LDL or bad cholesterol is a major risk factor for heart disease, and most people get their LDL screening done as part of yearly tests to find out about their cardiovascular health. However, there’s another marker in the blood that can be a better predictor, a new large review says. However, it is not a part of routine blood testing. Apolipoprotein B (ApoB) is a protein that attaches to harmful fat particles in the blood. It is mostly found on the surface of harmful lipoproteins, which cause heart disease. Since each one of the harmful particles contains one ApoB molecule, testing for it essentially captures the overall number of harmful plaque-producing compounds. Typically, doctors closely monitor LDL levels as a primary indicator of whether
someone is at risk of developing heart disease. If it is found to be elevated, they recommend lifestyle changes or starting medication to lower it. “The question of whether people should be routinely screened for apolipoprotein B (ApoB) reflects a growing shift in how we understand cardiovascular risk. Traditionally, low-density lipoprotein cholesterol (LDL-C) has been the cornerstone of heart disease risk assessment. However, mounting evidence suggests that ApoB may offer a more precise and clinically meaningful measure,” said Dr Abhijit Khadtare, Cardiologist, Ruby Hall Clinic, Pune.
Why is ApoB important?
According to experts, the issue is that normal LDL levels may not necessarily mean you are in the clear, as an undetected elevated ApoB, a phenomenon known as discordance, may be present. Factors like being overweight or having diabetes, or high triglyceride levels, make that mismatch between normal LDL and elevated ApoB more likely. “In these groups, ApoB better captures residual risk and can guide more accurate treatment decisions,” said Dr Khadtare.
Widely, ApoB testing is not available
The current guidelines by the American Heart Association do not recommend routine testing for ApoB as part of cholesterol screening, except for some patients with high triglycerides. Dr Khadtare, however, believes a balanced approach is needed for screening. “ApoB testing is not universally available, may be more expensive than standard lipid panels, and current clinical guidelines in many countries still prioritize LDL-C due to its long history, simplicity, and proven benefit in guiding therapy,” he said. “A balanced approach is emerging: ApoB should not replace LDL-C universally, but it should be routinely considered in individuals at intermediate to high cardiovascular risk, those with discordant lipid profiles, or those who experience cardiovascular events despite 'normal' LDL-C levels,” the doctor added.
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How is ApoB testing done?
Heart disease, being a significant contributor to deaths across the world, is an important condition that needs to be highlighted. Doctors say hardening of the arteries caused by a buildup of plaque-producing particles is best evaluated using the ApoB test. The test looks directly at the number of artery-clogging particles in the blood, offering a practical and comprehensive way to assess cholesterol burden. While the testing is not well-known to the general public, ApoB is hot among health influencers and increasingly touted in the commercial blood testing market. Also, there are no clear guidelines for what target ApoB levels should be. In healthy people, ApoB values less than 90 mg/dL are typically considered acceptable, with some saying lower targets closer to 70 mg/dL may be more optimal for preventing heart disease.
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