“𝗔𝗽𝗼 𝗕 𝗩𝘀 𝗟𝗗𝗟”
By focusing only on LDL as the "chief villain" and ignoring ApoB, which accounts for all atherogenic particles (including LDL, Lp (a), triglyceride-rich remnants, and others), you are missing the bigger picture one out of every ten times in individuals at significant risk for cardiovascular vents
𝐖𝐡𝐚𝐭 𝐢𝐬 𝐀𝐩𝐨𝐥𝐢𝐩𝐨𝐩𝐫𝐨𝐭𝐞𝐢𝐧 𝐁 (𝐀𝐩𝐨 𝐁)?
Apolipoprotein B (Apo B) is the main protein component of atherogenic lipoproteins like LDL, as well as all other Remnant particles (Lp (a) LDL, VLDL. etc.) which transport cholesterol in the blood. Apo B is the “driver” of “truck load” of LDL and other atherogenic particles that penetrates the endothelial barrier. ApoB is a more precise marker for tracking disease risk and therapy benefits than LDL-C or non-HDL-C. It can be measured accurately, quickly, and at a low cost. Even at major U.S. academic medical centers ApoB is ordered less than 1% as frequently as the standard lipid panel.
𝐖𝐡𝐲 𝐈𝐬 𝐀𝐩𝐨 𝐁 𝐌𝐨𝐫𝐞 𝐃𝐞𝐩𝐞𝐧𝐝𝐚𝐛𝐥𝐞?
• ApoB levels indicate the number of LDL particles, which can better predict heart disease risk than LDL levels alone.
• ApoB is more strongly associated with heart attacks and strokes than LDL cholesterol.
• High ApoB levels can reveal dangerous small LDL particles not identified by LDL cholesterol levels.:
• ApoB better predicts heart risk in individuals with metabolic syndrome, type 2 diabetes, or familial hypercholesterolemia.
𝐖𝐡𝐲 𝐢𝐬 𝐜𝐡𝐞𝐜𝐤𝐢𝐧𝐠 𝐀𝐩𝐨𝐥𝐢𝐩𝐨𝐩𝐫𝐨𝐭𝐞𝐢𝐧 𝐁 (𝐀𝐩𝐨 𝐁) 𝐧𝐨𝐭 𝐬𝐭𝐚𝐧𝐝𝐚𝐫𝐝 𝐥𝐢𝐤𝐞 𝐋𝐃𝐋?
• “Old habits die hard." Apo B is a newer marker compared to LDL. Cholesterol became widely recognized in the 1950s, and LDL followed in the 1960s. Apo B was discovered in 1970, and its link to atherosclerosis gained attention in the 1980s. Early studies, like Framingham (1960) and MRFIT (1970), used LDL as the primary marker, establishing LDL as the focus. However, Apo B studies began later (e.g., PROCAM-1979, ARIC-1987, Quebec Cardiovascular Study 1989, Women’s Health Study 2000, Interheart-2000, Dallas Heart Study 2000, and the IMPROVE-IT study 2015), all of which demonstrated Apo B’s superiority over LDL.
𝐈𝐭 𝐢𝐬 𝐭𝐢𝐦𝐞 𝐭𝐨 𝐨𝐯𝐞𝐫𝐜𝐨𝐦𝐞 𝐭𝐡𝐞 𝐫𝐞𝐬𝐢𝐬𝐭𝐚𝐧𝐜𝐞 𝐚𝐧𝐝 𝐬𝐭𝐚𝐫𝐭 𝐦𝐞𝐚𝐬𝐮𝐫𝐢𝐧𝐠 𝐀𝐩𝐨 𝐁 𝐫𝐨𝐮𝐭𝐢𝐧𝐞𝐥𝐲 𝐚𝐥𝐨𝐧𝐠𝐬𝐢𝐝𝐞 𝐋𝐃𝐋. 𝐀𝐭 𝐈𝐧𝐭𝐞𝐠𝐫𝐚𝐭𝐞𝐝 𝐇𝐞𝐚𝐫𝐭 𝐂𝐞𝐧𝐭𝐞𝐫, 𝐰𝐞 𝐫𝐨𝐮𝐭𝐢𝐧𝐞𝐥𝐲 𝐜𝐡𝐞𝐜𝐤 𝐚𝐧𝐝 𝐦𝐨𝐧𝐢𝐭𝐨𝐫 𝐀𝐩𝐨𝐁 𝐥𝐞𝐯𝐞𝐥𝐬. 𝐓𝐡𝐞 𝐭𝐚𝐫𝐠𝐞𝐭 𝐀𝐩𝐨𝐁 𝐥𝐞𝐯𝐞𝐥 𝐢𝐬 𝐥𝐞𝐬𝐬 𝐭𝐡𝐚𝐧 𝟖𝟎 𝐦𝐠/𝐝𝐋 𝐟𝐨𝐫 𝐡𝐢𝐠𝐡-𝐫𝐢𝐬𝐤 𝐢𝐧𝐝𝐢𝐯𝐢𝐝𝐮𝐚𝐥𝐬 𝐚𝐧𝐝 𝐥𝐞𝐬𝐬 𝐭𝐡𝐚𝐧 𝟔𝟎 𝐦𝐠/𝐝𝐋 𝐟𝐨𝐫 𝐭𝐡𝐨𝐬𝐞 𝐰𝐢𝐭𝐡 𝐞𝐬𝐭𝐚𝐛𝐥𝐢𝐬𝐡𝐞𝐝 𝐡𝐞𝐚𝐫𝐭 𝐝𝐢𝐬𝐞𝐚𝐬𝐞.
