When Shane Warne died of a heart attack in March 2022, he was 52. Fit-looking. Active. No public history of heart disease. And suddenly, a country that doesn't talk much about cardiovascular risk was having the conversation.
I remember where I was when I heard. I think a lot of Australians do. Not because celebrity deaths don't happen, but because this one felt close. A man who looked healthy, who was relatively young, who did the kinds of things men his age do — and who had a cardiac event nobody saw coming.
The aftermath was interesting. The Shane Warne Legacy Health Test initiative, launched through Monash University's Victorian Heart Institute, screened thousands of Australians in community pop-up events. The findings: 69% of those screened had at least one uncontrolled cardiovascular risk factor. More than a quarter had two or more. Among men screened at sporting events, nearly 80% had an uncontrolled risk factor. Half of those with elevated blood pressure hadn't had it checked in the past year.
These aren't numbers from a developing country. These are Australians at cricket matches and pharmacies.
Cardiovascular disease remains the second leading cause of death in Australia, accounting for roughly 45,000 deaths per year (about 24% of all deaths). Coronary heart disease alone is the leading single cause of death for Australian men. And the thing about heart disease is that it builds silently. The first symptom, for too many people, is the event itself.
This article covers the blood tests that contribute to a cardiovascular risk assessment — what they measure, why they matter, and how they fit together. It's also the last article in a ten-part series I've been writing about the blood tests that matter most for Australians. Many of the markers I'll cover here have appeared in earlier articles — cholesterol, HbA1c, CRP — but this article puts them in their cardiovascular context, which is where many of them carry the highest clinical stakes.
A note before we get into it
General information only. Cardiovascular risk assessment is a clinical decision that involves more than blood tests: blood pressure, family history, smoking status, age, sex, and medical history all factor in. Your GP is the right person to calculate your risk and guide management decisions.
If you have known cardiovascular disease, a family history of premature heart disease, or are currently on cardiovascular medication, work with your GP or cardiologist.
Why heart health testing matters, even when you feel fine
I've written this sentence in various forms across this whole series, but it lands hardest here: cardiovascular disease doesn't announce itself. It builds. The process of atherosclerosis — fatty deposits accumulating in your artery walls, narrowing the blood flow, creating conditions for a clot or rupture — happens over decades. Silently. Asymptomatically.
By the time you get chest pain, shortness of breath, or a cardiac event, the underlying disease is typically advanced. The goal of screening isn't to wait for symptoms. It's to identify risk factors early enough to do something about them.
And here's the genuinely encouraging part: cardiovascular death rates in Australia have declined by 78% since 1980. That's one of the great public health success stories. It's been driven by reductions in smoking, better management of blood pressure and cholesterol, improvements in acute treatment, and increased awareness. Testing is a core part of that engine — because you can't manage what you don't measure.
My dad is a good example. I've written about his story across two earlier articles — his cholesterol and his HbA1c. His LDL was stubbornly high. His HbA1c crept into the pre-diabetic range. His father had a heart attack at sixty-one. Individually, each of those things is a data point. Together, they form a risk profile. His GP didn't treat the cholesterol and the blood sugar as separate issues. She saw them as components of a cardiovascular risk picture that warranted intervention. Statin for the LDL. Lifestyle focus for the blood sugar. Monitoring for both.
He's sixty-three and feeling better than he has in years. Not because any single test saved him — but because someone looked at the whole picture.
The blood tests that build a cardiovascular risk picture
No single blood test predicts heart disease. But together, these markers build a composite picture that, combined with blood pressure, family history, and clinical assessment, informs your absolute cardiovascular risk.
Cholesterol (Lipid Panel)
What it measures
Total cholesterol, LDL, HDL, triglycerides, and TC/HDL ratio.
Why it matters for heart health
This is the cornerstone of cardiovascular blood work. LDL is the primary target — its role in driving atherosclerosis is one of the most well-established relationships in medicine. High triglycerides plus low HDL signals metabolic risk. The full lipid pattern is more informative than any individual number.
