The 3 Markers I Use to Understand Your Heart + Metabolic Risk
Especially in Perimenopause + Menopause
By Angel Turlington, WHNP-BC
Let’s simplify this and focus on HEALTH care & Lifestyle Medicine. You don’t need a long list of labs beyond hormone testing to understand how to age slower — you need the right combination:
- ApoB (particle number)
- hs-CRP (inflammation)
- HbA1c (metabolic health)
ApoB: The Particle Problem
ApoB measures the number of cholesterol-carrying particles that can enter your artery walls and form plaque.
- Each particle = one ApoB
- More ApoB = more opportunities for damage
This is one of the most accurate ways to assess cardiovascular risk.
hs-CRP: The Inflammation Driver
hs-CRP tells us how much underlying inflammation is present. And inflammation is what turns plaque into something dangerous:
- unstable
- rupture-prone
- more likely to cause heart attack or stroke
HbA1c: The Metabolic Signal
HbA1c reflects your average blood sugar over time. But more importantly, it gives insight into:
- insulin resistance
- metabolic stress
- how your body is aging internally
Even “normal” A1c levels can still signal early dysfunction.
Why These 3 Together Matter
This is where the conversation gets powerful. When we combine:
- ApoB (particles)
- hs-CRP (inflammation)
- HbA1c (metabolic health)
We are looking at the root drivers of cardiovascular disease and aging.
The Key Risk Metric
Research shows:
- ApoB >130 + hs-CRP >2 mg/L
= 69% increased risk of a major cardiovascular event
And importantly:
This combination was more predictive than all other biomarkers tested.
When we look at “inflammaging,” we think of metabolic health along with overall inflammation of the body. This is where we shift from risk → optimization:
- hs-CRP: < 1.0 mg/L → low inflammation
- HbA1c: < 5.0% → optimal metabolic function
These are not just “normal” ranges — they reflect a body that is functioning efficiently, not just adequately.
“Inflammaging”
As we age, especially through hormonal shifts:
- inflammation increases
- metabolic flexibility decreases
- cardiovascular risk quietly rises
This process is called Inflammaging.
- low-grade, chronic inflammation that drives aging + disease
And it shows up in your labs as:
- ↑ hs-CRP
- ↑ ApoB
- ↑ HbA1c
Estradiol has natural anti-inflammatory effects, which is one of the reasons many women feel better when hormones are optimized. But hormones don’t work in isolation — your daily lifestyle plays a major role in either lowering or driving inflammation.
An anti-inflammatory lifestyle is built on simple, consistent habits:
- Eating whole, nutrient-dense foods (foods from the earth, not processed or in a box or package)
- Prioritizing protein and fiber with every meal
- Minimizing processed sugars and seed oils (canola, corn, safflower, grapeseed)
- Moving your body regularly
- Sleeping well
- Managing stress
These daily choices help calm the immune system and support long-term health.
Why This Matters in Midlife
During perimenopause + menopause:
- estrogen declines
• insulin resistance can increase - fat distribution shifts
- inflammation rises
Meaning your risk profile can change quickly — even if it never has before.
What I Offer in My Practice
I focus on targeted, meaningful testing:
- ApoB
- hs-CRP
- HbA1c
Because these give us:
- clarity
- direction
- actionable insight
For Patients 55+ (Especially on Hormone Therapy)
I also recommend:
Coronary Artery Calcium (CAC) Score
A quick CT scan that:
- detects existing plaque
- gives a real-time snapshot of arterial health
Approx. cost: $200
Can be ordered through my office if you are under my care. It is done locally at Cardinal Point Imaging (my preferred site for DEXA and mammography, also offered to my clients).
Why This Matters — Especially with HRT
As we consider or continue estradiol therapy, we are always balancing:
- benefits (brain, bone, metabolism, quality of life)
- risks (including increased coagulability in some patients over 60)
The CAC score acts as a safety check.
Helping us:
- personalize therapy
- assess baseline risk
- move forward confidently
My Approach
This isn’t about fear. It’s about:
- understanding your body
- using data that actually matters
- making decisions that support how you want to age
Bottom Line
It’s not just cholesterol.
It’s not just inflammation.
It’s not just blood sugar.
It’s how all three interact.
Next Step
If you’ve never looked at these markers, now is the time. Book a discovery call to learn more.
Let’s move beyond “normal labs” and build a plan that actually supports your future.
