A father who had a heart attack at fifty, an uncle with stents: for many people the question about their heart risk starts with a story from the family. Cardiovascular disease is still one of the leading causes of death in the Netherlands. The RIVM (the Dutch National Institute for Public Health) tracks how many people die from it, and that number stays high. The good news: a large part of the risk is linked to factors you can partly influence, and your blood shows some of them, often years before any symptoms appear.
My view: with cardiovascular risk, the pattern of several values together matters more than one number. Anyone who only looks at their total cholesterol misses half the story.
Which blood values say something about your cardiovascular risk?
Several values together give a picture of your risk. The basis is your cholesterol and your blood sugar. On top of that there are more advanced markers that add context in specific situations. The table lists them, with what each value adds and where you have it checked.
| Blood value | What it adds | Where to check it |
|---|---|---|
| LDL cholesterol | The cholesterol that can build up in artery walls | LDL |
| HDL cholesterol | The favourable cholesterol, clears excess cholesterol | HDL |
| Triglycerides | A blood fat strongly tied to lifestyle | Triglycerides |
| ApoB | Counts the number of harmful particles, finer than LDL | ApoB |
| Lp(a) | An inherited risk factor, usually measured once | Lp(a) |
| hs-CRP | An inflammation marker linked to vascular risk | hs-CRP |
If you want your fat values measured together, a lipid blood test fits. For a broader picture of your heart and metabolic risk, use a complete metabolic panel. Read our explanation of ApoB, hs-CRP and homocysteine and the spoke on Lp(a) as a hidden risk factor.
What does each marker actually say?
The table gives the overview, but it only becomes useful once you understand why a value counts. Here it is per marker, in plain language.
LDL: the engine behind artery hardening
LDL particles carry cholesterol to your tissues. If too many keep circulating, they can lodge in your artery wall and form plaque there. The longer and the higher your LDL, the greater the chance this process continues. That is why LDL is the first value doctors look at in almost everyone. Lower is generally more favourable, and how low your target should be depends on your other risk.
HDL and triglycerides: the context around it
HDL carries excess cholesterol back to your liver and is therefore seen as favourable. A low HDL can be unfavourable, but artificially boosting HDL turns out to be no magic bullet. Triglycerides mainly say something about your lifestyle: they rise with lots of sugar, alcohol and a calorie surplus. A high triglyceride level often goes together with insulin resistance and belly fat.
ApoB and Lp(a): the finer picture
ApoB counts the actual number of harmful particles. Sometimes your LDL is fine while your ApoB is still high, and then ApoB tells the more honest story. Lp(a) is largely inherited and stays fairly stable throughout your life. A raised Lp(a) can increase your risk despite perfect cholesterol, which is exactly why a one-off measurement can be worthwhile.
hs-CRP: inflammation as an extra signal
hs-CRP is a sensitive inflammation marker. A slightly raised value can point to low-grade inflammation, which is linked to vascular risk. The value is not specific, because even a cold drives it up, so always interpret it alongside the rest.
What do your cholesterol values mean?
For most people these fasting reference values in mmol/L apply. They are a starting point, not a verdict, because your target depends on your total risk.
- Total cholesterol: below 5.0 mmol/L
- LDL cholesterol: below 3.0 mmol/L, lower at higher risk
- HDL cholesterol: men above 1.0, women above 1.3 mmol/L
- Triglycerides: below 1.7 mmol/L
- Total/HDL ratio: below 5, and the lower the better
The full explanation is in our cholesterol pillar: cholesterol, what it is and how to lower it. How your good and bad cholesterol relate to each other is in LDL and HDL cholesterol.
Which risk factors count alongside your blood?
Blood values are part of the story. Alongside them, factors that do not fit in a tube also count. The NHG cardiovascular risk management standard calculates your risk precisely from that combination. The more factors come together, the higher the risk.
- Blood pressure: high blood pressure strains your arteries day and night
- Smoking: one of the strongest modifiable risk factors
- Blood sugar: see our pillar on preventing type 2 diabetes
- Family history: cardiovascular disease at a young age in the family
- Belly fat: linked to metabolic syndrome
Can you lower your cardiovascular risk?
For many people lifestyle can favourably influence the risk. Not smoking, enough exercise and a heart-friendly diet are strongly associated with lower risk. The Hartstichting (the Dutch Heart Foundation) names these three as the pillars of prevention. The effect differs per person and per starting point, but the direction is the same for almost everyone.
- Diet: replace saturated fat with unsaturated fat and eat more fibre, in line with the Gezondheidsraad dietary guidelines
- Exercise: a guideline is around 150 minutes of moderate activity per week
- Smoking: quitting is probably the most impactful step you can take
- Weight: even 5 to 10% weight loss can shift your values favourably
A full approach for your fat values is in lowering cholesterol without medication. If your values stay high despite lifestyle, your doctor may consider medication based on your total risk.
How do you read your values together? An example
Suppose two people both have a total cholesterol of 6.0 mmol/L. Identical on paper, in practice two very different stories.
