From the Guidelines
Apolipoprotein B (Apo B) 100 testing is a valuable tool for assessing cardiovascular risk, particularly in patients with high or very high CVD risk, with target levels of <80 and <100 mg/dL, respectively, as recommended by the European guidelines on cardiovascular disease prevention in clinical practice 1. The significance of Apolipoprotein B (Apo B) 100 testing lies in its ability to provide a more accurate assessment of the adequacy of LDL-lowering therapy and its potential to identify patients with discordance between LDL-C and actual particle numbers. Key points to consider when interpreting Apo B-100 test results include:
- Apo B-100 levels can be substituted for LDL cholesterol in risk assessment, but do not add further to the risk assessment 1
- Apo B-100 is a better index of the adequacy of LDL-lowering therapy, with less laboratory error in its determination, particularly in patients with hypertriglyceridaemia 1
- Target levels for Apo B-100 should be below 80 mg/dL for subjects with very high CVD risk and below 100 mg/dL for those with high CVD risk 1 The use of Apo B-100 testing can help guide treatment decisions, including the initiation or intensification of lipid-lowering therapy, and can provide a more accurate assessment of residual risk in patients already on treatment. In clinical practice, Apo B-100 testing can be particularly useful for patients with diabetes, metabolic syndrome, or those with normal LDL-C but elevated triglycerides, as these conditions can mask cardiovascular risk when only standard lipid panels are used. Overall, Apo B-100 testing is a useful tool for assessing cardiovascular risk and guiding treatment decisions, with a simple blood draw required for the test, and target levels that can help identify patients at high or very high CVD risk 1.
From the Research
Significance of Apolipoprotein B (Apo B) 100 Testing
- Apolipoprotein B (Apo B) 100 testing is significant in assessing cardiovascular risk and guiding lipid-lowering therapy 2, 3, 4, 5.
- Apo B 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, 5.
- The 2019 European Society of Cardiology/European Atherosclerosis Society Guidelines concluded that Apo B was a better guide to the adequacy of lipid lowering than LDL-C or non-HDL-C 2.
Clinical Applications of Apo B 100 Testing
- Apo B 100 testing can be used to assess the effectiveness of statin therapy and guide treatment decisions 3, 4.
- Apo B offers a more consistent treatment target independent of hypertriglyceridaemia and can obviate technical problems related to high triglycerides 3.
- Measuring Apo B levels can help identify patients at high cardiometabolic risk, such as those with diabetes mellitus or metabolic syndrome 5.
Relationship between Apo B and Cardiovascular Disease
- Low levels of anti-apolipoprotein B-100 autoantibody (anti-apo B-100 Ab) have been correlated with an increased cardiovascular disease (CVD) risk in patients with diabetes 6.
- Serum anti-apo B-100 Ab levels have been shown to be a marker of unstable coronary plaque in patients undergoing elective percutaneous coronary intervention (PCI) 6.
- Apo B measurements may be useful in evaluating the risk of coronary plaque rupture and guiding treatment decisions 6.