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This may be the reason deadly heart problems go undetected, according to new study

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This may help identify patients who are at increased risk for a cardiovascular event, despite having normal LDL cholesterol levels.

Part of the annual physical exam includes getting tested for levels of HDL (the good) and LDL (the bad) cholesterol. However, recent research indicates that these conventional tests may not provide the most precise assessment of heart disease risk.

New evidence suggests that assessing levels of Apolipoprotein B-100 (ApoB), a protein that transports fat molecules, including LDL cholesterol (the “bad” cholesterol), throughout the body, maybe a more reliable predictor of atherosclerotic cardiovascular disease. This condition occurs when cholesterol plaque accumulates, solidifies, and narrows the arteries.

The study, presented at the 2023 American College of Cardiology annual Scientific Sessions in New Orleans, suggests that ApoB testing can assist in detecting patients who may remain susceptible to a cardiovascular incident, even if their LDL cholesterol levels are normal.

“Testing for ApoB doesn’t tell you how much cholesterol a patient has, but instead it measures the number of particles that carry it,” points out principal investigator Jeffrey L. Anderson.

The expert also said that ApoB testing is still uncommon, but is becoming more common.

“While it’s still not a commonly ordered test, we found that it’s both being used more often, and it could lead to a more accurate way to test for lipoprotein-related risk than how we do it now,” Dr. Anderson adds. “For example, some people have normal LDL cholesterol levels but still have a large number of particles due to an abundance of small, dense LDL particles.”

Several studies have shown that particle counts, as measured by ApoB levels, are better risk indicators than cholesterol levels.

Researchers from Intermountain Health looked at the EHRs of all of its patients between 2010 and February 2022 for this study.

They discovered that the number of Apo B testing cases rose from 29 in 2010 to 131 in 2021. In addition, they discovered that ApoB levels positively linked with LDL cholesterol, but that the ApoB/LDL cholesterol ratio rose as LDL cholesterol fell, indicating the existence of an excessive number of atherogenic tiny, dense LDL particles.

Dr. Anderson argues that ApoB may be more useful for risk assessment than LDL cholesterol, particularly in individuals with metabolic syndrome (normal LDL cholesterol but other risk factors including diabetes, pre-diabetes, or low HDL and high triglyceride levels).

“Data suggest that these particle numbers increase risk to a greater extent than just cholesterol levels alone,” says Dr. Anderson, adding, “ApoB could help us identify a population of patients with normal or even low LDL numbers but who are at higher risk and should be more aggressively treated.”

But, Dr. Anderson does not anticipate ApoB to overtake HDL and LDL testing as the norm anytime in the near future.

While apoB testing is a little more costly and hasn’t yet been fully integrated into the healthcare system, it should be seen as a helpful tool by physicians to better understand cardiovascular risk, particularly in these particular patient categories.

Image Credit: Getty

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