Most of us know that high cholesterol can increase cardiovascular risk.

But what if your standard cholesterol results look reasonable and there is still more to the picture?

As understanding of cardiovascular disease develops, clinicians are paying increasing attention to markers including Apolipoprotein B, Lipoprotein(a) and high-sensitivity C-reactive protein, alongside traditional cholesterol, blood pressure and blood sugar measurements.

This is particularly relevant to women approaching and moving through menopause.

Changing oestrogen levels can influence cholesterol, fat distribution, blood pressure and glucose regulation. Cardiovascular disease remains a major cause of illness and death in women, yet cardiovascular risk in women has historically been under-recognised [1].

Recent European cardiovascular guidance has also placed renewed emphasis on Lipoprotein(a), known as Lp(a), recommending that measuring it at least once during adulthood should be considered [2].

So what are these newer blood markers, and could they tell you something a standard cholesterol result does not?

Why Cardiovascular Health Changes Around Menopause

Oestrogen has several effects on the cardiovascular system.

Before menopause it helps support:

• Healthy blood vessels
• Cholesterol regulation
• Glucose metabolism
• Fat distribution

As oestrogen levels decline, several changes can occur.

Women may develop:

• Higher LDL cholesterol
• Increased abdominal fat
• Greater insulin resistance
• Higher blood pressure
• Increased metabolic risk

The British Heart Foundation highlights menopause as a stage when cholesterol, glucose control, blood pressure and abdominal fat can all change [1].

This does not mean menopause directly causes cardiovascular disease.

Age, genetics, smoking, diet, physical activity, blood pressure, weight, diabetes and family history all contribute.

However, midlife is an important time to understand your personal risk.

What Does a Standard Cholesterol Test Measure?

A conventional lipid profile usually includes:

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides
• Non-HDL cholesterol

These measurements remain extremely useful.

LDL cholesterol is a major causal contributor to atherosclerosis, the process in which fatty material accumulates within artery walls.

However, cholesterol concentration does not always reveal exactly how many potentially harmful lipoprotein particles are circulating in the bloodstream.

This is where markers such as ApoB can provide additional information.

What Is Apolipoprotein B?

Apolipoprotein B, usually shortened to ApoB, is a protein found on atherogenic lipoprotein particles.

These include:

• LDL
• Very low density lipoprotein
• Intermediate density lipoprotein
• Remnant particles
• Lipoprotein(a)

Each of these particles carries one ApoB molecule.

Measuring ApoB therefore gives an indication of the number of atherogenic particles circulating in your blood.

This is slightly different from measuring the amount of cholesterol carried within those particles.

Imagine two people with similar LDL cholesterol.

One may have fewer particles carrying more cholesterol each.

The other may have many more particles carrying a smaller amount each.

Their LDL cholesterol number might look similar, but their particle burden may differ.

Research has shown that higher ApoB can provide additional information about cardiovascular risk, including in women [3].

Why Can ApoB Be Particularly Useful in Metabolic Dysfunction?

ApoB can be particularly informative when someone has:

• Raised triglycerides
• Insulin resistance
• Type 2 diabetes
• Metabolic syndrome
• Abdominal obesity

These conditions can produce a larger number of smaller cholesterol-containing particles.

The LDL cholesterol concentration alone may therefore not always fully represent the number of atherogenic particles.

This can be relevant in perimenopause and menopause because insulin resistance and central weight gain become more common for some women.

What Is Lipoprotein(a)?

Lipoprotein(a), or Lp(a), is a cholesterol-containing particle that is largely determined by genetics.

Unlike many cardiovascular risk factors, your Lp(a) level is usually not substantially altered by:

• Weight loss
• Exercise
• Diet
• Lifestyle changes

This means someone who eats well, exercises regularly and has acceptable standard cholesterol results can still have a high Lp(a).

Elevated Lp(a) is independently associated with an increased risk of atherosclerotic cardiovascular disease and aortic valve disease [2][4].

