What we cover

Cardiovascular

Heart disease remains the thing most likely to kill an adult who currently feels well. It also has the longest warning period of anything we cover, and the widest gap between what is routinely measured and what the research says predicts an event.

What this beat covers

Two separate questions, which get conflated constantly. The first is what your risk looks like going forward, which blood markers estimate. The second is what has already accumulated in your arteries, which only imaging answers.

A standard lipid panel speaks to the first and is silent on the second. That silence is the single largest gap between a routine physical and a comprehensive assessment, and it is the reason a man with unremarkable cholesterol can be carrying twenty years of quiet arterial change.

We report on both, on where the guidance is settled and where it is contested, and on which of these measures a reader can realistically ask for.

Where the standard panel stops

Total cholesterol sums several things that behave differently and reports one number. LDL is usually calculated rather than measured. Neither counts the particles actually capable of depositing into an arterial wall, which is what ApoB does directly.

Lp(a) is largely genetic, barely moves with diet or training, and independently raises risk. It needs measuring once in a lifetime. Most adults have never had it done, which is not a scandal so much as an artefact of screening guidance written for populations rather than individuals.

The measures

What we write about in this area

ApoB: A direct count of atherogenic particles, rather than an estimate of the cholesterol they carry.
Lp(a): Largely inherited, independently associated with risk, and a once-in-a-lifetime measurement.
CIMT ultrasound: Roughly twenty minutes, no radiation, and it reports on arterial wall structure directly.
Coronary artery calcium score: A low-dose CT that quantifies calcified plaque in the coronary arteries.
Blood pressure, measured properly: Seated, rested and repeated. Single readings taken badly are a persistent source of both false alarms and false reassurance.

Questions we keep coming back to

When does imaging change what anyone would actually do?
How should a family history change the age at which measurement starts?
What is the honest evidence for screening asymptomatic adults, and where is it weak?

We work through these continuously. The Coastline Brief is where the answers land first.