From the Guidelines
The most accurate lipid blood marker is apolipoprotein B (apoB), which provides a direct count of all atherogenic lipoprotein particles in the bloodstream. Unlike traditional lipid panels that measure cholesterol content, apoB offers a more precise assessment of cardiovascular risk because each atherogenic lipoprotein particle contains exactly one apoB molecule, regardless of its lipid composition. This makes apoB superior to LDL cholesterol measurements, which can underestimate risk in patients with small, dense LDL particles or elevated triglycerides. ApoB testing is particularly valuable for patients with diabetes, metabolic syndrome, or those with normal LDL-C but elevated triglycerides. The test requires a standard blood draw after fasting, though non-fasting samples can also be used. Normal apoB levels are typically below 100 mg/dL, with optimal levels under 80 mg/dL for high-risk patients. While apoB testing is becoming more widely available, it's not yet included in all standard lipid panels, so you may need to specifically request it from your healthcare provider.
Some key points to consider:
- ApoB is a better predictor of cardiovascular risk than LDL cholesterol, especially in patients with high triglycerides or small, dense LDL particles 1.
- ApoB levels are highly correlated with non-HDL cholesterol, which is also a good predictor of cardiovascular risk 1.
- The measurement of apoB is particularly useful in patients with diabetes or metabolic syndrome, as it can help identify those at higher risk of cardiovascular disease 1.
- ApoB testing is not yet widely available, but it is becoming more common and can be requested by healthcare providers.
In terms of specific guidelines, the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol recommends measuring apoB in certain patients, such as those with high triglycerides or diabetes 1. The European Guidelines on Cardiovascular Disease Prevention in Clinical Practice also recommend measuring apoB in patients with high cardiovascular risk 1.
Overall, apoB is a valuable tool for assessing cardiovascular risk and guiding treatment decisions, and its use is supported by recent guidelines and studies 1.
From the Research
Most Accurate Lipid Blood Marker
- The most accurate lipid blood marker is apolipoprotein B (apoB) 2, 3, 4, as it integrates the conventional lipid markers into a single index that accurately quantitates the atherogenic risk due to the apoB lipoprotein particles.
- ApoB is a direct measure of circulating numbers of atherogenic lipoproteins, and its measurement can be standardized across laboratories worldwide 3.
- Discordance analysis of non-HDL cholesterol versus apoB demonstrates that apoB is the more accurate marker of cardiovascular risk 3, 4.
- ApoB is superior to non-HDL cholesterol as a secondary target in patients with mild-to-moderate hypertriglyceridemia, diabetes, obesity or metabolic syndrome, or very low LDL cholesterol < 70 mg/dL 3.
- Measuring apoB as well as the conventional lipids is essential for accurate diagnosis, and for almost all follow-up, however, apoB is all that need be measured 2.
Comparison with Other Markers
- Non-HDL cholesterol is calculated as total-HDL cholesterol, and includes the assessment of remnant lipoprotein cholesterol, an additional risk factor independent of LDL cholesterol 3.
- Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), and measuring Lp(a) particle number [Lp(a)-P] is more accurate than estimating Lp(a)-C 5.
- ApoA1 measurements may also contribute to cardiovascular risk assessment, but further studies are needed to determine whether ApoB and ApoA1 are superior to conventional lipid parameters as predictors of cardiovascular disease or therapeutic targets of hyperlipidaemias 6.