New Cholesterol Guidelines Recommend 3 Tests That Can Better Predict Heart Disease Risk

By Stephanie Brown

Published on March 16, 2026

Fact checked by Jennifer Klump

https://www.verywellhealth.com/thmb/ngU_zLt-rLQGAoC_RWMWh0AXbuw=/1500x0/filters:no_upscale():max_bytes(150000):strip_icc()/VWH-GettyImages-2257065509-d1374f93c7284578a58e7cedd7b25e57.jpg

Vladimir Vladimirov / Getty Images

Key Takeaways

• The American Heart Association and American College of Cardiology released updated cholesterol guidelines that expand how cardiovascular risk is assessed.

• The new guidance recommends three additional tests—apoB, lipoprotein(a), and coronary artery calcium.

• These tests can help identify hidden cardiovascular risk that standard LDL and HDL cholesterol tests may miss.

The American Heart Association and the American College of Cardiology have updated their cholesterol management guidelines for the first time since 2018, aiming to improve how healthcare providers assess cardiovascular disease risk.¹

The new guidelines recommend three additional screening tests beyond standard LDL (“bad”) and HDL (“good”) cholesterol measurements: coronary artery calcium, lipoprotein (a), and apolipoprotein B.¹

When Standard Cholesterol Test Falls Short

LDL and HDL are lipoproteins that carry cholesterol through the bloodstream. About one in four U.S. adults has high LDL cholesterol, which causes plaque to build up in the arteries and increases the risk of heart attack and stroke. ²HDL cholesterol helps remove LDL cholesterol from the body.³⁴⁵

Cholesterol levels are typically checked during routine blood work. If LDL levels are high, a healthcare provider may recommend cholesterol-lowering medications such as statins or lifestyle changes.⁶

However, cholesterol numbers alone don’t always capture a person’s full risk for heart disease, and some people may benefit from additional screening tests.

“Studies have shown that cardiovascular events associated with the lipoprotein dysregulation characterizing [cardiometabolic] disorders are inadequately predicted by LDL-C,” Carl E. Orringer, MD, a writing committee member of the 2026 guidelines and director of preventive cardiology at Naples Comprehensive Health Care System in Florida, told Verywell in an email.

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3 Tests That Can Better Predict Heart Disease Risk

The three recommended tests, which measure apolipoprotein B, lipoprotein (a), and coronary artery calcium, can offer “independent and important information about a patient’s risk,” Orringer said. They can help clinicians provide better and more targeted treatment.

1. ApoB: It Might Be More Accurate than LDL

Apolipoprotein B (apoB) is a protein attached to LDL that can cause plaque to build up in the arteries. ApoB does not attach to HDL, and each harmful LDL cholesterol particle can only have one apoB molecule. Measuring apoB gives healthcare providers a more precise count of the number of cholesterol particles that can lead to plaque buildup.⁷

De Oliveira-Gomes D, Joshi PH, Peterson ED, Rohatgi A, Khera A, Navar AM. Apolipoprotein B: bridging the gap between evidence and clinical practice. Circulation. 2024;150(1):62-79. doi:10.1161/CIRCULATIONAHA.124.068885

The apoB test may offer a more accurate measure of cardiovascular risk for certain people, including those with type 2 diabetes or cardiovascular-kidney-metabolic (CKM) syndrome.

“If the clinician wants to know if the patient is being treated in the most complete manner to reduce their atherogenic particle-related risk, apoB is the best test to order,” Orringer said.

2. Lp(a): A Common Genetic Risk Factor for Heart Disease

Lipoprotein(a), or Lp(a), is a type of LDL particle that is more likely to contribute to plaque buildup in the arteries than other forms of LDL.⁸High Lp(a) levels affect one in five people in the world and are linked to a higher risk of heart disease.⁹

Lp(a) levels are largely determined by genetics. That means you can have high Lp(a) even if you follow a heart-healthy lifestyle.

