Research has shown that the traditional emphasis on “good” and “bad” cholesterol to determine cardiovascular disease risk may be outdated. Instead, doctors are now looking at a more accurate marker of heart attack risk known as apolipoprotein B (apoB).
ApoB is the particle that carries cholesterol in the bloodstream. It is believed that heart risk is driven by the number and type of cholesterol particles rather than the cholesterol itself. Research has indicated that counting the number of these lipoprotein particles in the blood can more accurately predict cardiovascular risk than traditional cholesterol tests.
Surprisingly, many people with “normal” levels of LDL cholesterol, using standard measurement techniques, still have heart attacks. This is because some people have a high concentration of apoB particles despite having a “normal” amount of LDL cholesterol. This concept, known as “discordance,” highlights the importance of testing for apoB rather than relying solely on traditional cholesterol tests.
The emphasis on apoB testing has been supported by several large clinical trials and has been shown to be a superior predictor of cardiovascular events compared to LDL cholesterol. However, while some international lipid guidelines support apoB testing, U.S. cholesterol guidelines currently only recommend it for certain high-risk patients.
Advocates for apoB testing argue that it offers more specificity than non-HDL cholesterol and helps identify individuals who might otherwise go undetected with “normal” cholesterol numbers. Moreover, individuals with high apoB levels are typically advised to adopt the same treatments and lifestyle changes recommended for high cholesterol.
Overall, the shift towards apoB testing highlights the importance of reevaluating traditional approaches to cholesterol testing and risk assessment, especially for those with a family history of early disease. Experts are encouraging individuals to be proactive in monitoring their heart health and seeking out the necessary tests to stay ahead of potential issues.