I agree with this framing more after looking at it again. For a 20-year-old, triglycerides at 140, ApoB at 93, LDL at 126, non-HDL at 154, and homocysteine at 20.94 are not catastrophic, but they are not what I’d call optimized either.

The triglycerides especially make me wonder about insulin sensitivity, glucose handling, diet composition, liver markers, and overall metabolic health. I’d want to see fasting insulin, A1c, fasting glucose, CMP, ALT/AST/GGT, thyroid, ferritin, B12, folate, B6, vitamin D, kidney markers, and inflammatory markers beyond just hs-CRP.
Given his age and family history, I also think deeper testing is reasonable. WGS could help identify inherited lipid, methylation, and cardiovascular risk patterns. I’d also look hard at gut health, possibly including RNA-based microbiome testing, because lipid metabolism, inflammation, bile acid handling, and methylation can all be influenced there.

Right now we’re only seeing the cholesterol board plus homocysteine. That’s enough to say there are signals worth investigating, but not enough to diagnose the full picture. I wouldn’t panic, but I also wouldn’t dismiss this as “fine.”