From 2015 to 2018, nearly 93 million U.S. adults aged 20 or older had high or borderline high cholesterol (a total cholesterol greater than or equal to 200 mg/dL), according to research by the American Heart Association. That’s a startling statistic when you consider that high cholesterol also increases your risk for heart disease and stroke, two leading causes of death in the United States.

Because high cholesterol doesn’t have symptoms, many people don’t know their levels are high.

The only way to know whether you have high cholesterol is to get your cholesterol checked, which is often included in your annual wellness exam. This simple blood test, called a “lipid profile,” measures LDL or “bad cholesterol,” HDL, or “good cholesterol,” triglycerides and your total cholesterol counts. The results of this test can help inform you and your healthcare provider of your risks and come up with an action plan, if necessary.

However, a relatively new test, in conjunction with your annual lipid panel, can help provide more clarity into your personal heart disease risk.

The Test

As we mentioned earlier, in a traditional lipid panel, LDL, or “bad cholesterol” is measured. A high measurement of LDL is often used as an indicator of heart disease and stroke risks. But some emerging evidence suggests that a protein named apolipoprotein b (apoB) is an even more accurate marker that can identify potential high-risk patients.

ApoB is a protein that is primarily involved in the transportation of lipids, particularly cholesterol, in the bloodstream. It is a component of several types of lipoproteins, including LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein), which are responsible for carrying cholesterol and other fats from the liver to other parts of the body.

Lipoproteins that contain apoB, such as bad cholesterol, are particularly dangerous because they can penetrate the walls of arteries. Similar to LDL, these apoB particles can lead to plaque buildup in the arteries, increasing your risk of heart disease and stroke.

Why is apoB a Better Predictor of Heart Disease Risk?

Firstly, ApoB is a more direct measure of the number of artery-clogging lipoprotein particles in the bloodstream compared to traditional lipid panel measurements. This is because each LDL particle contains one ApoB molecule, so measuring ApoB provides a more accurate reflection of the number of LDL particles in the blood.

Secondly, research has shown that ApoB levels are a better predictor of cardiovascular disease risk compared to traditional lipid panel measurements. This is because some individuals may have a normal lipid panel but still have an increased number of artery-clogging lipoprotein particles, which can increase their risk of developing cardiovascular disease.

Finally, apoB measurement can also be used to monitor the effectiveness of lipid-lowering therapies such as statins, as apoB levels are more closely associated with cardiovascular risk reduction than LDL cholesterol levels.

Therefore, in some cases, measuring ApoB may provide more accurate information about an individual's cardiovascular risk and help guide treatment decisions.

Should You Add an ApoB Test to Your Lipid Panel?

Whether you should test for apoB depends on various factors, such as age, gender, family history of heart disease, and other cardiovascular risk factors, such as high blood pressure, high blood sugar, obesity, smoking, and physical inactivity. However, it may be a good idea to have your apoB levels measured at least once to see if it’s consistent with your cholesterol levels, especially if you have a family history of heart disease.

In general, apoB testing may be recommended if you have a family history of premature heart disease, if you have multiple cardiovascular risk factors, and/or if you have a history of diabetes or metabolic syndrome.

Additionally, apoB testing can also be useful for monitoring the effectiveness of lipid-lowering therapies, such as statins, in reducing cardiovascular risk.

It is worth noting that apoB testing may not be covered by insurance, and the cost may vary depending on the location, your healthcare provider and/or your preferred lab. Therefore, it is essential to discuss the potential benefits and risks of apoB testing with your doctor. They can help you decide whether testing is appropriate or not.

Regardless of if you choose to add apoB testing to your lipid panel, it is recommended that you receive regular lipid panel screenings in order to monitor cholesterol levels and introduce lifestyle interventions or medical treatments as soon as possible to reduce the risk of developing cardiovascular disease.

Finding a physician who can partner with you for your health is essential. We can help find a physician that’s appropriate and convenient for you. Call 1-877-THR-WELL (847-9355) or visit TexasHealth.org/FindaProvider today.