Understanding Your Cardiovascular Blood Test Results

You've had your cardiovascular blood test done. The results have arrived — a page of numbers, abbreviations, and reference ranges that might as well be written in another language. Sound familiar?

You're not alone. Most people receive their results with little explanation beyond "everything looks fine" or "your cholesterol is a bit high." But understanding what each marker actually tells you — and how they work together — puts you in a far stronger position to protect your heart health.

Let's break it down, marker by marker.

Your Results at a Glance

Here's a quick reference table for the key cardiovascular markers. We'll explain each one in detail below.

Marker	Desirable Range	Unit
Total Cholesterol	Below 5.0	mmol/L
LDL Cholesterol	Below 3.0 (lower if high risk)	mmol/L
HDL Cholesterol	Above 1.0 (men) / 1.2 (women)	mmol/L
Triglycerides	Below 1.7	mmol/L
Non-HDL Cholesterol	Below 4.0	mmol/L
ApoB	Below 0.9 (lower if high risk)	g/L
Lipoprotein(a)	Below 75	nmol/L
hs-CRP	Below 2.0	mg/L
Homocysteine	Below 15	µmol/L
HbA1c	Below 42	mmol/mol

Note: These are general desirable ranges. Your personal targets may differ depending on your age, medical history, and overall risk profile. Always discuss your results with a qualified healthcare professional.

Total Cholesterol

Total cholesterol is the broadest measure — it combines LDL, HDL, and other lipoproteins into a single number. The NHS considers a total cholesterol below 5.0 mmol/L desirable for most adults.

However, total cholesterol on its own is a blunt instrument. It doesn't distinguish between "good" and "bad" cholesterol, so a high reading isn't automatically alarming and a normal reading isn't automatically reassuring. Someone with very high HDL (protective cholesterol) might have an elevated total cholesterol that actually reflects good cardiovascular health.

Practical takeaway: Use total cholesterol as a starting point, but always look at the breakdown — particularly your LDL and HDL levels — for the real picture.

HDL and LDL Cholesterol

LDL — the one to watch

LDL (low-density lipoprotein) carries cholesterol into your artery walls and is the primary driver of atherosclerosis. NICE guidelines recommend an LDL below 3.0 mmol/L for the general population. If you're at high cardiovascular risk, targets drop to below 1.8 mmol/L; at very high risk, below 1.4 mmol/L.

Standard LDL values are usually calculated rather than directly measured, using a formula that becomes less accurate when triglycerides are elevated. This is one reason why ApoB (covered below) is increasingly preferred as a risk marker.

HDL — your ally

HDL (high-density lipoprotein) acts as a scavenger, transporting cholesterol away from your arteries back to the liver for disposal. Higher is generally better: aim for above 1.0 mmol/L in men and 1.2 mmol/L in women.

Low HDL is an independent risk factor for heart disease. Regular exercise, maintaining a healthy weight, and moderate alcohol consumption are the most effective ways to raise HDL naturally.

Practical takeaway: The ratio of total cholesterol to HDL matters. A ratio below 4.0 is considered healthy. If your total cholesterol is 5.5 but your HDL is 1.8, your ratio is about 3.1 — which is actually quite good.

Triglycerides

Triglycerides are a type of fat in your blood, largely influenced by diet and metabolic health. A fasting level below 1.7 mmol/L is desirable. Elevated triglycerides (above 2.3 mmol/L) are strongly associated with insulin resistance, metabolic syndrome, and increased cardiovascular risk.

High triglycerides often cluster with low HDL and high small dense LDL — a pattern sometimes called the atherogenic triad. If your triglycerides are elevated, it's worth checking your fasting glucose and HbA1c as well.

Practical takeaway: Triglycerides respond rapidly to dietary changes. Reducing refined carbohydrates, sugar, and alcohol can lower triglycerides significantly within weeks.

ApoB

Apolipoprotein B (ApoB) is a protein found on every atherogenic lipoprotein particle. Measuring ApoB tells you the total number of artery-damaging particles in your blood — arguably a better predictor of cardiovascular events than LDL alone.

