By Andrew Fang is a Medical Director at Doctor Anywhere
Ask most people what “metabolism” means and they’ll describe something vague – how fast they burn calories, or why weight gets harder to manage with age. Clinically, metabolic health is both more precise and more consequential than that, and a standard blood panel often doesn’t capture it fully – even in a country where the numbers are already a concern. MOH’s 2024 National Population Health Survey found that roughly 3 in 10 Singaporean adults have high cholesterol, and most don’t find out until a screening turns up the number.
Take cholesterol itself. Most people are used to seeing LDL on their results, and local clinical guidelines have long anchored management around it. But a growing body of clinical guidance – including newer international consensus statements – argues that apolipoprotein B (ApoB) can be a more accurate risk marker, and local guidelines already recognise it as a useful secondary target alongside LDL. Rather than measuring cholesterol content, ApoB directly counts the number of artery-clogging particles in the blood, which matters because two people can have identical LDL numbers yet very different actual particle counts – and therefore very different real risk.
Lipoprotein(a), or Lp(a), provides an additional perspective: unlike most cardiovascular risk factors, it’s roughly 70-90% determined by genetics rather than lifestyle. It’s also more common than most people realise — global prevalence of elevated Lp(a) runs an estimated 10-30% depending on ethnicity, and a Singapore cohort study found that patients with elevated levels had close to triple the risk of early-onset ischaemic heart disease. Yet local studies have found that many patients in Singapore have never had it tested, reflecting a broader awareness gap here. Knowing your number still matters, since a single test can flag a lifelong, inherited risk that would otherwise go unnoticed.
Meanwhile, insulin resistance can be developing years before blood sugar itself becomes abnormal on a standard test, making it a genuinely early warning sign rather than a late-stage diagnosis. Guidelines tend to wait for glucose to cross an established threshold before flagging a problem, largely because that’s the point at which risk is easiest to define at a population level. But that also means someone can be quietly building insulin resistance for years while their blood sugar still reads “normal.” Tests that look at insulin resistance more directly give an earlier, clearer signal, well before glucose numbers would ever raise a flag.
Nutrient markers like Vitamin B12 and D, though less discussed, are closely tied to energy, mood, and long-term metabolic and bone health, and deficiencies are common even in people who consider themselves healthy eaters – Vitamin D insufficiency in particular is frequently picked up locally, despite Singapore’s abundant sunshine, largely due to indoor lifestyles and sun avoidance.
The throughline across all of these: someone can have a completely “normal-looking” standard blood test and still be carrying meaningful metabolic risk that only shows up when you look at the more specific markers underneath. As local guidelines increasingly make room for tests like ApoB and Lp(a) alongside the traditional panel, the opportunity is to catch that risk while it’s still just a number to watch, not a diagnosis to manage.
“Two people can have identical LDL numbers and very different real risk. It’s not the cholesterol content that matters most — it’s the particle count.”
– Dr Andrew
“A completely ‘normal-looking’ blood test can still be hiding meaningful metabolic risk — it just doesn’t show up until you look at the markers underneath.”– Dr Andrew
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