The Silent Rise of Cardiometabolic Disease: How to Advocate for Your Health at Your Annual Physical

Cardiometabolic disease is no longer something we can blame solely on obvious lifestyle choices or assume that it only affects people who appear overweight. Its prevalence is rising quietly and often being missed during its preventable stages.

One of the most concerning trends is the growing number of individuals with a completely “normal” BMI who are now meeting criteria for pre-diabetes or early metabolic dysfunction. On paper, they look healthy. Their BMI falls between 18.5 and 24.9... they may even exercise regularly! Yet their fasting glucose is creeping upward, their triglycerides are elevated, and their insulin levels — when checked — tell a very different story.

The truth is, BMI was never designed to measure metabolic health. It does not account for visceral fat, which surrounds the organs and drives inflammation and insulin resistance. It does not reflect mitochondrial health, inflammatory burden, sleep quality, stress levels, or dietary quality. A person can look lean externally but still have elevated fasting insulin, a high triglyceride-to-HDL ratio, small dense LDL particles, and systemic inflammation. That is metabolic dysfunction — even if the scale suggests otherwise.

Pre-diabetes is typically defined by a fasting glucose between 100–125 mg/dL or an HbA1c of 5.7–6.4%. However, from a functional perspective, glucose elevation is often a late finding. Fasting insulin can rise for years before fasting glucose ever becomes abnormal. This is why practitioners trained through the Institute for Functional Medicine emphasize looking upstream at insulin, inflammation, and particle size rather than waiting for glucose to cross an arbitrary threshold.

If we only react once glucose becomes elevated, we have already missed years of opportunity for early intervention.

So what does this mean for you during your routine yearly physicals? There is good news.. you can adovcate for better preventative care! A critical issue is that standard lipid panels may not tell the whole story. A routine test typically measures total cholesterol, LDL-C, HDL-C, and triglycerides. But cardiovascular disease is not simply a cholesterol storage problem — it is an inflammatory and metabolic condition.

Advanced markers such as ApoB, LDL particle number, Lipoprotein(a), high-sensitivity CRP, and fasting insulin often provide a clearer picture of risk. ApoB reflects the number of atherogenic particles rather than just the cholesterol content inside them. LDL particle number and size matter because smaller, denser particles are more likely to penetrate the arterial wall. High-sensitivity CRP helps assess inflammatory burden, and fasting insulin reveals metabolic dysfunction long before glucose rises. Looking at these markers allows for a more personalized and preventative approach rather than a one-size-fits-all LDL target.

Requesting these advanced labs provides a far more comprehensive view of your cardiovascular health. Rather than simply measuring cholesterol at the surface level, they help identify what is happening at the microvascular and cellular level ... including inflammation, particle burden, and early metabolic dysfunction. By detecting these subtle changes early, you have the opportunity to adjust your nutrition, movement, sleep, and stress habits before microvascular damage progresses to macrovascular injury, plaque formation, and ultimately cardiometabolic disease.

If you’ve already been diagnosed with cardiometabolic dysfunction, you’ve likely experienced how quickly conventional medicine often turns to a statin as the first-line solution. While these medications can play an important role in certain situations, it’s worth pausing to understand what’s happening beneath the surface when a statin is introduced and how it influences your body beyond simply lowering LDL cholesterol.

Statins work by inhibiting HMG-CoA reductase, reducing the body’s production of cholesterol and lowering LDL levels. They are among the most prescribed medications in the United States and absolutely have a role, particularly in secondary prevention for individuals who have already experienced a cardiovascular event. However, when we look at primary prevention data more closely, the benefit is more modest than many people realize. The absolute risk reduction in lower-risk populations is small, with roughly one out of every fifty individuals avoiding a major cardiovascular event over several years of treatment. That does not mean statins are ineffective — but it does mean the risk-benefit discussion should be individualized rather than automatic.

It’s also important to understand that statins influence more than just cholesterol production. They reduce the synthesis of CoQ10, a compound essential to mitochondrial energy production. Mitochondria are the power houses of our cells. Reduced CoQ10 levels are thought to contribute to the muscle pain, fatigue, and exercise intolerance that some patients experience.. especially those on a statin. There is also discussion in the literature about statins lowering HDL in certain individuals. HDL is involved in reverse cholesterol transport and has anti-inflammatory and neuroprotective properties. Lower HDL levels have been associated with increased risk of cognitive decline, including Alzheimer’s disease, though this relationship is complex and influenced by many factors beyond cholesterol alone.

So at this point in the post you're probably wondering what the positive is in all of this... well I promise there is some reassuring data! The encouraging news is that lifestyle interventions can meaningfully shift these markers!

Improving insulin sensitivity through strength training and post-meal movement lowers cholesterol production and improves lipid patterns. By simply walking 20 minutes after a meal, you are helping your body more ways than one! Increasing soluble fiber intake from foods like oats, flaxseed, lentils, and chia seeds can also help bind bile acids and reduce LDL levels in the liver. Prioritizing omega-3 rich foods such as fatty fish helps reduce triglycerides and systemic inflammation.

Sleep plays a profound role in insulin regulation and inflammatory control, making seven to nine hours per night foundational rather than optional. Another key lifestyle factor is reducing ultra-processed food intake! Choosing to nourish your body with whole foods and meals prepared at home, you are further decreasing oxidized LDL formation and endothelial dysfunction in your vasculature. When these shifts are implemented consistently, they often rival or exceed the impact of medication in early cardiometabolic dysfunction.

Certain supplements may also support lipid optimization when used thoughtfully. Berberine has been shown to improve insulin sensitivity and modestly lower LDL and triglycerides. Red yeast rice contains naturally occurring monacolin K, which acts similarly to a low-dose statin and may reduce LDL, though it still influences CoQ10 production leaving your mitochondria protected. Soluble fiber supplements such as psyllium have demonstrated LDL-lowering effects when taken consistently.

For individuals already on statins, CoQ10 supplementation is sometimes considered to help support mitochondrial function and should be discussed with your provdier.

Ultimately, cardiometabolic disease is rising not simply because people weigh more, but because we are increasingly metabolically inflamed, under-slept, overstressed, and overexposed to processed foods. The conversation must move beyond asking whether LDL is below a certain number. We need to ask about insulin levels, inflammatory markers, particle counts, and metabolic flexibility. Cholesterol itself is not inherently the villain; rather, chronic inflammation and metabolic dysfunction drive cardiovascular risk.

True prevention is not about suppressing one lab value. It is about restoring metabolic resilience, identifying dysfunction early, and addressing root causes before irreversible damage occurs. That approach is more comprehensive, more individualized, and ultimately far more empowering as a patient.

I hope you’ve gained a few pearls of wisdom today and feel empowered to use this information to advocate for yourself at your annual physicals. These tests can be ordered by your primary care provider, and having this knowledge allows you to take a more proactive, preventative approach to your health. Prevention isn’t about doing more — it’s about asking better questions and making informed decisions that support long-term metabolic resilience.