The 2019 ESC/EAS guidelines recommend ApoB below 0.9 g/L for low-risk individuals, below 0.65 g/L for high-risk, and below 0.55 g/L for very high-risk patients. ApoB is especially useful when LDL and overall risk appear to disagree — for example, in people with diabetes, metabolic syndrome, or elevated triglycerides.

Practical takeaway: If your LDL looks fine but your ApoB is elevated, trust the ApoB. It's counting the actual particles, not estimating the cholesterol they carry.

Lipoprotein(a)

Lipoprotein(a), or Lp(a), is a genetically determined lipoprotein that increases cardiovascular and thrombotic risk. Unlike other lipid markers, Lp(a) levels are largely set by your genes and don't respond much to diet or standard medications.

A level above 75 nmol/L (approximately 30 mg/dL) is considered elevated and confers additional cardiovascular risk. Around 20% of the population has elevated Lp(a).

You only need to measure Lp(a) once in your lifetime, since it doesn't change significantly. If it's elevated, your doctor may set more aggressive targets for your other modifiable risk factors like LDL and ApoB.

Practical takeaway: Lp(a) is particularly important to check if you have a family history of early heart disease. If your level is elevated, focus on optimising every other risk factor you can control.

hs-CRP

High-sensitivity C-reactive protein (hs-CRP) measures low-grade inflammation in your body. Chronic inflammation plays a key role in the development and progression of atherosclerosis — the process by which plaques build up in your arteries.

A level below 1.0 mg/L is considered low risk, 1.0–3.0 mg/L is moderate risk, and above 3.0 mg/L is higher risk. Values above 10 mg/L usually indicate acute infection or inflammation and should be retested once the illness has resolved.

Practical takeaway: An elevated hs-CRP alongside other abnormal lipid markers significantly increases your overall risk. Regular exercise, weight management, and a Mediterranean-style diet have all been shown to reduce hs-CRP.

Homocysteine

Homocysteine is an amino acid that, at elevated levels, is associated with increased cardiovascular risk and may damage the lining of blood vessels. A level below 15 µmol/L is generally considered normal.

High homocysteine can result from deficiencies in vitamin B12, folate, or vitamin B6. It's also influenced by genetics, kidney function, and certain medications. The good news is that elevated homocysteine often responds well to supplementation with B vitamins.

Practical takeaway: If your homocysteine is elevated, ask your doctor to check your B12 and folate levels. Simple supplementation often brings levels back to normal.

HbA1c

HbA1c (glycated haemoglobin) reflects your average blood sugar over the past 2-3 months. While it's primarily a diabetes marker, it's included in comprehensive cardiovascular panels because diabetes is one of the strongest risk factors for heart disease.

A level below 42 mmol/mol is normal. Between 42–47 mmol/mol indicates pre-diabetes, and 48 mmol/mol or above suggests diabetes. Even in the pre-diabetes range, cardiovascular risk begins to climb.

Practical takeaway: If your HbA1c is creeping into the pre-diabetic range (42-47 mmol/mol), lifestyle changes — particularly reducing refined carbohydrates and increasing physical activity — can prevent progression to diabetes and significantly reduce your cardiovascular risk.

What to Do Next

Understanding your results is the first step. Here's how to act on them:

• Compare your results to the targets above — are any markers outside the desirable range?
• Look at the pattern, not just individual numbers — elevated triglycerides combined with low HDL and borderline LDL tells a very different story from high LDL alone
• Discuss your results with a healthcare professional — context matters, and your doctor can calculate your overall 10-year cardiovascular risk using tools like QRISK3
• Retest in 3-6 months if you're making lifestyle changes, so you can track your progress
• Don't panic about a single abnormal result — one elevated marker doesn't mean you're heading for a heart attack, but it does mean you should pay attention

The most empowering thing about cardiovascular blood tests is that almost every marker on this list is modifiable. Diet, exercise, weight management, and — when needed — medication can shift your numbers meaningfully. The key is knowing where you stand and taking informed action.

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