“We now know that 20% of the population has high levels of Lp(a), placing them at increased risk for both atherosclerotic cardiovascular disease and aortic valve stenosis,” Orringer said.

The new guidelines recommend having Lp(a) tested at least once, since lifestyle changes don’t lower Lp(a) levels.⁹

3. CAC Scan: A Test That Can Estimate Future Risk

The guidelines now recommend a coronary artery calcium (CAC) scan for certain people who have unclear heart disease. The test may be particularly helpful for men over 40 and women over 45 who have an intermediate risk of having a heart attack or stroke within the next decade.¹

A CAC scan uses a specialized CT scan to detect calcium deposits in the arteries that supply blood to the heart. The results can reveal early plaque buildup and help estimate a person’s risk of future heart problems.¹⁰

“CAC has been shown to be highly predictive of future cardiovascular disease events, and there is increasing evidence that those with severely elevated levels have a risk as high as that of very high-risk individuals with established cardiovascular disease,” Orringer said.

Healthcare providers can use CAC scores to help determine whether a patient may benefit from starting a statin medication or taking other steps to lower their cardiovascular risk.

Are These Tests Covered by Insurance?

Your healthcare provider may recommend one of the new screening tests during your next annual physical, but you can also ask if these tests are right for you.¹¹

Insurance does not always cover these tests. While Lp(a) is sometimes covered, the apoB test is usually no more than $100, and the CAC test can cost between $50 and $250 out-of-pocket.^112
13

Depending on your family history, age, and health status, you may benefit from one or all of these tests.

“Each of the above tests contributes different and additive information regarding risk,” Orringer said.

Read More:

• HEALTH A-Z

• HEART HEALTH

13 Sources

https://www.verywellhealth.com/thmb/hEZrL73FFGkN98J34JAaeHp5A2Q=/144x144/filters:no_upscale():max_bytes(150000):strip_icc():format(webp)/StephanieBrownnewheadshot-e5ca9ba2a404491384e9300a7871f190.jpg

By Stephanie Brown
Brown is a nutrition writer who received her Didactic Program in Dietetics certification from the University of Tennessee at Knoxville. Previously, she worked as a nutrition educator and culinary instructor in New York City.

Nothing new about that, and would hope those tests were common knowledge. Anyone concerned about Cardiac issue, should already know those.

Sad so many are so ignorant, and don't pay attention to their bodies, and get blood work done. Especially when hitting 50 yrs old.

Might want to add CAVI test to the list also, if those are showing high risk, or not. Good to know and an inexpensive test.

Edited August 6Aug 6 by KhunLA

Good post, those tests aren't normally included in packages offered, labs and hospitals in Thailand need to catch up

5 minutes ago, scubascuba3 said:

Good post, those tests aren't normally included in packages offered, labs and hospitals in Thailand need to catch up

Yeah I'm sure you would frequently subscribe to those tests that cost over 10K

Well I won't be doing anything until RFK Jr issues an expert ruling and Tik Tok makes an announcement...........I don't listen to scientists and so called experts.

8 minutes ago, MIke B Bad said:

Well I won't be doing anything until RFK Jr issues an expert ruling and Tik Tok makes an announcement...........I don't listen to scientists and so called experts.

Word is he’s holed up in a sauna with kid rock, unreachable

8 minutes ago, CallumWK said:

Yeah I'm sure you would frequently subscribe to those tests that cost over 10K

You need to shop elsewhere for your test. Even if including the CAVi test I suggested, you would spend probaly ~ 5k THB.

Just now, KhunLA said:

You need to shop elsewhere for your test. Even if including the CAVi test I suggested, you would spend probaly ~ 5k THB.

I based my comment on the prices mentioned in the OP, and then they don't even quoted the third test

1 hour ago, leverito said:

Insurance does not always cover these tests. While Lp(a) is sometimes covered, the apoB test is usually no more than $100, and the CAC test can cost between $50 and $250 out-of-pocket.

