What bloodwork tests indicate clogged arteries or increased risk of atherosclerosis in an adult patient with risk factors for cardiovascular disease?

Blood Tests Indicating Clogged Arteries

The essential bloodwork to detect clogged arteries includes a fasting lipid profile (total cholesterol, LDL, HDL, triglycerides), fasting glucose or hemoglobin A1c, serum creatinine with eGFR, and urinalysis for microalbuminuria—these tests identify both direct atherosclerotic risk factors and target organ damage from vascular disease. 1

Core Blood Markers for Atherosclerosis Detection

Standard Lipid Panel (Most Important)

• Fasting lipid profile is the cornerstone test and must include total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL cholesterol 1
• Total cholesterol and HDL can be measured non-fasting if necessary, though fasting samples are preferred for complete assessment 1
• Abnormal results must be confirmed with a repeated sample on a separate occasion, using the average of both results for risk assessment 1
• LDL cholesterol >3 mmol/L significantly increases cardiovascular disease risk across all arterial territories 2

Glucose Metabolism Markers

• Fasting blood glucose should be measured at the same intervals as lipid screening (every 5 years, or every 2 years if risk factors present) 1
• Hemoglobin A1c should begin at age 40-70 years in adults with BMI ≥25 kg/m², or age 45 in those without risk factors 1
• Diabetes and impaired fasting glucose are major independent predictors of atherosclerosis 3, 4

Kidney Function Tests (Critical for Vascular Damage)

• Serum creatinine with eGFR calculation is essential, as eGFR <60 mL/min/1.73 m² indicates chronic kidney disease and significantly elevated cardiovascular risk 1
• A decreasing GFR indicates increased risk for cardiovascular disease and all-cause mortality, with stage 3 CKD (GFR 30-59 mL/min/1.73 m²) conferring a two- to four-fold increased risk 5
• Urinalysis with microalbuminuria assessment should be performed, particularly in patients with diabetes or hypertension 1
• Microalbuminuria increases cardiovascular risk two- to four-fold and indicates vascular endothelial damage 5

Advanced Markers (When Standard Tests Are Insufficient)

Inflammatory Markers

• High-sensitivity C-reactive protein (hs-CRP) is an important predictor of atherosclerotic diseases and independently predicts residual cardiovascular risk even in statin-treated patients 6, 4
• Elevated hs-CRP indicates ongoing vascular inflammation and atherosclerotic plaque instability 3

Additional Lipid Markers

• Apolipoprotein B (apoB) and apolipoprotein AI (apoAI) are stronger predictors of coronary artery disease than LDL-cholesterol and HDL-cholesterol alone 6
• LDL particle number independently predicts residual atherosclerotic risk in statin-treated adults 4
• Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic vascular diseases, particularly in subjects with high LDL-cholesterol levels and multiple coronary risk factors 6
• Remnant-like particle cholesterol (RLP-C) estimation is important for coronary risk evaluation, as remnants of triglyceride-rich lipoproteins contribute to atherosclerosis 6

Other Markers

• Homocysteine contributes to increased risk of coronary and cardiovascular diseases 3

Age-Specific Screening Recommendations

Starting at Age 20

• High-risk patients should start comprehensive lipid and glucose screening at age 20 if any of the following risk factors are present: family history of premature cardiovascular disease, diabetes mellitus, current cigarette smoking, hypertension, or obesity 1

Starting at Age 35-45

• Average-risk men should begin lipid screening at age 35, while average-risk women should begin at age 45 1

Age 40-75 (Critical Period)

• All adults aged 40-75 should undergo lipid testing for comprehensive cardiovascular risk assessment 1
• Blood markers should be combined with age, sex, blood pressure measurements, smoking status, presence of diabetes, and family history to calculate 10-year ASCVD risk 1

Age 75+

• Routine lipid panel testing can be discontinued in adults over 75 years unless the patient is on statin therapy or has specific cardiovascular risk factors warranting continued monitoring 7

Screening Frequency

• Every 5 years for patients without risk factors 1
• Every 2 years for patients with risk factors present or lipid levels close to treatment thresholds 1
• Every 4-12 weeks after initiating lipid-lowering therapy to assess response 1

Common Pitfalls to Avoid

• Do not rely on a single lipid measurement for diagnosis or treatment decisions; abnormal results should be confirmed with a repeated sample on a separate occasion 7
• Do not screen all young adults indiscriminately; focus screening efforts on those aged 20-35 years (men) and 20-45 years (women) who have identifiable cardiovascular risk factors 7
• Do not ignore kidney function tests—chronic kidney disease is a powerful predictor of cardiovascular events and is often overlooked 5
• Do not forget that 90% of patients with coronary heart disease have at least one atherosclerotic risk factor, making comprehensive screening essential 5