Recent studies underscore the importance of measuring Apolipoprotein B (ApoB) and Lipoprotein(a) [Lp(a)] levels in predicting the risk of coronary artery disease (CAD). Together, these findings demonstrate that both biomarkers are essential to truly grasping the complexity of cardiovascular health. This holds particularly true for people without any prior heart disease. ApoB was long understood as the only key structural protein present in all atherogenic lipoproteins. This is composed of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and intermediate-density lipoprotein (IDL).
Coronary artery disease is the most common type of heart disease and can result in life threatening complications, such as heart attack. Lp(a) as an emerging driver of CAD risk Elevated levels of Lp(a) have become recognized as an independent and strong driver of CAD risk. The research shows that each one standard deviation increase apoB particle count greatly increases the risk of developing CAD. In reality, this increase is associated with a 33% higher risk of starting. In a specific population known as the SIMPLER group, researchers observed a 26% increase in CAD risk associated with ApoB.
ApoB particle count is a more direct measure of the number of atherogenic particles state of the arteries circulating in the bloodstream. Each of these particles carries one ApoB molecule, so it’s a key marker for determining cardiovascular risk. The study found that after conducting their analysis, ApoB containing particles came out as the predominant lipid related CAD risk factor. This unexpected finding calls for further investigation of these levels in the clinic.
Lp(a) qualifies for the ApoB-P category. This classification gives further weight to its role as the most important key CAD risk indicator linked to lipids. Even with the ongoing uncertainties, the relationship between Lp(a) and higher rates of atherosclerotic cardiovascular disease is strong. This association remains even after adjusting for cholesterol and ApoB levels. These kinetics indicate that Lp(a) is unique with regard to cardiovascular health and cannot be treated as such.
“In a large, healthy population without prior heart disease or lipid-lowering therapy, the total number of atherogenic lipoprotein particles (apoB-containing particles) emerged as the strongest lipid-related risk factor for coronary artery disease, regardless of their type (VLDL vs LDL) or size. In addition, elevated levels of lipoprotein(a) [Lp(a)] were identified as an independent and significant driver of [coronary artery disease] risk.” – Source from the study
Yu-Ming Ni, a researcher who helped conduct the analyses behind the recommendations, reiterated in an email that it’s crucial to consistently monitor Lp(a) levels.
“This study also helps to show the importance of [lipoprotein(a)].” – Yu-Ming Ni
Ni expanded on Lp(a)’s role as an independent risk factor for CVD.
“This particle [lipoprotein(a)] has been shown in previous studies and in this one to [be associated] with higher rates of [atherosclerotic cardiovascular disease], even when taking cholesterol and ApoB into account. So, it is a separate and independent risk factor [for heart problems],” – Yu-Ming Ni
“These findings support a shift in clinical practice toward routinely measuring apoB and Lp(a) to better assess cardiovascular risk, especially in primary prevention. Targeting apoB and Lp(a) directly may improve prevention strategies, as relying solely on LDL cholesterol could miss some individuals who still have high risk despite ‘normal’ LDL-C levels. Incorporating Lp(a) screening is key to identify high-risk patients who would otherwise go undetected with standard lipid testing.” – Jakub Morze
Patrick Kee, a second expert in cardiovascular health, explained ApoB’s importance.
“ApoB, a structural protein, is present in all atherogenic lipoproteins, including LDL, VLDL, and IDL. Each particle contains one apoB molecule, making it a direct measure of the number of atherogenic particles in the bloodstream. This is crucial because the number of these particles, rather than just the amount of cholesterol they carry, is a key driver of atherosclerosis and subsequent cardiovascular events.” – Patrick Kee
Kee was a big advocate for increasing Lp(a) testing. As he explained, new therapies will allow us to make prevention the frontline against atherosclerotic cardiovascular disease.
“I routinely test my patients for this particle, and there are new therapies for LPa that are in clinical trials and may show usefulness for preventing [atherosclerotic cardiovascular disease]. I recommend everyone be tested at least once for LPa in their life.” – Patrick Kee
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