49 minutes ago, CallumWK said:

I based my comment on the prices mentioned in the OP, and then they don't even quoted the third test

@callum

And yet, you state it will cost over 10k for thoses tests apA&B are simple blood test. You don't need 'a' done, unless 'b' is high. Without other risk factors, CAC isn't needed either.

Start with simple things, eat right & LOSE WEIGHT, to control HBP. Unless fairly fit and that failed, then added tests might be needing.

@leverito some silly priciing for those test, so assume you don't live in TH. Maybe if have insurance, and go to Bumugrad, you might charge that much.

Edited August 6Aug 6 by KhunLA

6 minutes ago, KhunLA said:

And yet, you state it will cost over 10k for thoses tests

It's obvious from your post history that maths wasn't your strongest subject at school.

2 hours ago, leverito said:

the apoB test is usually no more than $100, and the CAC test can cost between $50 and $250

That is $350 for TWO of the Three tests mentioned in the OP. And I don't care about the test you mention, because you always know everything better.

2 minutes ago, CallumWK said:

It's obvious from your post history that maths wasn't your strongest subject at school.

That is $350 for TWO of the Three tests mentioned in the OP. And I don't care about the test you mention, because you always know everything better.

You're a funny guy, actually believe what's on the internet. Having the ApoB done, I know the cost.

... "AI Overview

In Thailand, individual blood tests for Apolipoprotein B (ApoB) and Apolipoprotein A1 (ApoA1) typically cost about, 600 THB each at private independent laboratories.

Individual Lab Test Costs

• Apolipoprotein B (ApoB): ~600 THB per test

• Apolipoprotein A1 (ApoA1): ~600 THB per test

• Lipoprotein(a) [Lp(a)]: ~600 THB (frequently bundled with Apo markers).

  A Coronary Artery Calcium (CAC) test—often listed as a CT Calcium Score—in Thailand generally costs between 1,200 THB ($35 USD) at promotional or smaller private facilities." ...

Edited August 6Aug 6 by KhunLA

5 minutes ago, KhunLA said:

A Coronary Artery Calcium (CAC) test—often listed as a CT Calcium Score—in Thailand generally costs between 1,200 THB ($35 USD) at promotional or smaller private facilities." ..

Strange that I get a different result from Google.

AI Overview

A Coronary Artery Calcium (CAC) test, or CT calcium score scan, in Thailand generally costs between 2,500 and 7,300 Thai Baht

1 minute ago, CallumWK said:

Strange that I get a different result from Google.

AI Overview

A Coronary Artery Calcium (CAC) test, or CT calcium score scan, in Thailand generally costs between 2,500 and 7,300 Thai Baht

I'll stick with experience ...

https://aseannow.com/topic/1349251-are-you-or-i-pre-diabetic/page/2/#findComment-19788781

How did ask the question ? I simple asked how much for CAC test in TH.

I was surprised AI did state a low price. Being a CT scan, I'd expect

a couple 1000 baht.

Edited August 6Aug 6 by KhunLA

1 minute ago, KhunLA said:

How did ask the question ? I simple asked how much for CAC test in TH.

Is that good enough for you, don't bother with your next "I must have the last word as always" response because it will be invisible to me.

https://www.bangkokhospital.com/en/bangkok-heart/package/ct-coronary-calcium-score

6 minutes ago, CallumWK said:

Is that good enough for you, don't bother with your next "I must have the last word as always" response because it will be invisible to me.

https://www.bangkokhospital.com/en/bangkok-heart/package/ct-coronary-calcium-score

Still not 10k, even at highest price, and adding the 1200 for the other 2 test.

With BKK Hosp quoting 5200, oh yea, it's definitely cheaper elsewhere.

Edited August 6Aug 6 by KhunLA

3 hours ago, CallumWK said:

Yeah I'm sure you would frequently subscribe to those tests that cost over 10K

Usually packages are below 3k, but they won't be at your max 35 baht

2 minutes ago, scubascuba3 said:

Usually packages are below 3k, but they won't be at your max 35 baht

How would you know, since it's you who post here frequently that you ride around to get the cheapest package.

