Total Cardiac

Shows whether you carry too many cholesterol particles or an inherited one, and whether inflammation, thyroid or blood sugar adds to heart risk.

A standard lipid panel measures how much cholesterol your blood carries. What causes plaque is the number of particles carrying it, and the two can disagree badly, especially in people with high triglycerides or insulin resistance, who can have a normal LDL and a dangerous particle count. This panel measures both. ApoB counts every particle that can enter the artery wall, and the NMR fractionation counts and sizes them, so a discordant case gets caught. Lipoprotein(a) is the inherited particle a standard panel never reports, raised in about one person in five, and a single lifetime measurement is enough because it does not change with diet. High-sensitivity CRP and Lp-PLA2 are two different inflammation readings, one systemic and one specific to the artery wall. Fasting insulin and A1c come along because insulin resistance is the engine behind most of the bad patterns above, and homocysteine, uric acid and the omega-3 and omega-6 levels each carry independent risk a doctor can act on. TSH with free T4 and free T3 is included because an underactive thyroid raises LDL on its own and is the fix some high-cholesterol cases need. The blood count and metabolic panel are the baseline that goes with it.

Blood is drawn at a Quest Diagnostics, Labcorp or BioReference patient service center. Price by laboratory: Quest Diagnostics $349, Labcorp $349 or BioReference $349. Your price depends on your state and the laboratories near you. Enter your ZIP code to see them.

What’s included

• Lipid panel: Total cholesterol, HDL cholesterol and triglycerides, with calculated LDL cholesterol, non-HDL cholesterol and the cholesterol-to-HDL ratio.
• LDL and HDL particles (NMR): Counts of total and small LDL, total and large HDL, and large VLDL cholesterol-carrying particles, plus LDL, HDL and VLDL particle size, measured by nuclear magnetic resonance (NMR).
• C-reactive protein, high-sensitivity (hs-CRP): C-reactive protein, a protein the liver releases during inflammation, measured with a high-sensitivity method.
• Homocysteine: Homocysteine, an amino acid the body processes using vitamin B12, folate and vitamin B6.
• Cardio IQ Lp-PLA2 Activity: The activity of lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzyme made by certain white blood cells that travels in the blood mostly on LDL particles.
• Uric acid: Uric acid, a waste product of purine breakdown that the kidneys clear.
• Hemoglobin A1c: The percentage of hemoglobin with glucose attached, which reflects average blood sugar over about the past three months.
• Insulin: Insulin, the hormone that signals cells to take up glucose from the blood.
• Comprehensive metabolic panel (CMP): Glucose, sodium, potassium, chloride, carbon dioxide, calcium, the kidney tests BUN, creatinine and eGFR, total protein, albumin, bilirubin and the liver enzymes ALP, ALT and AST.
• Complete blood count (CBC): Red cells, white cells with a breakdown by type, and platelets, plus hemoglobin, hematocrit and red-cell size.
• TSH: Thyroid-stimulating hormone, the pituitary hormone that signals the thyroid.
• Apolipoproteins A1 and B, with ratio: Apolipoprotein A1, the main protein on HDL particles, and apolipoprotein B, the main protein on LDL and other cholesterol-carrying particles, with the B-to-A1 ratio.
• Lipoprotein(a): Lipoprotein(a), an LDL-like cholesterol-carrying particle that a standard lipid panel does not report.
• Omega-3 and omega-6 fatty acids: Omega-3 (EPA, DPA and DHA) and omega-6 fatty acids in the blood, with their ratios.
• Free T3: Free (unbound) triiodothyronine, the active form of thyroid hormone.
• Free T4: Free (unbound) thyroxine, the main hormone the thyroid releases.

Tests you can add

• Cystatin C with eGFR: Cystatin C, a protein filtered by the kidneys, with an estimated filtration rate (eGFR) calculated from it.
• Vitamin D (25-hydroxy): 25-hydroxyvitamin D, the main form of vitamin D circulating in the blood.
• Iron, TIBC and ferritin: Serum iron, total iron-binding capacity, iron saturation and ferritin, the body's iron-storage protein.

Before your draw

Fasting required.

Fast for 9 to 12 hours before your draw; water is fine. The insulin test needs a fasting sample, and the lipid panel is best done fasting. If you have an infection or are unwell, consider rescheduling your draw. If you take insulin or other diabetes medicine, ask your clinician how to take it while you fast. Don't stop your usual medicines unless your clinician tells you to. If you take biotin (vitamin B7), including in hair, skin and nail supplements or multivitamins, have your blood drawn at least 8 hours after a usual dose, or at least 72 hours after a high dose. If biotin was prescribed, ask your clinician before stopping it.