I covered this in detail in the cholesterol article, including how your GP uses absolute risk (not just your LDL number) to make management decisions.
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HbA1c and Fasting Glucose
What they measure
HbA1c reflects average blood sugar over 2–3 months. Fasting glucose shows blood sugar regulation after an overnight fast.
The cardiovascular connection
Diabetes and pre-diabetes are independent cardiovascular risk factors. Insulin resistance drives a cascade of metabolic changes: elevated triglycerides, reduced HDL, increased inflammation, endothelial dysfunction. Together, these accelerate atherosclerosis. Blood sugar control isn't just about diabetes management. It's also cardiovascular prevention.
Detailed coverage in the HbA1c article.
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hs-CRP (High-Sensitivity C-Reactive Protein)
What it measures
Low-grade systemic inflammation. CRP is produced by the liver in response to inflammatory signals throughout the body.
How it adds to the risk picture
Inflammation is central to atherosclerosis — from the initial endothelial damage that allows LDL to penetrate artery walls, through plaque development, to the inflammatory destabilisation that can trigger plaque rupture and a heart attack.
hs-CRP adds an inflammatory dimension to the standard lipid-based risk assessment. Some clinicians use it as part of cardiovascular risk stratification, particularly for patients in the "moderate risk" category where the clinical decision about treatment is less clear-cut.
Reference ranges
Below 1.0 mg/L — lower cardiovascular risk. 1.0–3.0 mg/L — moderate risk. Above 3.0 mg/L — higher risk (though a single elevated result should be confirmed, as hs-CRP can be transiently raised by infection, injury, or other acute inflammation).
Test it with Bloody Good:
Lipoprotein(a)
What it measures
A genetically determined lipoprotein particle that resembles LDL but carries additional risk. It's sometimes written as Lp(a) and pronounced "L-P-little-a."
Why it's an independent risk factor
Lipoprotein(a) is a cardiovascular risk factor you can't modify through lifestyle or standard lipid-lowering medication. It's genetically determined — you're essentially born with your level, and it doesn't change much over your lifetime.
Elevated Lp(a) increases the risk of atherosclerotic cardiovascular disease and aortic stenosis. The estimated prevalence of elevated Lp(a) (above 50 mg/dL or 125 nmol/L) is roughly 20% of the population globally.
What this means practically
If your Lp(a) is high, it changes how aggressively your other risk factors should be managed. A given LDL level carries more risk for you than for someone with normal Lp(a). Your clinician may target a lower LDL threshold, recommend earlier intervention, or consider additional treatments.
Why most people have never heard of it
Lp(a) testing isn't part of routine screening in Australia. Many people only discover their level if they have a cardiovascular event, a strong family history, or a clinician who thinks to check. The 2023 European Society of Cardiology guidelines recommend measuring Lp(a) at least once in every adult's lifetime. Australian guidelines are more conservative, but awareness is growing.
If you're doing a cardiovascular blood panel and you've never tested Lp(a), it's worth adding once. You only need to test it once because it doesn't change.
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Homocysteine
What it measures
An amino acid in the blood that, when elevated, has been associated with increased cardiovascular risk.
Why it matters
Elevated homocysteine has been linked to endothelial damage and increased thrombotic risk. It can be elevated due to B12 deficiency, folate deficiency, genetic factors (particularly MTHFR variants), kidney disease, or certain medications.
The nuance
While high homocysteine is associated with cardiovascular risk, the evidence for treating elevated homocysteine (typically with B vitamins) to reduce events is mixed. It's a marker that adds context rather than driving treatment decisions on its own.
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Full Blood Count (FBC)
What it covers
Red blood cells, white blood cells, haemoglobin, haematocrit, and platelets.
How it fits in
Haemoglobin and haematocrit are relevant because both anaemia and polycythaemia (elevated red cells) affect cardiovascular function. Elevated white blood cells can indicate chronic inflammation. Platelet count is relevant to clotting risk.
FBC is a broad marker. It's not specific to cardiovascular risk, but it's part of the baseline that helps complete the picture.
