October 13, 2026, 6:11 pm | Read time: 5 minutes
For many, preventive care is limited to the free check-ups available to those with statutory health insurance. Typically, these occur once between the ages of 18 and 34, and then every three years thereafter. Ideally, all values are within the normal range at these times, and the topic of preventive care is considered settled. But is that sensible? After all, individual lab values are just a snapshot. Some markers that reveal a lot about the risk of cardiovascular diseases aren’t even measured. I wanted to know which health values truly count for effective prevention, so I consulted preventive medicine specialist Dr. Hadi Saleh.
Saleh has made preventive care a central aspect of his work. Every week, he releases a podcast called “Mission Health,” where he discusses healthy aging, fitness, resilience, and nutrition with various experts. I have also had the opportunity to be a guest on his show.
In his practice in Berlin-Grunewald, the focus is primarily on preventing diseases rather than treating them. Saleh specifically targets certain values, which he does not view in isolation but over the long term. “A value can still be within the reference range and yet continuously deteriorate,” he explains to me.
What the Reference Range Indicates
The problem with reference ranges is that they show where the measurements of a healthy comparison group typically lie statistically. This can lead to a false sense of security. Someone at the upper edge of the reference ranges is formally considered unremarkable. However, if a value increases year after year, it can be an early warning signal long before it crosses the threshold into manifest disease.
Which Measurements Dr. Hadi Saleh Recommends Annually
“When we talk about meaningful prevention, I would look at the most important metabolic and cardiovascular markers at least once a year,” says Saleh. Specifically, he mentions:
- Fasting Blood Sugar: This measurement is usually taken in the morning after eight to twelve hours without food.
- Fasting Insulin: An elevated value may indicate that the pancreas needs to release more insulin to keep blood sugar within the normal range.
- HbA1c: Unlike fasting blood sugar, the so-called long-term blood sugar shows the average glucose level over the past two to three months.
- Kidney and Liver Values: Both organs play a central role in metabolism. Diseases often progress for a long time without noticeable symptoms.
- Lipid Profile: LDL and HDL cholesterol, as well as triglycerides, supplemented by Apolipoprotein B (ApoB)
The so-called HOMA index can be calculated from fasting blood sugar and fasting insulin. According to Saleh, it can be a good indicator of beginning insulin resistance, where the body’s cells respond less effectively to insulin. The insulin level often rises while blood sugar remains normal.
Depending on age, medical history, and personal risk, additional health values may be added, such as a blood count or inflammation markers, according to Saleh.
ApoB: Why the Number of Particles Can Be Crucial
Cholesterol is essential for our bodies. It is needed for cell walls and hormone production, among other things. However, because cholesterol is not water-soluble, it is transported in the blood in tiny particles called lipoproteins. There are different forms, which differ in their density: HDL (High-Density Lipoprotein) returns excess cholesterol to the liver, while LDL (Low-Density Lipoprotein), VLDL (Very-Low-Density Lipoprotein), and Lipoprotein(a) can penetrate the vessel wall and contribute to deposits. The more of these particles in the blood, the greater the risk.
Potentially vessel-damaging particles like LDL, VLDL, and Lipoprotein(a) each carry exactly one molecule called Apolipoprotein B (ApoB) on their surface, unlike HDL. Therefore, the ApoB value accurately indicates how many of these unfavorable particles are in the blood. The usual LDL cholesterol indicates how much cholesterol is in the LDL particles. While both values usually align well, they can diverge in some people. This often occurs with elevated triglycerides or type 2 diabetes. In such cases, LDL cholesterol may appear relatively unremarkable, even though many ApoB-carrying particles are present. For this reason, many experts consider ApoB a somewhat more reliable marker for cardiovascular risk. However, it is not routinely determined during check-ups starting at age 35.
The Effect of Eating One Avocado Per Day on Cholesterol
This Blood Value Should Be Checked at Least Once in Your Lifetime
Lipoprotein(a): One Measurement Is Usually Enough
Saleh makes an exception to the annual rhythm with Lipoprotein(a), or Lp(a): This largely genetically determined risk marker should “in my view be determined at least once in a lifetime,” explains the preventive medicine specialist.
Background: About 20 percent of people have significantly elevated Lp(a) levels due to heredity, which greatly increases the risk of heart attack and stroke. Unfortunately, Lipoprotein(a) changes little in adulthood and is only slightly influenced by diet or exercise. However, knowing about this risk factor allows individuals to work more consistently with their doctor on other modifiable risk factors. The cost of a one-time Lp(a) measurement is around 20 euros. Given the importance of the value, cardiologists like Dr. Christopher Schneeweis advocate that the determination of Lipoprotein(a) “should be a service covered by health insurance.”
4 Other Health Values You Should Know
In addition to blood values, Saleh suggests knowing “a few very simple health metrics.” These include:
- Blood Pressure
- Resting Heart Rate
- Body Weight
- Waist Circumference
For Saleh, preventive care also includes getting “a realistic picture” of one’s physical fitness. This could involve asking how quickly one gets out of breath when climbing stairs and assessing strength and endurance. “If you want to know more precisely, you can also have your cardiorespiratory fitness or VO2max determined.”
“What matters most is the overall picture and the development over time. Prevention becomes meaningful when we know the relevant values,” Saleh tells me. It’s not about the greatest number of tests, but about the right selection “from which actual consequences for prevention and lifestyle can be derived.”