Turning 40 marks a pivotal moment for health. While many cardiovascular, metabolic, or neurodegenerative diseases do not reveal themselves with symptoms for years, there are tests capable of spotting their earliest signals long before they manifest. Dr. Rebeca García, physician, surgeon, and specialist in preventive medicine and anti-aging, affirms that there are analyses and biomarkers that become essential at this age, because they can help us anticipate illness and safeguard long‑term wellness.
Most cardiovascular, metabolic, and neurodegenerative diseases do not emerge suddenly. They develop quietly over years or even decades
«For decades we’ve understood medicine as a tool to treat diseases. Yet, the true health revolution of the 21st century isn’t about curing, but about detecting the problem before it appears», says Dr. García, CEO of Life Clinics, to THE OBJECTIVE.
«Most cardiovascular, metabolic, and neurodegenerative diseases do not arise suddenly. They develop over years or even decades in silence. So, when a patient asks me what they should do after turning 40, my answer is clear: a basic blood test is no longer enough. We need to look beyond», explains the physician.
Normal glucose isn’t enough
One of the most common mistakes Dr. García points to is «thinking that if glucose sits within the normal range, everything is fine». But the reality is quite different, because «insulin resistance can be present for years before any glycemic alteration appears».
I consider it essential to assess not only glucose, but also basal insulin and to calculate insulin sensitivity indices
«During that silent period, metabolic changes are already underway that promote weight gain, inflammation, hypertension, fatty liver, and the future development of type 2 diabetes. Therefore I deem it essential to evaluate not only glucose but also the basal insulin levels and to compute insulin‑sensitivity indices. Detecting insulin resistance early allows us to act while there is still time to reverse it», she adds.
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Esta visión está respaldada por las European Guidelines of Cardiovascular Prevention de la European Society of Cardiology (ESC), que consideran la ApoB un marcador especialmente útil para estimar el riesgo cardiovascular, e incluso más preciso que el colesterol LDL en ciertos pacientes con obesidad, diabetes, síndrome metabólico o hipertrigliceridemia.
Lipoprotein(a): the most undervalued cardiovascular marker
«If I had to pick one biomarker that every adult should know at least once in a lifetime, it would probably be lipoprotein(a), or Lp(a). This particle is largely determined by genetics and is linked to an increased risk of heart attack, stroke, coronary disease, and valvular calcification», asserts Dr. García.
The key point is that «a person can have seemingly perfect cholesterol and still exhibit an elevated Lp(a). This means that many individuals considered low risk could actually be at higher risk. Unfortunately, it is still not routinely checked in most health exams. Knowing this enables personalized preventive strategies and a clearer understanding of one’s individual cardiovascular risk».
In this regard, the American Heart Association (AHA) regards Lp(a) as an inherited and independent cardiovascular risk factor and recommends its measurement in certain patients, especially where there is a family history of premature cardiovascular disease. Moreover, a 2023 review published in Lipids in Health and Disease concluded that both lipoprotein(a) and apolipoproteins are significantly associated with metabolic syndrome.
Apolipoprotein B: more important than total cholesterol
For years we have focused all attention on LDL cholesterol, but «today we know that apolipoprotein B (ApoB) is one of the best indicators of the real number of atherogenic particles circulating in the blood».
The modern preventive medicine is not about waiting for a disease to appear. It’s about identifying the biological changes that precede it and acting while we can still alter the course. The true aim is not to live longer, but to reach those years with better health, more energy, and a higher quality of life
In other words, it helps us better understand how many particles potentially capable of causing atherosclerosis are interacting with our arteries. Dr. García notes that two people can have the same LDL levels and yet carry very different cardiovascular risks: «ApoB provides far more precise information and should be part of any advanced preventive workup».
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Esta visión está respaldada por las European Guidelines for Cardiovascular Prevention de la European Society of Cardiology (ESC), que consideran la ApoB un marcador especialmente útil para estimar el riesgo cardiovascular, incluso más preciso que el colesterol LDL en ciertos pacientes con obesidad, diabetes, síndrome metabólico o hipertrigliceridemia.
Homocysteine: a silent alert
Another parameter the clinician finds particularly interesting is homocysteine. «Elevated levels can be associated with greater cardiovascular risk, cognitive alterations, vascular deterioration, and deficits in B vitamins group».
«Frequently we encounter seemingly healthy patients with elevated homocysteine without realizing it. Detecting it allows early intervention through nutritional strategies and correcting possible vitamin deficiencies», notes the expert.
Although the role of homocysteine remains under study, numerous studies have shown that elevated levels are associated with a higher risk of cardiovascular disease and stroke. However, the latest evidence indicates that reducing homocysteine with folic acid and B vitamins does not significantly reduce the risk of myocardial infarction or cardiovascular mortality, although it might slightly lower stroke risk in certain patients. Therefore, experts recommend interpreting homocysteine as an additional risk marker, always alongside the rest of clinical and analytical parameters, and not as an isolated therapeutic target.
Chronic inflammation: the invisible flame
«When we think of inflammation, we often imagine an injury or an infection. Yet there exists another, far more dangerous kind: low-grade chronic inflammation. It is silent, produces no obvious symptoms, and can remain active for years», warns the physician, who explains that this inflammation is linked to the development of:
- Cardiovascular disease.
- Type 2 diabetes.
- Obesity.
- Alzheimer’s disease.
- Autoimmune disorders.
- Some cancers.
«Markers such as ultra-sensitive C-reactive protein can help us detect this inflammatory state before clinical manifestations appear. Inflammation is, probably, one of the major common denominators of accelerated aging», she adds.
The connection between chronic inflammation and cardiovascular disease is well documented. Mayo Clinic, for example, notes that ultrasensitive C-reactive protein (CRP-us) can be a useful tool to identify individuals at higher cardiovascular risk when interpreted alongside other risk factors.
What analytics does Dr. García recommend from age 40?
Beyond a conventional blood panel, she considers the following markers particularly useful:
- Full blood count.
- Advanced lipid profile.
- Apolipoprotein B.
- Lipoprotein(a).
- Basal glucose and insulin.
- Glycated hemoglobin (HbA1c).
- Renal function.
- Liver function.
- Ultrasensitive C-reactive protein.
- Homocysteine.
- Vitamin D.
- Thyroid profile.
- Sex hormones when clinically indicated.
- Prostate-specific antigen (PSA) for men, according to age and context.
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«And, whenever possible, complement these data with body composition studies, arterial stiffness tests, and advanced cardiovascular assessment», she adds.
«Most serious diseases do not appear overnight: a heart attack begins years before the event; diabetes begins years before diagnosis; cognitive decline begins years before symptoms… That is why modern preventive medicine isn’t about waiting for a disease to show up. It consists of identifying the biological changes that precede it and taking action while we still can alter the course. The true aim is not to live more years, but to reach them with better health, more energy, and higher quality of life», she concludes.