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Kidney Function (eGFR and Creatinine)
What they measure
eGFR estimates kidney filtration rate. Creatinine is a waste product filtered by the kidneys.
The cardiovascular link
Chronic kidney disease is both a consequence and a driver of cardiovascular risk. Reduced kidney function is an independent risk factor for cardiovascular events, and the two conditions frequently coexist. The AusCVDRisk calculator includes kidney disease as a risk-modifying factor.
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Liver Function (ALT/AST)
What they measure
Liver enzymes that indicate liver cell stress or damage.
Why your GP cares
Non-alcoholic fatty liver disease (NAFLD), increasingly common in Australia, is strongly associated with metabolic syndrome, insulin resistance, and cardiovascular risk. Elevated liver enzymes can signal underlying metabolic dysfunction that's relevant to the cardiovascular picture. They're also important to monitor if you're starting statin therapy.
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How absolute risk works, and why it matters more than any single number
I covered this in the cholesterol article, but it bears repeating because it's the single most important concept in cardiovascular prevention.
Your GP doesn't look at your cholesterol in isolation. They calculate your absolute cardiovascular risk — the probability of a heart attack or stroke in the next five years — using a combination of factors: age, sex, blood pressure, cholesterol levels, smoking status, diabetes, and kidney disease.
The Australian tool is AusCVDRisk. It replaced the older Framingham-based model and better reflects the Australian population.
Low risk: Less than 5% five-year risk. Lifestyle focus. Monitor.
Moderate risk: 5–10%. Lifestyle plus possible medication, depending on clinical judgement and patient preference.
High risk: 10% or greater. Lifestyle plus medication typically recommended.
Two people with identical LDL levels can have completely different absolute risk because of differences in age, blood pressure, smoking, diabetes, and family history. This is why a cholesterol number alone doesn't tell you whether you need treatment. The full risk profile does.
The risk factors blood tests can't measure
Blood work is a powerful tool. But cardiovascular risk assessment also depends on things you can't measure in a test tube.
Blood pressure. Hypertension is the single largest contributor to cardiovascular disease burden in Australia (36% of the total CVD burden in 2024). It needs to be measured directly, either at your GP's office or with a home monitor.
Smoking status. Current smoking roughly doubles cardiovascular risk. It's a yes/no question, not a blood test.
Family history. A first-degree relative (parent, sibling) with premature cardiovascular disease (before age 55 in men, 65 in women) significantly increases your risk. This is information your GP needs to factor into the risk calculation.
Physical activity. Sedentary behaviour is an independent risk factor. Blood tests don't capture how much you move.
Stress and mental health. Chronic stress, depression, and social isolation have been associated with increased cardiovascular risk. These are real physiological factors that aren't reflected in blood work.
This is why a cardiovascular risk assessment is a conversation — not just a blood test. The blood work provides the data. But it's your GP who puts it together with your history, your lifestyle, and your other measurements to give you a meaningful risk picture.
Who should be testing
The Australian guideline (AusCVDRisk) recommends cardiovascular risk assessment for:
All adults from age 45 (or 35 for Aboriginal and Torres Strait Islander peoples).
Younger adults with specific risk factors: family history of premature cardiovascular disease, familial hypercholesterolaemia, diabetes, chronic kidney disease, or clinical evidence of atherosclerotic disease.
Consider earlier or more thorough testing if you have:
A strong family history of heart disease (especially premature events). Known metabolic risk factors (pre-diabetes, PCOS with insulin resistance, metabolic syndrome). An elevated lipid panel on previous testing. Persistent markers of inflammation (elevated hs-CRP). A personal history of conditions that increase cardiovascular risk (autoimmune disease, chronic kidney disease, HIV, history of pre-eclampsia).
After a cardiovascular event or diagnosis: Regular monitoring is essential and should be guided by your cardiologist or GP.
How to prepare
Fast for 8–12 hours. Triglycerides and glucose are the most sensitive to food intake. Water is fine.
Test in the morning. Fasting overnight and testing first thing produces the most consistent results.
