Dr. Prabhat AryaMD · Internal Medicine
ConditionsKnow your condition

Your heart risk add-ons, explained calmly.

These extra tests come in many health-check packages. None of them diagnoses heart disease, and none is an emergency on its own. They fine-tune your risk, and your LDL, BP, sugar and smoking still matter most.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed · Next review · Sources: Testing.com, MedlinePlus

Send your report for ₹199See every value

Read this first.

Go by the range printed on your own report. These tests are less standardised than most, so the ranges and units differ more between labs. The ranges below are typical adult ranges.

A high value here is not a heart problem in itself. It is one more piece in the picture of your risk over the next ten years or more. The big pieces are still age, LDL cholesterol, BP, sugar, smoking, kidneys and family history: see the lipid profile guide.

The most useful of these is Lp(a), because it is inherited, does not change much through life, and a high value means LDL should be kept lower. It needs checking only once. Homocysteine is high in many Indian vegetarians because of low vitamin B12; the B12 deficiency is the thing worth treating.

Compare with your last report, and do not repeat these tests often: most change little, and a repeat rarely changes the plan.

Every value, one by one.

hs-CRP (high-sensitivity C-reactive protein)

A very sensitive measure of low-level inflammation in the body. The ordinary CRP test is explained in the ESR and CRP guide

Typical adult range Below 1 mg/L is lower heart risk; 1–3 average; above 3 higher

High usually means
Between 3 and 10, it may add a little to heart risk, but a cold, a tooth infection, joint pain, smoking, extra weight or a recent injury can push it up just as easily. Above 10, it almost always means a current infection or inflammation, and says nothing about the heart.
Low usually means
Good news. There is no harm in a low hs-CRP.
Usually nothing to worry about when
It is 3–10 and you had a cold, fever, injury or dental problem recently: repeat in about two weeks once you are well.
See a doctor when
At your next check-up if it stays above 3 on a repeat. Within a few days if it is above 10 and you have fever, weight loss, joint swelling or feel unwell, to find the cause.

Homocysteine

An amino acid in the blood; B12, folate and vitamin B6 are needed to clear it

Typical adult range About 5–15 µmol/L

High usually means
In India most often from low vitamin B12, especially in vegetarians, and sometimes low folate. Metformin and long-term acid-reducing tablets can lower B12 and so raise homocysteine. Kidney disease, an underactive thyroid, smoking and older age also raise it. Lowering homocysteine with vitamins has not been shown to prevent heart attacks or strokes for most people, so the point of a high result is to find and treat a vitamin deficiency.
Low usually means
Not a concern.
Usually nothing to worry about when
It is 15–20 and your B12 and folate are being checked or treated.
See a doctor when
Within a few weeks to check B12 and folate if it is above 15. Within a week if it is very high (above about 50), or high with numbness, tingling, unsteady walking or memory problems.

Lp(a) (lipoprotein little a)

A cholesterol-carrying particle whose level is set by your genes. Printed in mg/dL or nmol/L; the two are not interchangeable

Typical adult range Many Indian labs flag above 30 mg/dL; heart guidelines treat above about 50 mg/dL (about 105–125 nmol/L) as a clear added risk

High usually means
Inherited from a parent, and adds to the risk of heart attack and stroke, especially in people with early heart disease in the family. Food, exercise and most cholesterol tablets change it little. What helps is keeping LDL, BP and sugar lower than usual and not smoking. Brothers, sisters and children may wish to be tested once.
Low usually means
Good news, and very common.
Usually nothing to worry about when
It is just above the lab’s flag (30–50 mg/dL) and your LDL, BP and sugar are well controlled.
See a doctor when
At your next check-up if it is above 50 mg/dL, to set a lower LDL target. Sooner, within a few weeks, if it is very high (above about 180 mg/dL), or if you or a close relative had a heart attack or stroke young.

Apo A1 (apolipoprotein A1)

The main protein in HDL, the “good” cholesterol

Typical adult range Varies with the lab and with sex (higher in women): go by the range on your report

High usually means
Usually good news, like a high HDL.
Low usually means
Moves with a low HDL: common in Indians with extra weight, inactivity, smoking, high triglycerides and diabetes. It adds to heart risk in the same way as a low HDL.
Usually nothing to worry about when
It is just below the range and your HDL, LDL and sugar are otherwise fine.
See a doctor when
At your next check-up if it is low together with high triglycerides, high sugar or high BP.

