Knowing your cholesterol level is an important step to good heart-health. Heart disease remains the second leading cause of death in Canada, and with bad cholesterol increasing the risk of heart attacks, strokes, and other cardiovascular problems, they need to be paid attention to.
High cholesterol affects 34 per cent of Canadians aged 40 to 59 and 60 per cent of those aged 60 to 79 but more than a quarter of Canadians with high cholesterol may be unaware they have it.
Millions of Canadian adults undergo cholesterol testing every year, but it’s still clearly not enough. They are a standard part of checkups, especially for anyone over 40, but not all cholesterol tests are created equal. In fact, some of the most important predictors of heart disease risk may be hiding in plain sight—unmeasured and undetected by standard blood work.
Here’s what you need to know about the types of cholesterol tests available in Canada, what they actually measure, and how to make sure you’re getting the ones that give you the full picture of your heart health.
The Standard Cholesterol Test: A Good Start, But Not the Whole Story
When your doctor orders a cholesterol test, you’re likely getting a standard lipid panel, which includes:
Total Cholesterol
A measure of all the cholesterol in your blood, including LDL, HDL, and other lipid components.
LDL
Low-density lipoprotein—often called “bad cholesterol.” High levels can raise your heart disease risk.
HDL
High-density lipoprotein—the “good cholesterol.” Higher levels are generally better for heart health.
Triglycerides
A type of fat in the blood that can also increase cardiovascular risk when elevated.
This panel is widely available, fully covered by provincial health plans, and has been the go-to screening tool for decades. For many people, it’s a good start.
But here’s the catch: the LDL-C number, which is the amount of cholesterol carried by LDL particles, doesn’t always accurately reflect the number of LDL particles (LDL-P) in the bloodstream. This difference can be significant because a higher number of LDL-P, even with a lower LDL-C, might still increase the risk of cardiovascular disease.
Testing for LDL-P
LDL particle (LDL-P) testing is available in Canada. It may be ordered by your healthcare professional as part of a comprehensive cardiac risk assessment, especially for individuals with certain risk factors or when traditional cholesterol tests don’t fully explain their risk. So, who should consider this test?
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People with a family history of early cardiovascular disease, especially those without typical risk factors like high cholesterol or diabetes.
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People with risk factors like type 2 diabetes, metabolic syndrome, or those already diagnosed with cardiovascular disease.
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People who have made lifestyle changes or are taking lipid-lowering medications, which will help assess treatment effectiveness.
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Those with elevated triglycerides or low HDL cholesterol, even if their LDL-C levels are within the target range.
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People who have been identified as having an elevated risk for cardiovascular disease based on other risk factors, such as Lp(a) levels, or coronary artery calcium scores.
In Canada, LDL-P testing is generally not covered by provincial Medicare unless it is ordered by your doctor.
It is available through private labs or as part of a more comprehensive lipid profile offered by some pharmacies or healthcare providers. The out of pocket cost can vary, but a standalone LDL-P test or an NMR LipoProfile test, which includes LDL particle number, may cost around $140. Confirm pricing with your local lab.
Apolipoprotein B: The Test Your Doctor Might Not Offer (But Should)
Enter Apolipoprotein B (ApoB)—a newer blood test gaining ground among heart specialists.
ApoB is a protein found on the surface of all the cholesterol-carrying particles that can clog arteries. Essentially, it tells you the number of dangerous particles, not just the amount of cholesterol they contain.
Why does that matter? Studies show that ApoB is a stronger predictor of cardiovascular risk than LDL cholesterol alone. Two people with the same LDL number can have very different ApoB levels—and different levels of heart disease risk.
Who Should Consider ApoB Testing?
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People with normal LDL but low HDL or high triglycerides
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Those with type 2 diabetes, polycystic ovary syndrome, or metabolic syndrome
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Anyone with a family history of early heart disease
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People already on statins who want to assess residual risk
In Canada, ApoB testing is available through many public labs but isn’t always automatically offered. Some provinces may only cover it when ordered by a specialist or with specific risk factors.
Beyond LDL: Other Emerging Cholesterol Tests
Newer tests are helping doctors refine cardiovascular risk and personalize treatment.
1. Lipoprotein(a) [Lp(a)]
- A genetically inherited form of cholesterol that increases heart disease and stroke risk
- Not usually measured unless requested
- Doesn’t respond to diet or statins
- Only needs to be tested once in your lifetime
2. Non-HDL Cholesterol
- Total cholesterol minus HDL—captures all “bad” cholesterol
- Often more accurate than LDL alone
- Can be calculated from a regular lipid panel
3. Triglyceride-to-HDL Ratio
- A marker of insulin resistance and metabolic risk
- Not part of official guidelines, but increasingly recognized in preventive care
Why Doctors Are Moving Beyond LDL
Canadian cardiology experts are starting to emphasize ApoB and non-HDL over LDL when assessing risk and guiding treatment. New Canadian Cardiovascular Society guidelines now include ApoB as a key risk marker, yet most family doctors still rely on standard panels.
If you’ve been told your LDL is “normal,” but you still have concerns—or a family history of early heart disease—it may be time to go deeper.
How to Talk to Your Doctor About Getting the Right Test
Don’t be afraid to ask questions. Here are some to bring to your next appointment:
- “Would an ApoB test give us better insight into my heart risk?”
- “Is my LDL number enough to determine if I’m at risk?”
- “Can we calculate non-HDL cholesterol from my existing results?”
- “Given my family history, should I be tested for Lp(a)?”
If your doctor isn’t familiar with ApoB or Lp(a), consider requesting a referral to a lipid specialist or cardiologist.
The Bottom Line: Advocate for Your Arteries
You can’t manage what you don’t measure. While traditional cholesterol tests remain helpful, they don’t always give the full picture. With emerging tests like ApoB and Lp(a), Canadians now have more powerful tools to assess and reduce cardiovascular risk—especially when standard results seem “normal” but something still feels off.
Your heart deserves precision—not guesswork.
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The information provided on TheHealthInsider.ca is for educational purposes only and does not substitute for professional medical advice. TheHealthInsider.ca advises consulting a medical professional or healthcare provider when seeking medical advice, diagnoses, or treatment. To read about our editorial process, click here.