Even Lifecare is out of your budget now

3 hours ago, CallumWK said:

Yeah I'm sure you would frequently subscribe to those tests that cost over 10K

3 hours ago, KhunLA said:

You need to shop elsewhere for your test. Even if including the CAVi test I suggested, you would spend probaly ~ 5k THB.

6 minutes ago, scubascuba3 said:

Usually packages are below 3k, but they won't be at your max 35 baht

It’s all cheap enough, nothing to really complain about.

3 hours ago, scubascuba3 said:

Good post, those tests aren't normally included in packages offered, labs and hospitals in Thailand need to catch up

Yea, I've had to order them, a few, as stand alone tests at private clinic. Haven't got the patience for daytime hospital Q'ing. Night clinic is silly priced to knock a few hrs off.

I no longer do the 'most included' check ups any more, as don't need most of. They're nicely priced though, if including the full abdominal ultrasound for <10k THB.

Although I had that done at private clinic recently, and only 1200 THB.

Still a few tests are hard to find, but with results of tests I do get, I can calculate the others, as equations are well known.

3 hours ago, CallumWK said:

Yeah I'm sure you would frequently subscribe to those tests that cost over 10K

Well I have, and none really expensive, and only one over 10k, full abdominal CT scan, 13 or 14k, I think. Endo or Colonoscomy are like 13k each now. EchoCardiogram was only 5k, and only 1k over govt hosp, and no waiting. CAVI was only 1k, I think.

Paid a silly price for cataract at BKK Hosp, but needed done ASAP, and he was excellent, but 2X what I could have had it done for. Next one will be done elsewhere.

Of course if you have ins, who cares what the price is, and why prices are so high. Catch 22. High premiums to pay for high cost, that people comply with.

I'll pay as needed, much cheaper than premiums, unless having some major issue, or bad gene pool.

Stay Healthy all. Get your damn blood work done. Avoid expensive maintenance if you do.

Edited August 6Aug 6 by KhunLA

6 minutes ago, KhunLA said:

Yea, I've had to order them, a few, as stand alone tests at private clinic. Haven't got the patience for daytime hospital Q'ing. Night clinic is silly priced to knock a few hrs off.

I no longer do the 'most included' check ups any more, as don't need most of. They're nicely priced though, if including the full abdominal ultrasound for <10k THB.

Although I had that done at private clinic recently, and only 1200 THB.

Still a few tests are hard to find, but with results of tests I do get, I can calculate the others, as equations are well known.

Well I have, and none really expensive, and only one over 10k, full abdominal CT scan, 13 or 14k, I think. Endo or Colonoscomy are like 13k each now. EchoCardiogram was only 5k, and only 1k over govt hosp, and no waiting. CAVI was only 1k, I think.

Paid a silly price for cataract at BKK Hosp, but needed done ASAP, and he was excellent, but 2X what I could have had it done for. Next one will be done elsewhere.

Of course if you have ins, who cares what the price is, and why prices are so high. Catch 22. High premiums to pay for high cost, that people comply with.

I'll pay as needed, much cheaper than premiums, unless having some major issue, or bad gene pool.

Stay Healthy all. Get your damn blood work done. Avoid expensive maintenance if you do.

A lot of the packages include unnecessary tests, i always check with Gemini whether particular tests are worthwhile often the answer is no, just because they are offered doesn't mean it's necessary.

Lifecare Lab needs to tweak their popular packages

9 hours ago, CallumWK said:

Strange that I get a different result from Google.

AI Overview

A Coronary Artery Calcium (CAC) test, or CT calcium score scan, in Thailand generally costs between 2,500 and 7,300 Thai Baht

Forget Google for this. Just look at hospital websites.

Usual cost is around 5k baht but there are periodic promotions, especially toward the end of the year, that can beas low as 3k.