Apo B (apolipoprotein B)

The protein on every particle that can build up in arteries (LDL, VLDL and Lp(a)): a count of the harmful particles

Typical adult range Under about 100 mg/dL is a common aim for most adults; lower aims apply with diabetes or after a heart attack or stroke

High usually means
More harmful particles in the blood. It usually goes up with LDL. It can be high even when LDL looks normal, especially with high triglycerides, diabetes, fatty liver and a big waist, which is when it is most useful.
Low usually means
Good. Usually seen on cholesterol tablets.
Usually nothing to worry about when
It is a little above 100 and you have no other heart risks.
See a doctor when
At your next check-up if it is above about 130, or above your target if you have diabetes, kidney disease or heart disease.

Apo B/Apo A1 ratio

The harmful particles (Apo B) compared with the protective ones (Apo A1)

Typical adult range Lower is better; often under about 0.7 in men and 0.6 in women

High usually means
The balance is tipped towards the particles that build up in arteries: high Apo B, low Apo A1, or both. It points the same way as high LDL or triglycerides and low HDL.
Low usually means
Good.
Usually nothing to worry about when
It is mildly high and your LDL, HDL and other risks are fine.
See a doctor when
Go by your LDL, Apo B and overall heart risk; this ratio alone does not decide treatment.

Results that go together.

PatternsTypical, not certain
When you seeIt usually means
High Lp(a) with a parent or sibling who had a heart attack youngThe Lp(a) may explain the family history. Keeping LDL well down, BP and sugar controlled and no smoking matter even more for you. Ask about testing close relatives once.
High homocysteine, low B12 and a high MCVVitamin B12 deficiency, very common in vegetarians and people on metformin. Treating B12 helps the blood and nerves. See vitamin B12 deficiency.
High Apo B with normal LDL and high triglyceridesMore harmful particles than LDL suggests, typical of insulin resistance, fatty liver and prediabetes. Check your sugar and HbA1c.
hs-CRP above 10 with fever, cough or a recent injuryThis is inflammation from the illness, not heart risk. Repeat after you recover if it was meant to measure heart risk.
High homocysteine with raised creatinineThe kidneys clear homocysteine; kidney disease raises it. The kidneys need attention first. See the kidney tests guide.

Get help today if

  • Chest pain, pressure or tightness lasting more than a few minutes, with sweating, breathlessness or spreading to the arm, jaw or back: call 112. Do not drive yourself.
  • Sudden weakness of the face, arm or leg on one side, slurred speech or sudden loss of vision: call 112 and note the time it started.
  • hs-CRP or CRP far above 10 with high fever and breathlessness or confusion: go to hospital today, as this points to a serious infection.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Read more.

Questions people ask.

  1. My Lp(a) is high. What should I do?

    Do not panic. Lp(a) is inherited and diet barely changes it. What helps is keeping LDL lower than usual, controlling BP and sugar, staying active and not smoking. If a close relative had a heart attack or stroke young, see a doctor within a few weeks. Lp(a) needs checking only once in life.

  2. Is high homocysteine dangerous?

    On its own it is not an emergency. In India it is most often a sign of low vitamin B12 or folate, especially in vegetarians. Get B12 and folate checked and treated. Lowering homocysteine with vitamins has not been shown to prevent heart attacks in most people, so it does not need repeated testing.

  3. What is the difference between CRP and hs-CRP?

    They measure the same protein. Ordinary CRP picks up infection and inflammation at higher levels. hs-CRP measures very low levels and is used to estimate heart risk, but only when you are well; any infection makes it unreliable for that.

  4. Are Apo B and Apo A1 better than a lipid profile?

    Apo B can be more accurate than LDL when triglycerides are high or in diabetes. For most people, a standard lipid profile with non-HDL cholesterol gives nearly the same information at lower cost. These tests are useful extras, not replacements.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

Send your report for ₹199

Dr. Prabhat Arya · MBBS, MD (Internal Medicine)