Advanced blood tests: what it costs and what the evidence says

Three markers have guideline support for defined uses:

• ApoB (apolipoprotein B) is a protein on the particles that carry cholesterol and cause plaque in arteries. European guidelines (2019) recommend measuring it as part of routine cholesterol tests for some people, such as those with diabetes or high triglycerides. US guidelines (2019) count a high level as a factor that raises heart risk.
• Lp(a) (lipoprotein(a)) is a cholesterol particle whose level is mainly set by your genes. The 2025 European update advises considering a test at least once in each adult's life. A high level raises heart risk, but it has not yet been shown that lowering it prevents heart disease.
• HbA1c shows your average blood sugar over the past 3 months (CDC). The US Preventive Services Task Force (2021) lists it as one of the tests for diabetes screening in adults aged 35 to 70 who are overweight or have obesity.

Other markers have less support. The US Preventive Services Task Force (2021) found too little evidence to judge screening adults without symptoms for low vitamin D. Guidelines differ on hs-CRP, a marker of inflammation: US and European heart guidelines use a raised level to refine heart risk, but the Task Force (2018) found too little evidence to recommend it for screening.

Established means: Recommended in clinical guidelines for defined uses.