Every cholesterol and heart test, and which ones you need
Most people need one test: a standard lipid panel, every 5 years from age 19, plus Lp(a) once in their life. Everything else answers a narrower question, like whether plaque has already started or whether your LDL is telling the truth. Here’s every test that bears on cholesterol and plaque, what it measures, who it’s for, how it’s done, what it risks, what it costs and what you do with the result.
What we’d do
Get a lipid panel and hold your LDL and non-HDL against the goal for your risk. Add Lp(a) once. Ask for ApoB if your triglycerides run high or you have diabetes. Consider a calcium scan only if you’re 40 or older (men) or 45 (women), your risk is borderline or intermediate, and the result would change whether you start a statin.
Why it’s confusing
Clinics, apps and wellness companies sell bigger and bigger panels, and a list of 40 numbers feels more thorough than four. But a test is only useful if its result would change what you do. The 2026 US guideline names who each one is for, and most people don’t need most of them.
The tests
Prices are self-pay prices from Labcorp’s direct-to-consumer site on November 15, 2026, and the guideline’s range for calcium scans. With a doctor’s order, insurance may cover blood tests.
Standard lipid panel
- Measures
- Total cholesterol, HDL and triglycerides. LDL is usually calculated from those three, and non-HDL is total minus HDL.
- For
- Every adult from 19, at least every 5 years, more often with risk factors. Every child once between 9 and 11.
- How
- A blood draw from your arm. Fasting is optional, since a normal meal moves LDL about 8 points and triglycerides about 26. Fast if your last nonfasting triglycerides were 400 or more.
- Risk
- A needle.
- Cost
- $59 self-pay at Labcorp. Often covered.
- Then
- Hold your LDL and non-HDL against the goal for your risk, or put them in the panel check.
ApoB
- Measures
- The number of particles that can cause plaque. Each carries one ApoB.
- For
- People on treatment who’ve reached their LDL and non-HDL goals, above all with high triglycerides, diabetes or a very low LDL. An ApoB of 120 or more counts as a risk enhancer.
- How
- A blood draw, often added to the same tube as your panel. No fasting needed.
- Risk
- A needle.
- Cost
- $69 self-pay at Labcorp.
- Then
- Check it on apob.guide’s checker, and see its test page.
Lp(a)
- Measures
- An inherited particle that adds risk on top of LDL. Food barely moves it.
- For
- Every adult, at least once. It hardly changes, so once is usually enough.
- How
- A blood draw.
- Risk
- A needle.
- Cost
- $49 self-pay at Labcorp.
- Then
- At 125 nmol/L (50 mg/dL) or more, risk is about 1.4 times higher, and at 250 or more at least double. The guideline says to lower LDL harder (what is Lp(a)?).
hs-CRP
- Measures
- Inflammation in your body.
- For
- Mostly people at borderline risk deciding about treatment.
- How
- A blood draw, done twice, when you’re well.
- Risk
- A needle.
- Cost
- $69 self-pay at Labcorp.
- Then
- At 2 mg/L or more on two tests, with no other cause, the guideline says a high-intensity statin can be useful at borderline risk.
Coronary calcium scan
- Measures
- Hardened plaque in your heart’s arteries, as a score.
- For
- Men 40 and older and women 45 and older at borderline or intermediate risk, when the statin decision is uncertain. Never needed with FH.
- How
- A CT scan of the heart, a few minutes, no dye.
- Risk
- About 1 millisievert of radiation, like a mammogram. Fewer than 1 in 10 get an incidental finding that may need follow-up.
- Cost
- $50 to $250 out of pocket, the guideline says. Coverage varies.
- Then
- A zero can let some people wait and rescan in 3 to 7 years, and any calcium points toward treatment (do I need one?).
Coronary CT angiogram
- Measures
- Soft and hard plaque, and how narrow the arteries are.
- For
- Without symptoms, only selected people likely to have soft plaque, such as those with inflammatory diseases, HIV or diabetes, the guideline says.
- How
- A CT scan with iodine dye through a vein.
- Risk
- Radiation that varies with the scanner, from under 1 millisievert on newer machines in one 2013 study to more on older ones, and the dye.
- Cost
- Varies, often covered when a doctor orders it.
- Then
- Plaque found can guide how hard to treat.
Carotid ultrasound
- Measures
- Plaque in the arteries of your neck.
- For
- The guideline mentions it as one way to see plaque during a risk discussion.
- How
- An ultrasound probe on your neck.
- Risk
- None from the scan itself.
- Cost
- Varies, often covered when a doctor orders it.
- Then
- Plaque seen is a reason to treat more firmly.
Advanced lipoprotein panels (NMR, LDL-P)
- Measures
- LDL particle number and sizes, by a lab method called NMR.
- For
- The guideline uses ApoB to count particles and sets no goals for LDL-P.
- How
- A blood draw.
- Risk
- A needle, and numbers that are hard to act on.
- Cost
- $119 self-pay at Labcorp for the NMR LipoProfile.
- Then
- ApoB answers the same question, more simply.
Genetic test for familial hypercholesterolemia
- Measures
- Variants in genes like LDLR, APOB and PCSK9 that cause inherited high LDL.
- For
- Adults with an LDL of 190 or more and no other cause found. About 2.5% of them carry a variant. Children and other relatives of someone with FH should have their cholesterol checked, from age 2.
- How
- A sample sent to a genetics lab, ordered by a doctor or genetic counselor.
- Risk
- No physical risk. A result can affect your family too, so it helps to talk it through first.
- Cost
- Varies, often covered when the guideline’s criteria are met.
- Then
- A positive result means treatment, and testing your parents, brothers, sisters and children (when it’s your genes).
Home finger-prick tests and kits
- Measures
- Total cholesterol and HDL, often triglycerides, with LDL usually calculated. Some mail-in kits add ApoB.
- For
- Watching which way things move between lab panels.
- How
- A drop of blood from your finger, put in a meter or mailed to a lab.
- Risk
- Accuracy. The FDA says they can be close if you follow the directions, and accuracy varies by brand.
- Cost
- Varies by device and kit.
- Then
- Repeat any surprise at a lab before acting on it (are home tests accurate?).
The order to do them in
Start with the panel and Lp(a). If your LDL and non-HDL are under your goal and your Lp(a) is normal, you’re done for 5 years. If they’re over, start with food and retest in 6 to 12 weeks. Add ApoB when triglycerides or diabetes make your LDL less reliable, and a calcium scan only when it would decide treatment. How to test, and how to tell if it changed covers getting a clean result.
7 sources
- Blumenthal RS, Morris PB, Gaudino M and others, 2026 ACC/AHA guideline on the management of dyslipidemia, Circulation, 2026api.iscpcardio.org
- American College of Cardiology, ACC/AHA issue updated guideline for managing lipids, cholesterol, press release, 13 March 2026acc.org
- Labcorp OnDemand, heart health tests and prices, checked 15 November 2026ondemand.labcorp.com
- Langsted A, Freiberg JJ, Nordestgaard BG, Fasting and nonfasting lipid levels, Circulation, 2008pubmed.ncbi.nlm.nih.gov
- Sniderman AD, Thanassoulis G, Glavinovic T and others, Apolipoprotein B particles and cardiovascular disease: a narrative review, JAMA Cardiology, 2019pubmed.ncbi.nlm.nih.gov
- Submillisievert median radiation dose for coronary angiography with a second-generation 320-detector row CT scanner in 107 consecutive patients, Radiology, 2013pmc.ncbi.nlm.nih.gov
- US Food and Drug Administration, Cholesterol home use testsfda.gov