This does not mean everyone should get one, though. The key issue is: what would you do based on the results? In an asymptomatic person, the only action that might be indicated would be modification of risk factors (lipid profile, diabetes etc) and if you are already doing that to maximum extent possible, the test isn't going to be of much practical utility. On the other hand, if there is consideration of putting you on statins or other lipid lowering drugs, then a CAC scan may be helpful in deciding this.

On 8/6/2026 at 10:01 AM, KhunLA said:

Sad so many are so ignorant,

Tell this the Antivaxxer

🧠 The bigger picture

Cardiology is shifting toward:

“How much cholesterol is in your blood?” ❌

To...

→ “How many particles are damaging your arteries?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you already have plaque?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you have inherited risk?” ✅

Yes, but doesn't matter what the number is the solution is statins.

That’s a "precision medicine approach" 😁

1 hour ago, SiSePuede419 said:

🧠 The bigger picture

Cardiology is shifting toward:

“How much cholesterol is in your blood?” ❌

To...

→ “How many particles are damaging your arteries?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you already have plaque?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you have inherited risk?” ✅

Yes, but doesn't matter what the number is the solution is statins.

That’s a "precision medicine approach" 😁

Relative to each individual, if wanting or needing a statin. Influencers are giving statins an undeserved bad rap.

And statin may be the only 'possible' solution, if have plaque, or more so, having 'hardening of the blood vessels' already, and why I put myself back on them.

Not my cardiologist, as he's not script happy, and said ... UP2U. Not on for HBP or high LDL, but to try to reverse my CAVI score, and bring it down to normal range for my age.

If healthy or almost healthy, then controlling your sugar (HbA1C), insulin is way more important, and statin won't help that.

My LDL/Trig., BP & HbA1C are excellent. Just trying to maintain, and manage the plague & level of hardening I have already.

Edited August 10Aug 10 by KhunLA

On 8/10/2026 at 12:33 PM, KhunLA said:

And statin may be the only 'possible' solution, if have plaque, or more so, having 'hardening of the blood vessels' already,

False assumption that statins is the only possible solution.

Alignment of your body's natural system with nature is the solution.

Fasting, exposure to morning light, exercise, proper nutrition, more exercise, heat shock proteins from sauna or hot water, breathing exercises, stretching exercises, more exercise.

More physics, more biology.

Less Guess and Giggle pharmaceutical interventions.

Your solution of "statins" is one choice not the only choice nor necessarily the best choice.

On 8/10/2026 at 12:04 AM, SiSePuede419 said:

🧠 The bigger picture

Cardiology is shifting toward:

“How much cholesterol is in your blood?” ❌

To...

→ “How many particles are damaging your arteries?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you already have plaque?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you have inherited risk?” ✅

Yes, but doesn't matter what the number is the solution is statins.

That’s a "precision medicine approach" 😁

Statins have their place for control of heart disease.

2 hours ago, SiSePuede419 said:

False assumption that statins is the only possible solution.

Alignment of your body's natural system with nature is the solution.

Fasting, exposure to morning light, exercise, proper nutrition, more exercise, heat shock proteins from sauna or hot water, breathing exercises, stretching exercises, more exercise.

More physics, more biology.

Less Guess and Giggle pharmaceutical interventions.

Your solution of "statins" is one choice not the only choice nor necessarily the best choice.

They would, most, fall under common sense. Referring to 'medical' help.

On 8/10/2026 at 11:04 AM, SiSePuede419 said:

🧠 The bigger picture

Cardiology is shifting toward:

“How much cholesterol is in your blood?” ❌

To...

→ “How many particles are damaging your arteries?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you already have plaque?” ✅

Yes, but doesn't matter what the number is the solution is statins.

→ “Do you have inherited risk?” ✅

Yes, but doesn't matter what the number is the solution is statins.

That’s a "precision medicine approach" 😁

Lemme guess, your medical recommendation is a bunch of suspect herbs 🤯🤣