac story.
• 14:05
  SPEAKER_00: These are not experimental, they're not exotic, they are available at most major labs right now.
• 14:11
  SPEAKER_00: The only reason you haven't had them is that nobody has ordered them.
• 14:16
  SPEAKER_00: Now you know what to ask for.
• 14:18
  SPEAKER_00: If you want to go deeper on cholesterol specifically, the next video on this channel is on your screen right now.