6. ApoB (Apolipoprotein B)
ApoB (apolipoprotein B) measures the number of potential plaque-forming particles circulating in the bloodstream — not just the cholesterol they carry. Because each LDL, VLDL, and remnant cholesterol particle contains one ApoB protein, higher levels (generally above 130 mg/dL) indicate more plaque-forming particles overall.
So in some cases, LDL could appear normal while ApoB is elevated — which is why clinicians note this marker may be a clearer predictor of metabolic risk. “Many experts consider ApoB a stronger risk marker than LDL cholesterol alone, especially for predicting heart attack and stroke risk in people with high triglycerides, diabetes, obesity, or metabolic syndrome,” Osuji says. While insurance coverage of this test has been improving because multiple guidelines now recognize ApoB to determine individuals’ health risks, not all insurance plans cover it.
ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are enzymes that can rise when the liver is under stress.
Elevated ALT and AST levels may be an early sign of nonalcoholic fatty liver disease (NAFLD), a liver condition strongly linked to insulin resistance and metabolic dysfunction that often develops silently without noticeable symptoms initially. “Even mild liver enzyme elevations, particularly ALT, commonly suggest [NAFLD] in patients with obesity or insulin resistance,” Khalifa says.
An increase in ALT (typically above 45 International Units per liter, or IU/L) or AST (above 35 IU/L) can also be triggered by other factors. “These markers are not specific to fatty liver disease, so clinicians also consider alcohol use, medications, supplements, infections, and other possible causes,” Osuji says.
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