Lipid panel improvements mega-thread — November 2025

kate.chem said:

Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c…

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. I would drop the "get everything" instinct further than this thread does. Every extra test is another chance at a false positive, and incidental findings have their own cost in scans, biopsies and worry.

Worth separating that from the lipid panel, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

MikeFit_NJ said:

My prescriber ordered three tests and this board recommends about twenty, and I would like to know which of those two lists is right.

PSA: get baseline labs BEFORE starting baseline bloodwork therapy. You need a "before" picture to measure progress. My recommended pre-treatment panel:

1. CMP + A1C + fasting insulin
2. Complete lipid panel with particle count if possible
3. hsCRP, ferritin, B12, vitamin D
4. Thyroid panel (TSH + free T4)
5. CBC with differential
6. Liver panel (ALT, AST, GGT)
7. DEXA scan or body composition

Total cost at Quest without insurance: ~$200. Worth every penny for the data.

Dr.LipidDallas said:

I would drop the "get everything" instinct further than this thread does.

Coming at Dr.LipidDallas’s question from a different direction. ApoB is the more informative number and it is cheap. LDL-C estimates cholesterol mass in atherogenic particles; ApoB counts the particles, and it is particle count that tracks risk — which is why the two can disagree and why the disagreement is the clinically interesting case. Triglycerides fall substantially with weight loss and improved insulin sensitivity, HDL moves modestly, and LDL-C often barely moves at all, which surprises people who expected everything to improve together.

A narrower follow-up, since the general answer is now clear:

What actually belongs on a baseline panel, as opposed to the enormous list that gets pasted around here?

Closing the loop on my own question.

Took the whole panel in rather than the one flagged line, and the conversation lasted two minutes instead of generating three more tests.