The Biomarkers that Really Matter

It used to be that information about your health, whether a test result or a measurement, was viewed primarily as a diagnosis or a sign that a condition was likely unavoidable. Modern biomarkers and preventive medicine have changed that. Today, advanced tests and technologies, including genetic screening, sophisticated imaging, and artificial intelligence, can identify health risks years before symptoms appear. This gives patients and physicians opportunities to personalize care and take preventive action.

Preventive medicine has become remarkably sophisticated. For example, newer blood tests can look beyond traditional measures such as cholesterol and glucose to identify genetic factors that may increase the risk of heart disease and other chronic illnesses. One example is lipoprotein(a), or Lp(a), a genetically determined form of cholesterol associated with an increased risk of heart disease that often goes undetected by standard lipid panels. Because elevated Lp(a) can contribute to blood clots, arterial blockages, and inflammation, it’s sometimes referred to as a "triple threat" by some experts. Lp(a) testing may be available through MDVIP-affiliated physicians based on state regulations.

Another important advancement is high-sensitivity C-reactive protein (hsCRP) testing, which allows physicians to detect low levels of inflammation that might otherwise go unnoticed. The liver produces C-reactive protein in response to inflammation. While inflammation can result from infections or autoimmune disorders, chronic low-grade inflammation is also linked to cardiovascular disease. Unlike standard CRP testing, hsCRP can detect subtle elevations that may signal an increased risk of heart attack or stroke, even in otherwise healthy individuals.

Researchers have also identified myeloperoxidase (MPO) as an important biomarker of inflammation and cardiovascular risk. Immune cells release MPO during the body's inflammatory response. Although it helps defend against pathogens, elevated levels can damage blood vessels and contribute to plaque formation. MPO testing may identify cardiovascular risk in people whose cholesterol and triglyceride levels appear normal and, in some cases, may signal an elevated risk of heart attack or stroke within the next 6 to 24 months.

These tests are just a few examples of how advances in biomarker technology are helping physicians identify risk factors, monitor wellness, and create more personalized prevention strategies. Combined with digital health data from wearables, apps, and fitness trackers, patients have access to more health information than ever before. The challenge is determining which information is most useful.

In my view, the most valuable health data are insights that lead to meaningful behavioral changes and better outcomes. One area I pay particular attention to is hidden inflammation.

How Biomarkers Have Changed Health Outcomes

Biomarkers are measurable substances found in blood, tissue, or other bodily fluids that reflect biological processes, disease activity, or responses to treatment and lifestyle modifications.

Since the 1960s, physicians have used factors such as blood pressure, cholesterol levels, smoking history, and diabetes status to assess cardiovascular risk. Identifying these risk factors early helped transform heart disease from an inevitable outcome into a largely preventable condition for many people.

The landmark Framingham Heart Study demonstrated the importance of these risk factors and played a major role in reducing premature heart disease deaths in the United States. Today, preventive cardiology continues to evolve as we learn more about the connections between heart disease, inflammation, metabolism, and genetics. This growing understanding allows physicians to provide increasingly personalized recommendations designed to prevent serious events such as heart attacks and strokes.

Modern Biomarkers That Reveal Hidden Inflammation

One area of particular interest is hidden inflammation. For years, we assumed that people with low LDL cholesterol had a low risk of arterial blockage, while those with high LDL levels faced greater risk. LDL (or low-density lipoprotein) is often referred to as "bad cholesterol" and can contribute to plaque buildup and atherosclerosis when levels are elevated.

However, clinical experience and ongoing research have revealed that the relationship is not always so straightforward. I often see what I call "discordance," where cholesterol levels and actual cardiovascular risk do not match. In these situations, inflammation biomarkers can help identify individuals with hidden disease, even when traditional cholesterol levels appear favorable.

Genetic testing allows us to look beyond the standard lipid panel, which measures total cholesterol, LDL, HDL, and triglycerides. Traditional tests remain extremely valuable and, when combined with blood pressure, diabetes status, family history, and smoking history, often provide a strong picture of a patient's health. Advanced biomarkers become particularly useful when we need additional information.

For example, two individuals may have identical LDL and triglyceride levels, yet one may carry elevated Lp(a), a genetic risk factor that a standard lipid panel would miss. In these cases, a coronary artery calcium scan can provide additional insight. This noninvasive CT scan looks for calcium deposits within the coronary arteries and can help physicians better assess cardiovascular risk and tailor treatment plans accordingly.

Because of its importance, I recommend that patients have their Lp(a) level measured at least once in their lifetime. The American Heart Association now supports baseline Lp(a) testing for risk assessment. Although no approved medications currently target Lp(a) directly, several promising therapies are in late-stage development.

Other Important Biomarkers to Monitor

In addition to advanced cardiovascular biomarkers, I recommend paying close attention to three other important measures:

Hemoglobin A1c
Hemoglobin A1c reflects average blood sugar levels over approximately three months and is a valuable tool for identifying insulin resistance, prediabetes, and type 2 diabetes. Patients working to improve blood sugar control may benefit from measuring A1c several times per year.

Some patients may also benefit from using a continuous glucose monitor (CGM). Even short-term CGM use can provide valuable insight into how specific foods and eating patterns affect blood sugar levels and help guide healthier choices.

Blood Pressure
Blood pressure remains one of the most important predictors of long-term health. Fortunately, it is easy to monitor using home blood pressure cuffs, wearable devices, or pharmacy-based machines. Regular monitoring can help patients and physicians develop personalized treatment plans that combine lifestyle modifications and, when necessary, medication.

LDL Cholesterol
Knowing your LDL cholesterol level and working to maintain it within an appropriate range remains essential for cardiovascular health. Healthy eating, regular physical activity, and weight management can help improve cholesterol levels. Target LDL goals vary based on individual risk factors, so patients should work with their physician to determine the most appropriate target for their situation.

The advanced biomarker testing available through many MDVIP annual wellness exams includes several assessments that are not routinely offered in traditional primary care settings. Ultimately, however, biomarkers are most valuable when they inspire meaningful lifestyle changes. The goal isn't simply to collect more data. It's to use that information to make better decisions, reduce risk, and improve long-term health.