From the Guidelines
Apolipoprotein B (ApoB) management to reduce cardiovascular risk should focus on lowering levels to <80 mg/dL for high-risk patients and <100 mg/dL for subjects with very high CVD risk, through lifestyle modifications and pharmacotherapy, prioritizing statin therapy as the primary approach. The management of ApoB involves both lifestyle modifications and pharmacotherapy. Key lifestyle modifications include:
- A Mediterranean diet low in refined carbohydrates
- Regular physical activity
- Weight management
- Smoking cessation Pharmacotherapy primarily involves statin therapy, with high-intensity statins being most effective at reducing ApoB levels 1. ApoB is considered a similar risk marker to LDL cholesterol and a better index of the adequacy of LDL-lowering therapy, with less laboratory error in its determination, particularly in patients with hypertriglyceridaemia 1. Target ApoB levels should be individualized based on overall risk assessment, with the goal of reducing cardiovascular risk through the lowering of atherogenic lipoproteins 1. The use of ApoB as a marker of cardiovascular risk is supported by its representation of the total number of atherogenic particles, with each ApoB-containing lipoprotein carrying exactly one ApoB molecule. In clinical practice, the measurement of ApoB can be substituted for LDL cholesterol, but it does not add further to the risk assessment, and its determination can be easily and inexpensively provided by laboratories 1.
From the Research
Management of Apolipoprotein B to Reduce Cardiovascular Risk
- Apolipoprotein B (ApoB) is considered a more accurate measure of cardiovascular risk and a better guide to the adequacy of lipid lowering than low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (HDL-C) 2.
- The 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines concluded that ApoB can be measured more accurately than LDL-C or non-HDL-C, and it is a stronger predictor of cardiovascular events 2.
- Studies have shown that ApoB is a better predictor of cardiovascular risk than LDL-C, and it retains its predictive power in patients receiving lipid-modifying therapy 3.
Therapeutic Strategies to Lower ApoB
- Lowering the concentration of all ApoB-containing lipoproteins should be the focus of therapeutic strategies to reduce cardiovascular risk 4.
- Statin therapy is effective in reducing ApoB levels, but many individuals continue to have atherosclerotic cardiovascular disease (ASCVD) events despite statin therapy 5.
- New approaches, such as therapies that target lipoprotein(a) and inflammation, are being developed to further reduce ASCVD risk in patients with high triglycerides 5.
Measurement of ApoB
- Measurement of ApoB could improve cardiovascular risk prediction, especially when used in conjunction with LDL-C 6.
- The apo B/apo A-I ratio has been reported as a better predictor of cardiovascular events than LDL-C, and it retains its predictive power in patients receiving lipid-modifying therapy 3.
- Standardization of ApoB measurement is necessary to ensure accurate and reliable results, and the addition of ApoB to the routine lipid panel could enhance patient management 6.