Heart disease remains the leading cause of death worldwide.
Yet most people still rely on a standard cholesterol panel to assess their cardiovascular risk.
The problem?
A standard cholesterol test only tells part of the story.
Many people suffer heart attacks despite having “normal” cholesterol levels, while others live long healthy lives despite elevated cholesterol.
If you want a true understanding of your cardiovascular health, you need to look deeper.
Step 1: Start With The Right Blood Tests
HsCRP: The Inflammation Marker
Heart disease is not simply a cholesterol problem.
It is an inflammatory disease.
High sensitivity C-reactive protein (HsCRP) is one of the most widely studied markers of systemic inflammation and cardiovascular risk.
Research shows that cardiovascular risk begins to rise as HsCRP increases, even when cholesterol levels appear normal.
Many preventative health practitioners aim for:
HsCRP below 0.5 mg/L
A raised HsCRP can indicate ongoing inflammation from poor metabolic health, excess body fat, infections, poor sleep, environmental toxins, smoking, or chronic stress.
Triglyceride To HDL Ratio
This simple calculation can reveal underlying insulin resistance long before diabetes develops.
When triglycerides rise and HDL falls, it often indicates metabolic dysfunction that is silently damaging blood vessels.
For Australians using mmol/L measurements, many practitioners aim for:
Triglyceride:HDL Ratio below 0.9
Optimal is often considered below 0.7.
This ratio frequently provides more insight into metabolic health than total cholesterol alone.
Fasting Insulin
One of the biggest mistakes in preventative medicine is waiting for blood sugar levels to rise before taking action.
Blood glucose and HbA1c can remain normal for years while insulin levels steadily increase.
Elevated insulin contributes to:
• Endothelial dysfunction
• Oxidative stress
• Inflammation
• Plaque development
Many longevity practitioners aim for:
Fasting insulin below 5 mIU/L
By the time fasting insulin reaches double digits, vascular damage may already be occurring.
ApoB
ApoB measures the number of cholesterol carrying particles capable of entering the artery wall.
Rather than estimating risk, ApoB provides a direct count of potentially atherogenic particles.
Many cardiovascular specialists now consider ApoB superior to LDL cholesterol alone.
Targets commonly used include:
Optimal: Below 0.8 g/L
Higher risk individuals often target below 0.65 g/L.
Lipoprotein(a)
Lipoprotein(a), often called Lp(a), is one of the most important cardiovascular markers that many people have never tested.
Unlike most cholesterol markers, Lp(a) is largely genetic.
People with elevated Lp(a) can develop cardiovascular disease despite excellent lifestyle habits and otherwise favourable blood work.
Because Lp(a) is genetically determined, it only needs to be measured once in most individuals.
Step 2: Move Beyond Blood Tests
Blood markers tell us about risk.
Imaging tells us whether disease is already present.
This is where modern cardiovascular diagnostics become invaluable.
Coronary Artery Calcium Score (CAC)
The CAC scan measures calcified plaque within the coronary arteries.
Unlike cholesterol measurements, it provides direct evidence of existing atherosclerosis.
A CAC score of zero generally indicates very low short term cardiovascular risk.
As scores rise, cardiovascular risk rises substantially.
Many experts consider CAC one of the most powerful tools available for preventative cardiology.
CT Coronary Angiography (CTCA)
CT Coronary Angiography takes assessment one step further.
Rather than measuring calcified plaque only, it visualises both:
• Calcified plaque
• Soft plaque
Soft plaque is particularly important because many heart attacks originate from unstable, non-calcified plaque.
CTCA can identify narrowing long before symptoms appear.
Coronary Angiography
This remains the gold standard for identifying significant coronary artery blockages.
A catheter is inserted into the coronary arteries and contrast dye is used to visualise blood flow.
It is generally reserved for individuals with symptoms, abnormal stress testing, or suspected significant disease.
Additional Useful Assessment
Other tools include:
• Echocardiography
• Exercise stress testing
• Cardiac MRI
• Advanced lipid testing
• Endothelial function testing
Each provides different information, but none answers the most important question:
Why does plaque develop in the first place?
The Missing Piece: Nitric Oxide
When researchers look at healthy arteries versus diseased arteries, one molecule consistently separates the two.
Nitric Oxide.
Nitric Oxide is a signalling molecule produced by the lining of your blood vessels.
It acts as the body’s natural vascular protection system.
As we age, Nitric Oxide production declines dramatically.
Research suggests production may decline by approximately 50% by middle age.
This decline affects virtually every aspect of cardiovascular health.
Why Nitric Oxide Matters
Healthy Nitric Oxide levels help:
• Relax blood vessels
• Improve blood flow
• Reduce inflammation
• Prevent platelet aggregation
• Reduce oxidative stress
• Maintain endothelial function
In simple terms:
Nitric Oxide helps maintain a smooth, flexible, healthy artery wall.
Without sufficient Nitric Oxide, arteries become more vulnerable to damage, inflammation, plaque formation and impaired circulation.
Nitric Oxide And Heart Disease
Most cardiovascular disease begins with endothelial dysfunction.
The endothelium is the delicate lining inside blood vessels.
When Nitric Oxide production falls:
• Blood vessels stiffen
• Blood pressure rises
• Inflammation increases
• Plaque formation accelerates
Many researchers now view impaired Nitric Oxide signalling as one of the earliest events in the development of cardiovascular disease.
Nitric Oxide And Dementia
Your brain consumes approximately 20% of your body’s oxygen supply.
Healthy blood flow is essential for memory, cognition and long term brain function.
Nitric Oxide helps regulate cerebral blood flow and supports the health of tiny blood vessels throughout the brain.
Reduced Nitric Oxide production has been linked with:
• Reduced cerebral perfusion
• Vascular dementia
• Cognitive decline
• Neurodegenerative disease
The same molecule that protects your arteries also protects your brain.
One Molecule. One Fix.
Heart disease is complex.
Dementia is complex.
Ageing is complex.
But many of the pathways that drive them converge on a single protective mechanism.
Nitric Oxide.
The goal is not simply to lower cholesterol.
The goal is not simply to lower inflammation.
The goal is to restore the body’s natural protective systems.
Because when Nitric Oxide levels are optimised, blood vessels function better, circulation improves, inflammation falls and the body becomes more resilient against the diseases most likely to shorten our lives.
The future of cardiovascular health isn’t just finding disease earlier.
It’s restoring the protective mechanisms that prevent disease from developing in the first place. The good news is you can test and monitor your nitric oxide levels through a simple daily saliva test.
Then you can optimise levels daily with a combination of Ultimate 4 and Boost. Ultimate 4 provides dietary sources of standardised nitrates which convert to nitric oxide. Boost creates the optimal internal environment to allow nitric oxide to work efficiently and slow nitric oxide breakdown. 