Thirty-four markers, twenty in range, fourteen outside their reference or target. They fall into five decisions, not fourteen. Lab 15.09.2026

• Lipids. LDL 158 mg/dl, non-HDL 190, apolipoprotein B 118, triglycerides 212, HDL 41. With age 44, non-smoker, systolic 138 and non-HDL 190 mg/dl, SCORE2 gives a ten-year risk of around 3 %, which is moderate for his age. At moderate risk the goals are LDL below 100 mg/dl and apolipoprotein B below 100; he is above both. Lab 15.09.2026 BP 16.09.2026 Eur Heart J + 2
• Lipoprotein(a) 92 nmol/l. In the grey zone of 75 to 125 nmol/l. Not high enough to reclassify him on its own, high enough to count as a modifier on top of a moderate risk. It does not need measuring again. Lab 15.09.2026 Eur Heart J
• Sugar. HbA1c 5.8 %, fasting glucose 104 mg/dl: prediabetes by both ADA criteria, for the first time. Fasting insulin 14 µU/ml gives a HOMA-IR of 3.6. With his father's diabetes at 55 and the waist of 101 cm, this is the finding with the most to gain: the Diabetes Prevention Program cut progression to diabetes by 58 % with weight loss and activity. Lab 15.09.2026 Diabetes Care Diabetologia N Engl J Med
• Liver. ALT 52 U/l and GGT 78 U/l are raised; AST, bilirubin and albumin are normal. FIB-4 is 0.9, below 1.3, so advanced fibrosis is unlikely. The pattern, with the triglycerides, the waist and two glasses of wine a day, is steatosis; an ultrasound confirms it, and the treatment is the same as for the sugar. Lab 15.09.2026 J Hepatol Am J Gastroenterol
• Vitamin D 17 ng/ml. Deficient. Supplement, re-test in three months. Lab 15.09.2026 J Clin Endocrinol Metab

What is fine and stays fine: kidney (eGFR 94, albumin-to-creatinine ratio 8 mg/g), thyroid (TSH 2.1), blood count, B12 and folate, iron. Ferritin 186 µg/l is in range but at the upper end; with the liver values it is worth one look in a year, not now. Uric acid 7.4 mg/dl is above the reference and does not need a drug without gout; it falls with the same measures as the rest. hs-CRP 2.6 mg/l is in the average-risk band. Lab 15.09.2026 Kidney Int Thyroid WHO Ann Rheum Dis Circulation

The tiredness has no single laboratory explanation. Thyroid, iron, B12 and blood count are normal; vitamin D is low; six hours of sleep with snoring is the more likely cause, and it goes on the list for the visit.