- Person A: HDL 2.0, LDL 3.4, triglycerides 0.8, non-smoker, normal blood pressure. The ratio is favourable and there are few other risk factors.
- Person B: HDL 0.9, LDL 4.5, triglycerides 2.5, smoker, high blood pressure. The same total value, but an unfavourable ratio and several risk factors stacking up.
This shows why one number can be misleading. The ratio and the whole profile determine the picture. This example is illustrative and does not replace assessment by a doctor, but it makes clear why you should look at the whole. Person A can keep monitoring with peace of mind, while person B benefits from targeted lifestyle changes and possibly a conversation with the GP about their total risk. The same result, two very different next steps.
How often do these values change?
Not every marker moves at the same speed. Your LDL and triglycerides respond within weeks to months to lifestyle and diet. Your HDL shifts more slowly. Lp(a) is largely inherited and stays fairly stable throughout your life, so in principle you only need to measure it once. That difference partly determines how often a repeat measurement makes sense: for your fat values after a lifestyle change a check after 3 months is logical, for Lp(a) a single measurement is enough.
When is it useful to measure your heart risk?
A measurement can be especially informative with a family history of cardiovascular disease, or if you recognise several risk factors. Some people choose to measure periodically to catch changes in time. A one-off Lp(a) measurement is worthwhile, because that value is inherited and stays fairly stable throughout life. Your GP can help you decide what suits your situation.
What does a heart-friendly eating pattern look like?
Abstract advice such as "eat healthier" helps little. Concrete works better. The Gezondheidsraad (the Dutch Health Council) dietary guidelines and the advice from the Voedingscentrum (the Netherlands Nutrition Centre) come down to a few practical lines:
- Fat: choose olive oil, nuts, avocado and oily fish over butter, fatty meat and pastries.
- Fibre: oats, legumes, wholegrain products, vegetables and fruit bind cholesterol and keep you full.
- Sugar and alcohol: limit soft drinks, sweets and alcohol, because they drive up your triglycerides.
- Salt: less salt helps your blood pressure, a separate but important risk factor.
- Fish: fish at least once a week, preferably oily fish for the omega-3.
You do not have to change everything at once. One structural change that you keep up delivers more than a strict diet you drop after two weeks.
Blood pressure, smoking and blood sugar: the factors beside your fats
Your fat values do not tell the whole story. High blood pressure strains your artery wall day and night and speeds up artery hardening. Smoking lowers your HDL and damages the inner layer of your arteries, making it easier for LDL to lodge. A raised blood sugar, especially with early insulin resistance, goes together with unfavourable fat values and extra vascular damage. These factors stack: two mild abnormalities together often weigh more heavily than one severe one on its own. The NHG cardiovascular risk management standard therefore works with the combination, not with isolated numbers. If you want to include your blood sugar, read our pillar on preventing type 2 diabetes.
Frequently asked questions
Is cholesterol the only value that counts for my heart?
No. Cholesterol matters, but blood sugar, blood pressure, ApoB and Lp(a) count too. It is about the whole picture, not one number.
Can I have normal cholesterol and still be at risk?
Yes, that is possible. An inherited high Lp(a) or high blood pressure can play a role despite normal cholesterol. Discuss your risk with your GP.
How often should I have my values checked?
With a normal profile and no risk factors, once every few years is enough. With raised values or a family history, more often can be useful. Your GP advises based on your risk.
My values are fine but my family history is loaded, what now?
A favourable profile is reassuring, but inherited factors such as a high Lp(a) do not show up in your ordinary cholesterol. If a cardiac event at a young age runs in your close family, a one-off Lp(a) measurement can add context. Discuss your family history with your GP, even if your cholesterol is fine. A loaded family history is no reason to panic, but it is a good reason to follow your values deliberately rather than waiting.
Does exercise really help or is it mainly diet?
Both count, but they act on different values. Diet has the biggest effect on your LDL, exercise mainly on your HDL and triglycerides. Combined, they reinforce each other. Exercise also has separate benefits for your blood pressure and your blood sugar.
Why early measuring pays off
Artery hardening is a creeping process that takes years to decades. The damage you build up at forty often only shows much later. That is exactly why prevention is so valuable: the earlier you know your risk factors, the more time you have to adjust before there is irreversible damage. A favourable change in your lifestyle at forty or fifty can measurably lower your risk over the years that follow. You do not have to wait for symptoms, because with cardiovascular disease they often only appear once a lot has already happened. A measurement gives you the insight to act now instead of afterwards.
What to take from this
Look at the whole of your values and your lifestyle, not at one number. Discuss your cardiovascular risk with your GP, especially with a family history. Every blood test result at Vitalcheck includes a professional assessment by a BIG-registered doctor. A blood value is not a diagnosis: always discuss treatment decisions with your GP.
Sources
- NHG cardiovascular risk management standard. Dutch College of General Practitioners.
- RIVM. Cardiovascular disease: figures and context. Public Health and Care. Accessed 2026.
- Hartstichting. Risk factors for cardiovascular disease. Accessed 2026.
- Gezondheidsraad. Dietary guidelines. Accessed 2026.
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