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The Longevity Review Without the sales pitch
Weak

Older Inflammatory Markers (ESR, Fibrinogen, Lp-PLA2)

Last reviewed 25 August 2026 · Evidence-graded review — see Methodology

Three inflammation-adjacent markers that appear on expanded cardiac panels, almost always alongside hs-CRP. Each is genuinely associated with cardiovascular risk. The problem is that hs-CRP is already on the panel, and stacking further correlated inflammatory markers on top of a conventional risk model moves almost nobody into a different treatment decision.

Why it grades Weak

Kaptoge S, Di Angelantonio E, et al. (Emerging Risk Factors Collaboration) “C-reactive protein, fibrinogen, and cardiovascular disease prediction.” N Engl J Med 2012;367:1310–1320 added CRP or fibrinogen to a conventional risk model in 246,669 people without cardiovascular disease and found only a slight improvement in prediction. Thompson A, et al. (Lp-PLA2 Studies Collaboration) “Lipoprotein-associated phospholipase A2 and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies.” Lancet 2010;375:1536–1544 found Lp-PLA2 associated with coronary risk at a magnitude comparable to conventional risk factors — and it never became a treatment target, because darapladib, the drug built to inhibit it, failed its outcome trials.

Kaptoge S, et al. N Engl J Med. 2012. PubMed: PMID 23034020 · Thompson A, et al. Lancet. 2010. PubMed: PMID 20435228

Commonly sold as an “advanced cardiac” or “inflammation” add-on at extra cost. hs-CRP already occupies this space, and none of these three has been shown to change what a doctor would do next.
FrequencyNot recommended as a screen in asymptomatic adults
Cost (SGD)S$30–90 depending on how many are bundled
Appropriate forNo clear screening role. ESR remains useful where a specific inflammatory condition is actually suspected

Singapore guidance

Not covered in the current review

Singapore’s national screening committee has not reviewed these markers for cardiovascular screening in the current volume. ESR does appear on its not-recommended list, but for osteoporosis screening, a different purpose.

Source: Screening Test Review Committee report 2026, Volume 1 (Academy of Medicine Singapore and Ministry of Health, February 2026), Table 2E(i). The full national list · How this is used.

What you would actually pay

Healthier SG
Not subsidised
MediSave
Not among the screenings named for outpatient claims

Source: Healthier SG Screening (HealthHub) and MediSave outpatient care (Ministry of Health). Absence from either list is not a statement that the test is discouraged — only that no subsidy or claim applies. Gross prices compared.

What it costs when it is wrong

Basis
No published harm criterion found
Severity
Not documented

Not covered in the current volume of the committee’s report, so no harm criterion was found either way.

An empty finding, not a clean bill of health: this means nothing documented was found for this test. It is not a claim that the test is safe.

Screening harm is not only a laboratory question: the committee’s own criteria advise against a test when “the screening test, or follow-up tests arising from a positive screen, are associated with significant medical risks”. Sources on overdiagnosis → · How this is graded.

FAQ

Is the Older Inflammatory Markers (ESR, Fibrinogen, Lp-PLA2) worth doing in Singapore?

Judged for screening an asymptomatic adult, Older Inflammatory Markers (ESR, Fibrinogen, Lp-PLA2) grades weak on our rubric. It typically costs S$30–90 in Singapore. It is most appropriate for no clear screening role. ESR remains useful where a specific inflammatory condition is actually suspected. It is not recommended as a screen in asymptomatic adults.

Weighing this against something else? Compare it with two other tests → · Price it inside a panel →