Most people with elevated Lp(a) have no symptoms.

The only way to know your level is to measure it.

Should Everyone Have Lp(a) Tested?

The 2025 focused update of the European Society of Cardiology and European Atherosclerosis Society dyslipidaemia guidance recommends considering Lp(a) measurement at least once during adulthood [2].

HEART UK has also highlighted the value of one-time Lp(a) testing because levels are primarily genetically determined and usually remain relatively stable throughout life [4].

Testing may be particularly useful where there is:

• A family history of premature heart disease
• A family history of high Lp(a)
• Cardiovascular disease despite apparently reasonable cholesterol
• Unexplained high cardiovascular risk
• Familial hypercholesterolaemia
• Intermediate cardiovascular risk where additional information could affect management

For most people, Lp(a) does not need to be measured repeatedly.

What Does a High Lp(a) Result Mean?

A high result does not mean you are destined to have a heart attack or stroke.

It means one additional risk factor has been identified.

HEART UK classifies higher Lp(a) concentrations into increasing levels of cardiovascular risk, and results should be interpreted alongside factors such as:

• LDL cholesterol
• Blood pressure
• Smoking
• Diabetes
• Weight
• Family history
• Age
• Kidney health

Because lifestyle has little direct effect on Lp(a), management currently focuses heavily on reducing other modifiable cardiovascular risks.

This could include more intensive management of LDL cholesterol, blood pressure, glucose and smoking.

Are There Treatments Specifically for Lp(a)?

This is an area of rapidly developing cardiovascular research.

As of 2026, there is no widely approved medication specifically used solely to lower Lp(a) and proven to reduce cardiovascular events.

However, several targeted treatments are in late-stage clinical trials [5].

These include therapies designed to reduce the liver’s production of apolipoprotein(a), a key component of Lp(a).

This is one reason Lp(a) has received significant attention in cardiovascular medicine during 2026.

For now, identifying high Lp(a) helps clinicians understand overall risk and manage the cardiovascular factors that can currently be modified.

What Is hs-CRP?

High-sensitivity C-reactive protein, or hs-CRP, measures very low levels of C-reactive protein in the blood.

CRP increases when inflammation is present.

The high-sensitivity version can help identify low-grade inflammation associated with cardiovascular risk.

The updated European guidance identifies hs-CRP above 2 mg/L as one of several cardiovascular risk modifiers that can provide additional context in selected patients [2].

However, hs-CRP is not specific to cardiovascular disease.

Levels can also rise because of:

• Infection
• Injury
• Autoimmune disease
• Other inflammatory conditions

A single raised result therefore needs appropriate clinical interpretation.

What About Apolipoprotein A?

Apolipoprotein A1 is the principal protein associated with HDL particles.

Some advanced lipid panels measure both ApoA and ApoB.

Looking at the wider lipid picture can provide additional information about the balance between atherogenic particles and HDL-associated particles.

As with all cardiovascular biomarkers, these values should be interpreted within the overall clinical picture rather than treated as isolated targets.

Why Blood Sugar Belongs in the Same Conversation

Cardiovascular and metabolic health are closely connected.

Insulin resistance and rising blood glucose can increase cardiovascular risk even before diabetes develops.

Useful markers can include:

Fasting glucose

This provides a snapshot of blood glucose at the time of testing.

HbA1c

HbA1c reflects average glucose exposure over approximately the previous two to three months.

Together with cholesterol, blood pressure and body composition, these values help build a more complete metabolic picture.

What Does hs-CRP Add?

Some women may have apparently reassuring standard cholesterol numbers but other metabolic or inflammatory risk factors.

hs-CRP can sometimes provide an additional layer of information.

However, it should never be viewed as a standalone heart disease test.

Its value comes from combining it with:

• Lipids
• Blood pressure
• Glucose regulation
• Family history
• Lifestyle
• Medical history

What About HRT and Heart Disease?

