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Biomarker reference

Heart & long-term risk

The markers a routine checkup usually skips, and the ones that decide your next thirty years.

Cardiovascular markers describe the risk of arterial disease long before any symptom appears, and the ones that matter most are largely absent from a standard Indian health checkup. A routine lipid panel reports how much cholesterol is being carried; it does not report how many particles are carrying it, which is what determines how much collides with an artery wall. Nor does it capture lipoprotein(a), an inherited risk factor more common in South Asians and invisible on every routine panel. This matters disproportionately in India, where 53.4% of cardiovascular deaths occur before the age of 70 and the share of all deaths that are cardiovascular nearly doubled between 1990 and 2016. Read together, these markers answer a question a cholesterol number alone cannot: how much arterial risk is actually accumulating, and how much of it was inherited rather than acquired.

01

Why are these markers read together?

No marker in this group means much on its own. Heart & long-term risk covers 17 of the measurements in the Peak Brain panel, and a physician reads them as a pattern — one value at the edge of a reference range means something quite different depending on what the others are doing.

  • ApoB counts atherogenic particles; Lp(a) captures the inherited component that sits on top of them. Someone with a normal ApoB and a high Lp(a) has a risk profile that neither number describes alone.
  • Inflammation modifies the whole picture. A raised hs-CRP alongside a high ApoB describes substantially greater risk than either finding in isolation, because inflamed arterial walls retain particles more readily.
  • Kidney markers belong in this group because kidney function and vascular health track together closely — early albumin leak into urine is a vascular finding as much as a renal one.
02

What does this group explain?

  • Why a "normal cholesterol" report is weak reassurance in a population where 81.2% of adults have some lipid abnormality.
  • Why coronary disease arrives roughly a decade earlier in Indians, and at lower body weights, than Western risk calculators assume.
  • Which part of your cardiovascular risk is modifiable by diet, training and weight, and which part was set at birth and needs a different response.
03

Heart & long-term risk: marker explanations

ApoB

ApoB, or apolipoprotein B, is a protein that sits on the surface of every cholesterol particle capable of lodging in an artery wall.

Lp(a)

Lp(a), pronounced "L-P-little-a", is a cholesterol-carrying particle whose blood concentration is set almost entirely by the genes you inherited.

04

Also measured in this group

These markers are included in the panel and read alongside the ones above. They have no standalone reference page, because outside the context of a full panel there is little useful to say about them individually — and a page that exists only to fill a URL is worse than no page.

  • ApoA1protective particles
  • ApoB:ApoA1 ratiothe balance
  • Remnant cholesterolthe missed fraction
  • LDL:HDL ratiothe classic cardiac ratio
  • LDL particle numbercount, not just mass
  • Small dense LDLthe dangerous subfraction
  • Lp-PLA2plaque inflammation
  • Myeloperoxidasevessel wall stress
  • hs-Troponin Isilent cardiac injury
  • NT-proBNPcardiac strain
  • Serum creatininekidney workload
  • eGFRfiltration rate, calculated
  • BUN:creatinine ratiohydration against kidney
  • Cystatin Ckidney cross-check
  • Urine albumin:creatinineearly vessel damage
05

Who reviews this group

Reviewer assignment follows speciality. Pages in this group are assigned to Dr. Nitesh Arora (MD, DM), and each page carries a byline naming its reviewer and the date of review.

Heart & long-term risk: common questions

Which cardiovascular marker matters most?

ApoB, for most people. It counts the particles capable of lodging in an artery wall rather than weighing the cholesterol inside them, and it predicts events more reliably than LDL cholesterol where the two disagree. Lp(a) is the one to measure once, because it is inherited, more common in South Asians, and never appears on a routine panel.

My cholesterol is normal. Do I still need these tests?

Frequently, yes. Normal LDL cholesterol with a high ApoB is a common and clinically meaningful pattern, particularly alongside insulin resistance. And Lp(a) is entirely independent of the standard panel — a person can carry substantially elevated lifetime risk with a spotless cholesterol report.

How often should cardiovascular markers be retested?

ApoB and hs-CRP respond to intervention and are worth repeating after a meaningful change in diet, weight or medication — ninety days is a reasonable interval. Lp(a) is genetically determined and does not drift, so once in adult life is enough.

The programme

One marker rarely answers the question.

Peak Brain draws a full blood and urine panel at your home, has a licensed physician read every marker together rather than one at a time, and turns what they find into a ranked 90-day protocol with a retest at the end.

How the programme works