Advanced markers & what's worth it

hs-CRP (vascular inflammation: <1 low / 1–3 average / >3 high) is a genuine, guideline-endorsed risk-enhancer at ≥2 mg/L — and CANTOS proved inflammation is a causal, targetable axis independent of LDL. Metabolic markers — fasting glucose, HbA1c, fasting insulin, and the TG/HDL ratio — capture insulin resistance, the upstream driver of atherogenic dyslipidaemia and the one you can most modify. These, plus free remnant cholesterol, are the additions with real yield. Evidence ●●●●○

Several markers are prognostic but not actionable, and lowering them didn't help in trials: LDL particle number (NMR) is largely redundant with ApoB (and arguably inferior on the newest data); oxidised LDL and myeloperoxidase have no standardised assay or treatment; Lp-PLA2 failed as a drug target (darapladib trials were null); and homocysteine is the textbook case — easy to lower with B-vitamins, but doing so didn't reduce events (HOPE-2, NORVIT). Interesting biology; not decision-changing. Evidence ●●○○○ as routine tests

Most people capture ~90% of the value from a short set: a standard panel (which hands you non-HDL and remnant cholesterol free), one ApoB, a one-time Lp(a), glucose/HbA1c, and — if your calculated risk is intermediate and the decision is uncertain — a coronary calcium score. The big direct-to-consumer 'advanced cardiac panels' bundle many markers, look impressive, and rarely change what a clinician would do. More tests mostly buy anxiety and cost.