This is an important distinction.

HRT is prescribed to manage menopause symptoms and, where appropriate, to support other aspects of menopause health.

NICE specifically advises that HRT should not be prescribed for the primary or secondary prevention of cardiovascular disease [6].

However, cardiovascular health remains relevant when deciding:

• Whether HRT is appropriate
• Which route may be preferable
• What other risk factors should be managed
• Whether additional investigation is needed

The decision to use HRT should therefore sit alongside cardiovascular risk assessment rather than replace it.

The Menopause Medic Core Metabolic Health Panel

The Menopause Medic’s Core Metabolic Health Panel is designed to provide a more detailed view of cardiovascular and metabolic health than a standard cholesterol test alone.

It includes:

• Glucose
• HbA1c
• Standard lipid profile
• Apolipoprotein A
• Apolipoprotein B
• Lipoprotein(a)
• hs-CRP
• Uric acid
• Liver function
• DHEAs
• AMH
• Vitamin D
• TSH
• Free T4

This type of panel may be useful for women who want a detailed health baseline or are making changes to their weight, nutrition, lifestyle or treatment.

What Is the Complete Health Baseline?

For women looking at overall health rather than hormones alone, The Menopause Medic also offers a Complete Health Baseline.

This includes metabolic and cardiovascular markers alongside:

• Kidney function
• Liver function
• Iron and ferritin
• Active B12
• Folate
• Vitamin D
• Inflammatory markers

The aim is not to generate as many numbers as possible.

The purpose is to identify useful information that can help guide personalised decisions.

Do You Need Advanced Cardiovascular Blood Testing?

Not every woman requires every test.

A comprehensive cardiovascular assessment might be particularly worth discussing if you have:

• A strong family history of heart attack or stroke
• High cholesterol
• High blood pressure
• Insulin resistance
• Prediabetes or diabetes
• Significant abdominal weight gain
• PCOS or PMOS
• Early menopause
• A history of pregnancy complications associated with cardiovascular risk
• Previous abnormal blood results
• A desire to establish a detailed midlife health baseline

Results should be interpreted by an appropriately qualified healthcare professional.

Cardiovascular Health Is More Than Cholesterol

Your total cholesterol number is useful, but cardiovascular health is more complicated than a single result.

ApoB can provide information about the number of potentially harmful circulating particles.

Lp(a) can uncover an important inherited risk factor.

HbA1c and glucose help assess metabolic health.

hs-CRP can provide additional information about inflammation in selected circumstances.

Together with blood pressure, family history, lifestyle and medical history, these markers can help create a more personalised picture of midlife health.

Support at The Menopause Medic

The Menopause Medic combines menopause care with hormonal, cardiovascular and metabolic assessment.

Women can access:

• Specialist menopause consultations
• Comprehensive blood testing
• Core metabolic health testing
• HRT reviews
• Medical weight management
• Testosterone consultations
• Diagnostic referrals where appropriate

Face-to-face appointments are available in Berkhamsted and St Albans, with virtual consultations available across the UK.

References

[1] British Heart Foundation. Menopause and heart and circulatory conditions.

[2] European Society of Cardiology and European Atherosclerosis Society. Focused Update of the Guidelines for the Management of Dyslipidaemias.

[3] Marston NA et al. Excess Apolipoprotein B and Cardiovascular Risk in Women and Men.

[4] HEART UK. Lipoprotein(a) information and consensus guidance.

[5] European Heart Journal. Lipoprotein(a)-lowering therapies: a promising future. 2026.

[6] NICE. Menopause: identification and management, NG23.

[7] The Menopause Medic. Core Metabolic Health Panel and Complete Health Baseline.

Medical Disclaimer

This article is intended for general information and education only and does not constitute medical advice, diagnosis or treatment. PCOS or PMOS cannot be diagnosed using blood results alone. Speak to an appropriately qualified healthcare professional for individual assessment.