Three Tests Your Doctor Probably Isn't Ordering (and Why They Matter)
There's a saying I've carried with me since medical school, attributed to a Harvard dean, that goes something like this: half of what you learn in medical school will turn out to be wrong or outdated within five years of graduation. The trouble is, nobody can tell you which half.
At first, I wasn't sure I believed this. However, I now know differently. Some of what I learned in training turned out to be incomplete. Some of it has been refined. And some of it I've had to set down entirely in favor of something better. When I trained, roughly twenty years ago (how?!), the tools we had to assess cardiovascular risk were limited. We checked standard lipid panels and followed guidelines that were evidence-based for their time.
But medicine changes. New studies are published and science moves forward. We can now see things we couldn't see before. Not metaphorically. Literally. Tests that were once reserved for research settings or high-risk patients are now accessible and affordable. Here are three worth knowing about.
ApoB
You've probably had your LDL cholesterol checked. But LDL measures cholesterol content, not the number of particles carrying it through your bloodstream. ApoB measures those particles directly, and particle number turns out to be a much stronger predictor of cardiovascular risk than LDL alone. Two people can have identical LDL numbers and very different ApoB levels, with very different long-term risk profiles. This is a simple blood test that can be done alongside the regular lipid panel. I recommend this for all of my patients.
Coronary Artery Calcium Score (CAC)
This is a low-dose CT scan that detects calcium deposits in the walls of your coronary arteries, an early and direct sign of plaque buildup. There is no dye, no contrast, and roughly the same radiation exposure as a mammogram. A score of zero is reassuring and shifts risk assessment significantly. A score above zero tells us something important is already happening. For anyone in the gray zone on cardiovascular risk, a CAC score is a powerful tool to help guide the treatment plan.
VO2 Max
Your body's maximum capacity to use oxygen during exercise is one of the strongest predictors of long-term mortality we have. Stronger than smoking status. Stronger than having diabetes or hypertension. And unlike many risk factors, it is highly modifiable. Knowing your number gives you a baseline, a goal, and a concrete reason to take your cardiorespiratory fitness seriously.
For women in perimenopause especially, this matters. Estrogen decline affects cardiovascular fitness, muscle mass, and bone density simultaneously, and most women are never told this is happening or given tools to respond to it.
