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Measuring cardiovascular disease risk and the importance of apoB

While there is more to ASCVD risk than just lipoproteins, if you don’t know your apoB level, you are not fully taking advantage of the tools at our disposal to estimate your risk of cardiovascular and cerebrovascular disease. Imagine a smoker not knowing they smoke, or someone with high blood pressure never getting strapped up to a BP cuff. Know your risks and manage them accordingly

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 Use of Apolipoprotein B in the Era of Precision Medicine: Time for a Paradigm Change?

Recent international guidelines and position statements concur that the plasma concentration of apolipoprotein B (apoB) is the most accurate measure of lipoprotein associated ASCVD risk. This is especially true for the growing number of individuals with diabetes, obesity, or the metabolic syndrome, and those on statin therapy. Most guidelines, however, continue to promote LDL-C as the primary risk marker due to uncertainty as to whether the greater accuracy of apoB is sufficient to warrant a paradigm shift.

Articles of Interest

The better cholesterol test you didn’t know you needed

There’s a better predictor of heart disease risk, some doctors and researchers say, but many doctors and patients aren’t talking about it.

ApoB may better predict mortality risk in statin-treated patients

A new study shows apolipoprotein B (apoB) and non-HDL cholesterol – but not LDL cholesterol – are associated with increased risk for all-cause mortality and myocardial infarction in patients taking statins. Moreover, apoB was a more accurate marker of all-cause mortality risk than non-HDL or LDL cholesterol and was more accurate at identifying MI risk than LDL cholesterol.

ApoB test may be more accurate measure of heart disease risk

“I believe that our results, combined with a lot of other data showing the value of measuring apoB levels, support a revision of the guidelines to recommend apoB testing for everybody, not just those with certain clinical risk factors,” Dr. Navar said.

Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target

A single molecule of apoB is present in every atherogenic particle; therefore, it has been proposed as a better predictor of cardiovascular events. Standard LDL-C, on the other hand, is a measurement of lipid concentration in lipoprotein particles that are heterogeneous and vary in size, density and lipid content. Over 90% of total apoB is normally found in LDL particles.

Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice

Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking.

Standardization of Apolipoprotein B, LDL‐Cholesterol, and Non‐HDL‐Cholesterol

Concern continues about whether the measurement of apolipoprotein B (apoB) is adequately standardized, and therefore, whether apoB should be applied widely in clinical care. This concern is misplaced. Our objective is to explain why and what the term “standardization” means.

The Blood Tests That Can Flag Your Hidden Heart Disease Risk

Two blood tests you probably haven’t heard of might predict your risk of heart disease better than standard tests do. The first measures a protein called apolipoprotein B, or apoB for short, that contributes to artery-blocking plaque. The other test, for lipoprotein(a), measures a type of bad cholesterol. High levels of each have been linked to increased risk of heart disease.A growing number of specialists and primary care doctors say these tests can help give you a more precise and earlier indication of possible heart problems than more common tests for things like LDL, the best-known bad cholesterol marker. In some cases, these lesser-known tests identify at-risk people whose standard lipid tests look normal. Proponents say the tests should supplement, not replace, your standard lipid panel, which is generally recommended every one to six years for adults. Other doctors are wary of ordering the tests, citing a lack of consensus on what constitutes normal levels and whether and how to treat them—not to mention the extra cost. U.S. medical organization guidelines don’t universally recommend them.

The Importance of Apo B and Lipoprotein Little a [Lp(a)]

The lipid profile measured in the clinic usually involves 5 items. Three are measured (cholesterol, triglycerides, and high-density lipoprotein cholesterol [HDL-C]) and 2 are derived (low-density lipoprotein cholesterol [LDL-C] and non-HDL-cholesterol [non-HDL-C]). Various ratios are possible, but 2 measurements, apolipoprotein B (apo B) and lipoprotein (a), add special value. Apo B provides a measure of the atherogenic particles in the blood that carry apo B. These include LDL, very low-density lipoprotein, intermediate-density lipoprotein, and lipoprotein (a)

The Lower the ApoB, the Better: Now, How Does ApoB Fit in the Upcoming Era of Targeted Therapeutics?

More recently, the hypothesis that entrapment of apolipoprotein B-100 (apoB)-containing particles within the arterial wall along with the resulting inflammation are the initial drivers of atherosclerosis has gained more relevance. In addition to LDL particles, apoB lipoproteins include triglyceride-rich lipoproteins (TGRL), such as very low-density lipoproteins and their remnants, and lipoprotein (a) [Lp(a)], as well.

What is Apolipoprotein B? Here's What Your ApoB Blood Test Means

Currently, clinicians measure ApoB levels less than LDL because the latter is included in a standard lipid panel test for yearly physicals. But, emerging research indicates that it's actually an essential indicator of heart health and disease risk. ApoB is the main structural protein found in low-density lipoproteins (LDL) and all potentially atherogenic lipoproteins. It assists in moving and clearing cholesterol from the blood. High levels indicate decreased clearance of cholesterol from the blood.

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StatPearls

ApoB containing lipoproteins play a crucial role in atherogenesis, including promoting plaque formation within arteries. Many studies in the recent past have demonstrated that increased levels of apoB are a better predictor of risk for cardiovascular disease (CVD) than the aforementioned traditional markers.