Cardiovascular Risk Assessment

How much does the Cardiovascular Risk program cost?

Two options are available. A one-time comprehensive evaluation and plan is $2,000 and includes extensive labs — extended lipid panel, inflammation markers, insulin resistance risk, omega fatty acids, and thyroid — plus a polygenic risk score for cardiovascular disease (over $400 value), delivered entirely via telemedicine with a personalized optimization plan. The 12-month annual program with ongoing management is $4,000 and adds targeted repeat labs at 6 months, monthly telemedicine appointments, and unlimited portal and email messaging. A Cleerly CTA or coronary calcium (CAC) scan is recommended for baseline if not done recently and is not included in either price. Extra labs, supplements, prescriptions, and peptides are billed separately.

What is ApoB and why is it better than LDL-C?

ApoB (apolipoprotein B) is a protein that wraps around every atherogenic lipoprotein particle — exactly one ApoB per particle. LDL-C measures the cholesterol content inside LDL particles, but doesn't tell you how many particles are carrying that cholesterol. Two people can have identical LDL-C levels but very different ApoB levels — and very different cardiovascular risk. Since it's particles that embed in arterial walls (not cholesterol itself), particle count predicts risk more accurately. The 2021 European Cardiovascular Society guidelines now recommend ApoB as the primary lipid treatment target.

What is Lp(a) and why does it matter?

Lipoprotein(a) — or Lp(a) — is a modified form of LDL with an additional protein called apolipoprotein(a) that makes it both highly atherogenic (promotes plaque buildup) and thrombogenic (increases clotting risk) simultaneously. Lp(a) levels are 80–90% genetically determined — lifestyle changes and most statins don't significantly lower them. Elevated Lp(a) above 50 mg/dL or 125 nmol/L confers 2–3x increased cardiovascular risk and is the leading genetic cause of premature heart disease. About 20% of the global population has elevated Lp(a). New targeted RNA-based therapies in trials can lower it by over 80%.

What's the difference between a CAC score and a CTA?

A coronary artery calcium (CAC) score uses a low-radiation CT to detect calcified (hard) plaque in the coronary arteries. It's excellent for reclassifying intermediate-risk patients — a score of 0 dramatically lowers event probability, while a high score (300+ Agatston units) prompts aggressive prevention. However, CAC only detects hard plaque and completely misses soft (non-calcified) plaque, which can be unstable and equally dangerous. A coronary CT angiography (CTA) provides a more complete picture by visualizing both hard and soft plaque, identifying stenosis, and characterizing plaque composition. We may recommend CTA when soft plaque is suspected — particularly in younger patients, those with elevated Lp(a), or when CAC is low but clinical suspicion remains high.

What does hs-CRP tell me about my heart risk?

hs-CRP (high-sensitivity C-reactive protein) is a marker of systemic inflammation. In the cardiovascular context, elevated hs-CRP (above 2 mg/L) reflects ongoing vascular inflammation that accelerates atherosclerosis independent of cholesterol levels. The landmark JUPITER trial showed that people with normal LDL-C but elevated hs-CRP derived significant benefit from statin therapy. hs-CRP also motivates lifestyle interventions — it responds to anti-inflammatory diet, weight loss, and aerobic exercise, making it a useful motivational and monitoring tool.

How is homocysteine related to cardiovascular risk?

Homocysteine is an amino acid that, at elevated levels (above 10–15 μmol/L), damages arterial endothelium and promotes clot formation. Elevated homocysteine is an independent risk factor for cardiovascular disease, stroke, and dementia. The most common cause is deficiency in B12, folate, and B6 — which is nutritionally modifiable. Testing homocysteine is valuable because the treatment (targeted B-vitamin supplementation) is safe, inexpensive, and effective, yet it's completely omitted from standard cardiovascular panels.

How is this different from a standard annual physical?

A standard annual physical includes a basic lipid panel, blood pressure, blood sugar, and weight, then applies a Framingham or ASCVD 10-year risk calculator. This misses ApoB, Lp(a), particle size, inflammatory markers, and imaging — all of which substantially refine risk estimates and change treatment decisions. For a 45-year-old with a family history of early heart disease and "normal" cholesterol, only an advanced assessment reveals whether early atherosclerosis is actually present.

What is included in a heart risk assessment?

A complete cardiovascular risk assessment includes the standard lipid panel plus the markers that predict events independently of it: ApoB for particle count, Lp(a) for inherited risk, hs-CRP for vascular inflammation, homocysteine, fasting insulin and HOMA-IR for insulin resistance, HbA1c, and an omega-3 index. Imaging with a coronary artery calcium score or coronary CT angiography adds the actual plaque burden. Sorrell MD's evaluation also includes a polygenic risk score for coronary disease.

Do I need to fast for cardiovascular risk testing?

Fasting for 10–12 hours is recommended because triglycerides, fasting insulin and HOMA-IR are meaningful only in the fasted state. ApoB, Lp(a), hs-CRP and homocysteine are not affected by meals. Water, and usually black coffee, are fine before the draw.

How often should ApoB and Lp(a) be checked?

Lp(a) is about 90% genetically determined, so one measurement is enough for most people; a repeat is only useful after a change that can shift it, such as menopause or starting hormone therapy. ApoB should be rechecked 6–12 weeks after any change in treatment and then annually once at target.

Does Sorrell MD coordinate with imaging centers for CAC and CTA?

Yes. Dr. Sorrell can order a CAC score or coronary CTA — or help interpret one you've already had — integrating the findings into a comprehensive risk assessment and action plan. Lab panels are ordered through national networks (Quest, LabCorp) with draw sites near you — all coordinated via telemedicine.