Close Banner

Integrative Health

The 6 Functional Heart Tests Your Cardiologist Probably Isn't Running

Author: Jason Wachob

April 26, 2026

mbg Founder & Co-CEO

By Jason Wachob

mbg Founder & Co-CEO

Jason Wachob is the Founder and Co-CEO of mindbodygreen and the author of Wellth.

Image by CorAeon x mbgcreative

April 26, 2026

Blending advanced diagnostics and Mediterranean-inspired lifestyle strategies, CorAeon is a physician-led functional medicine practice founded by a functional cardiologist and psychiatrist team who treat cardiovascular and mental health as one connected system. Learn more at coraeon.com.

I recently sat down with a husband-and-wife duo who are changing the way we think about heart health for an episode of the mindbodygreen podcast.

Giovanni Campanile, M.D., a functional cardiologist, and Sandra Cammarata, Ph.D., a functional psychiatrist, are the founders of CorAeon. Their approach combines advanced cardiovascular testing with questions many cardiologists gloss over, such as your relationships, stress levels, and sleep.

And these lifestyle factors are critical. I was surprised when they told me that a Harvard longevity study found the number one predictor of living long is the quality of your relationship with your spouse or partner by age 50, not your cholesterol.

But they also shared some seriously advanced testing that most conventional cardiologists aren't running. These tests can predict your future risk much better than the standard lipid panel. Let's break it down.

ApoB & the ApoB/A1 ratio

This is the marker Campanile considers most important. ApoB is the "bad" marker that causes disease. ApoA1 is the "good" marker that helps clear cholesterol out of your arteries.

The ratio of these two has a direct correlation on heart attacks and major adverse cardiac events, Campanile explained.

If you are not at increased risk of heart disease, you want your ApoB/ApoA1 ratio to be below 0.6. If you have existing heart disease or increased risk, Campanile recommends aiming to get this ratio as close to 0.2 as possible.

Lowering ApoB and this ratio can be achieved with shifts in lifestyle factors, but it's harder for some people than others. Getting to 0.2 usually requires a PCSK9 inhibitor, Campanile noted, a newer class of drugs that can reduce cholesterol by 50 to 60 percent with minimal side effects.

RELATED READ: How I Finally Got My ApoB Down After Years Of Heart-Healthy Habits

Lp(a) — the genetic wildcard

Lipoprotein(a), or Lp(a), is a genetic predisposition for heart disease that's completely independent from lifestyle. This means you can eat perfectly, exercise daily, and still have elevated Lp(a).

When treating patients with elevated Lp(a), Campanile tends to be more aggressive with treatment, often using PCSK9 inhibitors to lower overall cardiovascular risk.

Fasting insulin, HOMA-IR & metabolic markers

Insulin resistance and metabolic syndrome are epidemics in the Western world, Campanile says. And these conditions can directly affect your heart.

When you have insulin resistance, it makes your cholesterol particles smaller and more numerous. This makes it easier for the particles to slip through artery walls and cause damage.

When it comes to metabolic markers, most doctor's simply test A1C, a 3-month blood sugar average. While Campanile says this is useful, he also tests his patients' fasting insulin, fasting glucoe, C-peptide, and HOMA-IR, which are markers directly tied to insulin resistance, the real metabolic driver of heart disease.

Here's what Campanile says you should aim for when it comes to metabolic markers:

- Hemoglobin A1C: Around 5

- Fasting insulin: Ideally below 10, optimally at 5

- Fasting glucose: Around 75 to 80 mg/IL

- C-peptide: Another marker of insulin production

- HOMA-IR: A calculation based on insulin and glucose that's directly related to development of diabetes and heart disease

Excess amounts of insulin in your body can also cause cancer and diabetes, so managing insulin resistance extends beyond heart health. It also helps prevent your overall disease risk.

Advanced lipid testing

If you've ever had bloodwork done, you probably got the classic "good cholesterol, bad cholesterol" breakdown. Campanile told me that's accurate, but not the most useful in terms of future risk. The problem is that standard panels don't tell you about particle size or particle number. If you have big, fluffy cholesterol particles, they can't penetrate the artery wall as easily. But if you have a lot of small, dense LDL particles, they can slip through and cause damage.

Campanile uses two advanced panels to assess this.

The Boston Heart test has long been a go-to for advanced lipid markers. It can tell you whether you're a hyper-absorber of cholesterol (like me – I discovered I'm an ultra-absorber of saturated fat) or a hyper-producer. This helps personalize treatment.

The Cardio Zoomer is a cutting-edge panel Campanile helped design with Vibr