A routine physical usually includes a metabolic panel, a cholesterol panel and a blood count. Five markers that are often not included unless requested are ApoB, Lp(a), fasting insulin, hs-CRP and ferritin. Each adds context, and none is a diagnosis on its own.
An annual physical is built to catch common problems cheaply. It does that job well. It was never designed to be a complete map, and a few useful markers sit outside it unless someone asks.
What a routine physical usually covers
Most annual visits include some version of three tests:
- A metabolic panel: glucose, kidney function, liver enzymes and electrolytes
- A lipid panel: total cholesterol, LDL, HDL and triglycerides
- A complete blood count: red cells, white cells and platelets
Many also add HbA1c or a thyroid test based on age and history. That is a solid base. The five markers below add detail in places where the base panel is blunt.
1. ApoB: a count of the particles
A standard lipid panel reports how much cholesterol is carried inside LDL particles. It does not report how many particles there are.
Apolipoprotein B (ApoB) fills that gap. Each of the particles that can enter the artery wall carries one ApoB molecule, so the ApoB level works as a particle count. Two people with the same LDL cholesterol can have different particle counts, and a 2019 review in JAMA Cardiology summarizes the evidence that particle number tracks cardiovascular risk more closely.
The 2018 US cholesterol guideline lists an elevated ApoB as a "risk-enhancing factor" that can inform decisions when the usual numbers leave doubt. Our guide to ApoB vs. LDL goes deeper.
2. Lp(a): the inherited one
Lipoprotein(a), written Lp(a) and said "L-P-little-a," is a cholesterol-carrying particle whose level is set largely by genetics. Diet and exercise change it very little, and it stays fairly stable through adult life.
A high level is linked with a higher risk of heart attack, stroke and aortic valve disease. Because it is inherited and stable, a 2019 scientific statement from the National Lipid Association describes when measuring it is reasonable, including a personal or family history of early cardiovascular disease. Several lipid societies now suggest most adults have it checked once.
A high Lp(a) is not a diagnosis. It is information that can change how firmly a clinician manages the other risk factors.
3. Fasting insulin: the early signal
Fasting glucose and HbA1c show whether blood sugar is already raised. Fasting insulin shows how hard the body is working to keep it normal.
In insulin resistance, the pancreas makes more insulin to hold glucose steady. Insulin can therefore run high for some time while glucose still looks fine.
This marker comes with caveats. It is not part of standard diabetes screening, laboratories use different methods, and there is no single agreed cut-off. It is most useful as one piece of context, read by a clinician next to glucose, HbA1c, triglycerides and waist size.
4. hs-CRP: a marker of inflammation
High-sensitivity C-reactive protein (hs-CRP) measures low levels of a protein the liver makes in response to inflammation.
Long-running low-grade inflammation is linked with cardiovascular risk. The JUPITER trial, published in the New England Journal of Medicine in 2008, enrolled adults with unremarkable LDL cholesterol and an hs-CRP of 2.0 mg/L or higher, and the 2018 US cholesterol guideline lists that same level as a risk-enhancing factor.
It is a nonspecific test. A cold, a hard workout, an injury or a dental infection can raise it for days. A single high value is usually repeated after a couple of weeks before anyone reads much into it.
5. Ferritin: your iron stores
A blood count can look normal while iron stores are already running low. Ferritin reflects how much iron the body has in reserve, and a low ferritin is the most specific blood marker of iron deficiency.
Low stores are common in people who menstruate, in frequent blood donors, in endurance athletes and in people who eat little or no meat. Symptoms can include fatigue, hair shedding and restless legs, which overlap with many other conditions.
Ferritin also rises with inflammation, so a normal or high result does not always rule out low iron. A high ferritin has its own list of causes that a clinician would work through. Our article on ferritin in women covers this in more detail.
Does everyone need all five?
No. More testing is not automatically better. Extra markers can produce borderline results that lead to worry and repeat tests without changing anything.
The better question is whether a result would change a decision. Family history of early heart disease, a borderline cholesterol result, a growing waistline with normal glucose, or unexplained fatigue are the kinds of situations where these markers earn their place. A clinician can help choose.
How to ask for them
These tests are widely available and can be added to an ordinary blood draw. Fasting for 8 to 12 hours is needed for fasting insulin and is often requested for the rest of a morning panel.
DirectCare AI offers clinician-ordered blood testing that includes markers beyond the routine panel, with results explained in plain English by a US-licensed clinician.
This article is educational and is not medical advice. Talk with a licensed clinician about which tests are appropriate for you.
References
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143. Source
- Sniderman AD, Thanassoulis G, Glavinovic T, et al. Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiol. 2019;4(12):1287-1295. Source
- Wilson DP, Jacobson TA, Jones PH, et al. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2019;13(3):374-392. Source
- Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195-2207. Source
- Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843. Source
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See my numbers →Editorial disclosure: This article is for informational purposes only and does not constitute medical advice. All treatments at DirectCare AI are prescribed by US-licensed clinicians based on individual medical evaluation. Compounded medications are not FDA-approved and are not reviewed by the FDA for safety, effectiveness, or quality. Always consult a US-licensed clinician before starting or changing any therapy.
