From the Guidelines
For lipid assessment, checking apolipoprotein B (apo B) is recommended as it provides a good estimate of the number of atherogenic particles in plasma, including LDL, VLDL, and IDL, and has been shown to be equal to LDL-C in risk prediction 1. When evaluating lipid profiles, apo B is a crucial marker as it represents the total number of atherogenic particles, with each particle containing one apo B molecule.
- Apo B has been demonstrated to be a valuable risk predictor, comparable to LDL-C, in several prospective studies 1.
- The measurement of apo B can be particularly important in cases of high concentrations of small dense LDL, as it may provide a more accurate assessment of cardiovascular risk.
- Although apo B has not been evaluated as a primary treatment target in statin trials, post-hoc analyses suggest that it may be a better treatment target than LDL-C 1.
- Recent data from meta-analyses have shown mixed results regarding the benefit of apo B beyond non-HDL-C or traditional lipid ratios, but apo B remains a significant marker of CV risk 1.
- In clinical practice, measuring apo B can provide valuable information for treatment plans, especially in patients with a family history of premature cardiovascular disease, diabetes, metabolic syndrome, or previous cardiovascular events.
- Standard lipid panels measuring total cholesterol, LDL, HDL, and triglycerides are still the first-line tests in most clinical settings, but apolipoproteins like apo B can offer additional risk stratification.
From the Research
Lipid Measurement Options
- Apolipoprotein B (apoB) is considered a more accurate measure of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) 2, 3, 4, 5.
- ApoB measurement can be used to assess the adequacy of lipid-lowering therapy and guide statin/ezetimibe/Proprotein convertase subtilisin/kexin type 9 (PCSK9) therapy 2, 4.
Comparison of ApoB and LDL-C
- Studies have shown that apoB is superior to LDL-C in risk assessment both before and during treatment with lipid-lowering therapy (LLT) 4, 5.
- There can be discordance between levels of LDL-C and apoB, as well as LDL-C and non-HDL-C, despite high levels of population-wide correlation 4, 5.
- When there is discordance between LDL-C and apoB, or LDL-C and non-HDL-C, atherosclerotic cardiovascular disease risk generally aligns better with apoB or non-HDL-C 4.
Clinical Use of ApoB
- ApoB testing can inform clinical prognosis and care, as well as enable family cascade screening, when an inherited lipoprotein syndrome is identified 4.
- The use of apoB in conjunction with a standard lipoprotein lipid profile can provide additional information for assessing risk and managing lipid-lowering therapy 4.
- ApoB can be used to diagnose distinct lipoprotein phenotypes and guide clinical management of cardiovascular risk in adults 4, 5.