Avoid alcohol for 24–48 hours. Alcohol transiently raises triglycerides and can affect liver enzymes.
Don't test when acutely unwell. Infection or acute illness can elevate CRP, liver enzymes, and other markers.
Continue your medications unless told otherwise. If you're on a statin, test while taking it — the result reflects your medicated level.
Know your blood pressure. Your GP will measure this at the visit, but if you track at home, bring your readings.
Know your family history. This is non-negotiable input for any cardiovascular risk assessment.
Understanding your results as a pattern
Cardiovascular risk isn't determined by a single number. It's a pattern. Here's how the markers fit together.
The metabolic cluster: Elevated triglycerides + low HDL + elevated HbA1c + elevated fasting glucose + abdominal adiposity = metabolic syndrome. This pattern is one of the strongest predictors of cardiovascular events and is increasingly common in the Australian population.
The inflammatory layer: Elevated hs-CRP on top of metabolic markers suggests active inflammation is accelerating the process. This may shift the clinical approach, particularly for patients in the moderate-risk category.
The genetic card: Elevated Lp(a) with any combination of the above amplifies the risk beyond what standard calculators capture. This is why testing Lp(a) once in your life is worth considering.
The protective markers: Good HDL, low triglycerides, normal blood sugar, low CRP, healthy kidney and liver function. These collectively suggest a lower-risk profile. But they don't eliminate risk entirely, particularly in the presence of a strong family history or high blood pressure.
Your GP reads these markers together — not as a list, but as a story about where your cardiovascular health stands and where it's heading.
Tests to consider through Bloody Good
Core cardiovascular panel:
| Test | What it covers | Category |
|---|---|---|
| Cholesterol (Lipid Studies inc. HDL) | Full lipid panel | Core |
| HbA1c | Blood sugar trend | Core |
| High-Sensitivity CRP | Inflammation | Core |
| Fasting Glucose | Blood sugar snapshot | Core |
| Lipoprotein(a) | Genetic cardiovascular risk (test once in your lifetime) | Advanced |
| Homocysteine | Associated with endothelial damage and B-vitamin status | Advanced |
| Full Blood Count (FBC) | Haemoglobin, haematocrit, immune markers | Broader context |
| Liver Function Test (LFT) | Metabolic health and statin monitoring | Broader context |
| Kidney Function (eGFR) | Kidney function as an independent CVD risk factor | Broader context |
| Iron Studies (Including Ferritin) | Anaemia context | Broader context |
If you want comprehensive coverage:
The Bloody Good Test covers 100 biomarkers including the full lipid panel, HbA1c, fasting glucose, liver and kidney function, FBC, thyroid, iron, vitamin D, and more. For a cardiovascular baseline that also covers every other major health domain, this is the most efficient path.
What this series has been about
This is the tenth and final article in a series I started writing because I got my own blood tested and was surprised by what I found.
A ferritin of 28 that explained months of fatigue. A vitamin D of 41 in the middle of a Brisbane winter. A dad whose cholesterol and blood sugar told a story his lifestyle alone couldn't account for. A girlfriend whose PCOS diagnosis reframed everything she'd been told about her body. A mate at the gym who was sure his testosterone was the problem, when the real answer was probably simpler and broader.
None of these stories were dramatic. None of them involved a crisis. They were all quiet discoveries — things that blood testing revealed before symptoms forced the issue.
That's the point. Blood testing isn't about finding something wrong. It's about understanding where you stand, so you can make decisions with data instead of guessing.
If you've read all ten articles, you now know more about your blood markers than most people ever will. If you've only read this one, I hope it's been useful. Either way, the next step is the same: get tested. Save your results. Compare over time. Talk to your GP about what the numbers mean for you.
And if any of this series has helped you understand your health a little better, or pushed you to order a test you'd been putting off, then it did what I wanted it to do.
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General information only. This article is not medical advice and is not a substitute for care from a qualified health professional. If you have concerning symptoms or urgent health issues, seek medical attention promptly.