February is Heart Health Month, and at McDaniel Nutrition Therapy, it’s one we return to with intention each year.
You’ll often hear that up to 80% of chronic disease, including heart disease, can be prevented or improved through lifestyle choices: how we eat, move, sleep, and manage stress. There’s a lot of truth in that. And at the same time, genetics matter. Heart disease is one area where inherited risk can be particularly strong.
This dual reality: lifestyle matters AND genetics matter is always part of the client conversation at McDaniel Nutrition Therapy. And we love staying curious, informed, and grounded as science continues to evolve. Founder and dietitian Jennifer McDaniel brings both professional expertise and personal perspective to this work. With a strong family history of heart disease, she has spent years proactively engaging with cardiology care, advanced lab testing, and preventive strategies, both for herself and for her clients. That lived experience shapes how heart health conversations are held at MNT: informed, compassionate, and realistic.
The Labs Worth Knowing (and Advocating For)
We can’t address what we don’t measure. Routine cholesterol screening is an important foundation of heart health care.
Current guidelines recommend adults begin cholesterol screening by age 20, with repeat testing every 4–6 years if risk is low. Those with family history, metabolic conditions, perimenopause or menopause, or prior abnormal results may benefit from more frequent testing.
Beyond the standard lipid panel, there are additional markers that can offer meaningful insight, especially for individuals with genetic risk or “normal” labs that don’t seem to tell the full story.
Dietitians play a key role here, helping clients understand:
- which labs may be worth discussing with their provider
- how results fit together rather than standing alone
- and how trends over time matter more than any single number
Lipoprotein(a): A Key Genetic Marker
One lab that’s receiving increased attention is lipoprotein(a), often written as Lp(a).
Lp(a) is a genetically determined lipoprotein associated with higher risk of atherosclerosis, heart attack, and stroke. Unlike LDL cholesterol, Lp(a) is largely unaffected by diet, exercise, or weight loss. Levels are inherited and tend to remain stable across the lifespan, you could even test it in childhood and gain insight into lifelong risk!
This marker can be particularly helpful for explaining:
- strong family history of heart disease
- cardiovascular events at younger ages
- or why traditional cholesterol numbers appear “normal” despite underlying risk
And, and important to know: Lp(a) can be reported in two different units:
- mg/dL (mass concentration)
- nmol/L (particle number)
These units are not interchangeable. In general, levels above 50 mg/dL or 125 nmol/L are considered elevated. Knowing which unit is used, and interpreting it correctly, is key.
LDL, ApoB, and the Bigger Picture
LDL cholesterol and Lp(a) are important markers, but they’re not the whole picture.
Additional labs that can add valuable context include:
- ApoB, which reflects the number of atherogenic particles
- Triglycerides
- Non-HDL cholesterol
- HDL cholesterol (still relevant, though no longer viewed in isolation)
ApoB can be especially useful because it counts cholesterol-containing particles rather than just measuring how much cholesterol they carry. In many people, LDL and ApoB move together, but when they don’t, ApoB can help understand your risk. AND, just as important as individual values are patterns over time.
When Bodies Change, Labs Change
Hormonal transitions, particularly during perimenopause and post-menopause, can significantly affect cholesterol levels. Declining estrogen plays a role in lipid metabolism, and it’s not uncommon to see LDL rise even when lifestyle habits remain unchanged.
This is something MNT dietitians see often: clients who “do everything right,” yet might see their labs shift anyway. Bodies change. Context matters. Interpreting labs through a hormonal and life-stage lens is essential.
Lifestyle, Medication, and Real-Life Tradeoffs
Once labs are understood, the next question is often: What do we do with this information?
For some people, lifestyle changes are enough. For others, medication becomes part of the conversation.Statins are among the most well-studied medications available, with decades of safety and efficacy data. Tools like the 10-year ASCVD risk calculator can help guide these discussions, though they don’t replace individualized decision-making.
Another Tool: Coronary Calcium Scores
For some individuals, a coronary artery calcium (CAC) score can provide additional clarity. This scan measures calcified plaque in the coronary arteries and is especially helpful for people in a gray zone, those with genetic risk, mildly elevated labs, or uncertainty about medication.
A score of zero can be reassuring. A higher score may support earlier or more aggressive prevention. It doesn’t replace lab work, but it adds another layer of understanding.
The Big Picture
Heart health isn’t about perfection. It’s about awareness, personalization, and making choices that are both informed and livable.
We encourage our clients to use Heart Health Month as a yearly pause: to review labs, notice trends, and make shifts, if needed.
At McDaniel Nutrition Therapy, our dietitians help clients interpret complex information, translate research into real life, and build prevention strategies that honor both science and humanity.
If heart health has been on your mind this month, this is a meaningful place to start. And if you’d like support in understanding your labs or deciding next steps, the MNT team is here to help.