The Cleveland HeartLab panel is a set of blood tests from a specialty cardiac laboratory, included in every Cardio Res-Q assessment. In our program it reports Lp(a), ApoB, hs-CRP, oxidized LDL and small dense LDL, plus other proprietary Cardio Res-Q markers that the clinic does not itemize publicly.
Three of those markers, Lp(a), ApoB and hs-CRP, are well studied and named in US guidelines. The other two, oxidized LDL and small dense LDL, are linked with heart risk in research but are not part of routine guideline-based testing. This page explains what each one measures and how much weight it can carry.
Key takeaways
- The panel comes with both the $775 and $999 assessments, drawn after a 10 to 12 hour fast.
- Lp(a), ApoB and hs-CRP have strong evidence and appear in US cholesterol guidance.
- Oxidized LDL and small dense LDL are research-backed associations, but guidelines do not ask for them routinely.
- It does not count LDL particles, a different kind of test the clinic does not offer.
- Your provider explains every result at your consult, including the markers that are not itemized publicly.
What the panel reports
| Marker | What it reflects | Evidence status |
|---|---|---|
| Lp(a) | An inherited cholesterol-carrying particle | Strong. US guidance advises measuring it once in all adults |
| ApoB | The number of cholesterol-carrying particles that can enter artery walls | Strong. A recognized risk-enhancing factor |
| hs-CRP | Low-grade inflammation | Moderate. A recognized risk-enhancing factor |
| Oxidized LDL | LDL that has been chemically damaged by oxidation | Limited. Associated with heart disease in small studies |
| Small dense LDL | Cholesterol carried in smaller, denser LDL | Linked with risk in a large cohort. Not part of guideline treatment decisions |
The program page also describes the panel as covering inflammation and vascular stress, clotting and plaque-vulnerability factors, oxidative stress and antioxidant status. It does not list the individual tests, and your provider walks you through all of them at your assessment.
The three well-established markers
These are covered in depth in their own guides, so here is the short version.
- Lp(a) is largely set by your genes and is measured once. Nothing lowers it yet, and the clinic does not treat it. See the Lp(a) test guide.
- ApoB counts atherogenic particles and can flag risk when LDL cholesterol looks normal. See the ApoB test guide.
- hs-CRP measures inflammation and can be thrown off by a recent cold or injury. See the hs-CRP test guide.
The 2018 US cholesterol guideline lists ApoB of 130 mg/dL or more, Lp(a) of 50 mg/dL or more, and hs-CRP of 2.0 mg/L or more as risk-enhancing factors.1 These are the markers most likely to shift a treatment discussion.
Small dense LDL: what it is and what the evidence shows
LDL particles are not all the same size. Small dense LDL is the share of LDL cholesterol carried in the smallest, densest particles.
The best evidence comes from a US cohort of about 11,400 adults followed for around 11 years. People in the highest quarter of small dense LDL cholesterol had about 1.5 times the risk of coronary heart disease of those in the lowest quarter, after accounting for established risk factors.2 Levels were higher in people with diabetes and tracked with an unhealthy lipid profile overall.
That is a real association. It does not show that measuring small dense LDL changes care or outcomes. Small dense LDL tends to run high with high triglycerides and insulin resistance, so it often points to problems that other tests already show. Neither small dense LDL nor oxidized LDL appears among the risk-enhancing factors in the 2018 US cholesterol guideline.1
Oxidized LDL: what it is and what the evidence shows
Oxidized LDL is LDL that has been chemically altered by oxidation. In the artery wall, it is thought to drive inflammation and the formation of plaque. That makes it a reasonable thing to study.
The clinical evidence is thinner. A recent systematic review in people with chronic inflammatory diseases found only three suitable observational studies, with about 1,060 participants in total.3 Oxidized LDL was higher in people with cardiovascular disease, and the authors called it a possible marker for further study. That is a signal, not a basis for treatment on its own. As far as we can verify, US guidelines do not recommend routine oxidized LDL testing.
What the panel is not
Be clear about what you are paying for.
- It does not count particles. The panel does not report an LDL particle count, and it is not a nuclear magnetic resonance lipoprotein test. The clinic does not offer those tests.
- It is not an imaging test. Blood markers estimate risk. They do not show whether plaque has formed. A coronary calcium score looks for calcified plaque directly.
- It is not a diagnosis. No single marker tells you that you have heart disease, and an unusual result on a newer marker is read alongside your standard numbers and history.
In 2018 the US Preventive Services Task Force found the evidence insufficient to judge the benefits and harms of adding hs-CRP, the ankle-brachial index or a calcium score to standard risk assessment in adults without symptoms.4 That caveat applies even more to markers with less research behind them.
Next step: getting the panel
The Cleveland HeartLab panel is included in both assessments on the Cardio Res-Q program page: the Comprehensive Assessment at $775 and the Enhanced Assessment at $999, which adds CIMT and a calcium score. Your labs, including the panel, are drawn at least a week before your 1-hour consult with Dr. Varano, after a 10 to 12 hour fast. Both assessments are direct-pay and not billed to insurance.
Ongoing care afterward is optional. If you have questions about the panel before you book, contact our team.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Can I see the full list of tests in the panel?
The clinic names Lp(a), ApoB, hs-CRP, oxidized LDL and small dense LDL. The other proprietary markers are not itemized publicly, and your provider reviews every result with you at the consult.
Is this the same as an LDL particle count?
No. The panel does not count LDL particles. If you want a particle count specifically, Cardio Res-Q does not offer it.
My small dense LDL is high. What does that mean?
It is a signal worth discussing, often alongside triglycerides, blood sugar and ApoB. It is not a diagnosis on its own, and decisions rest on your whole picture.
Can I order the panel by itself?
It is offered as part of the $775 and $999 assessments. A standalone panel is not listed, so ask our team.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
