Researchers at Intermountain Health have identified ApoB protein testing as potentially more informative than traditional cholesterol testing for spotting individuals at higher risk of cardiovascular disease. The findings were shared at the annual scientific sessions of the American College of Cardiology in New Orleans, underscoring a shift toward more precise risk assessment in everyday clinical practice.
Current cardiovascular health screenings routinely include measurements of HDL and LDL cholesterol, the so called good and bad cholesterol. These tests help doctors estimate a patient’s overall risk. A newer body of research, however, points to ApoB as a marker that may offer clearer insight into the underlying atherosclerotic process. ApoB carries fat molecules, including LDL cholesterol, throughout the bloodstream. Because each atherogenic particle in the blood contains one ApoB molecule, higher ApoB levels can reflect a greater number of cholesterol-carrying particles capable of forming arterial plaques. In other words, ApoB is tightly linked to the processes that lead to plaque buildup and narrowed arteries.
The researchers examined electronic medical records from 2010 through February 2022 to explore how ApoB relates to traditional lipid measures. The analysis showed a positive connection between ApoB levels and what clinicians classify as bad cholesterol. More importantly, ApoB demonstrated stronger predictive value for cardiovascular risk, particularly in patients whose LDL levels appeared normal on standard testing. This nuance matters because patients can have normal LDL readings yet still harbor a higher burden of atherogenic particles if ApoB is elevated.
This discrepancy means some individuals may have seemingly favorable LDL results but carry a hidden risk due to elevated ApoB. The result is a more accurate picture of who is at risk for adverse cardiovascular events, including heart attack and stroke. For clinicians, ApoB testing can provide additional confidence when making decisions about prevention strategies and therapies, especially in patients who fall into gray areas where LDL results are not clearly alarming. The practical implication is that ApoB can complement traditional lipid panels, helping tailor prevention plans to the unique risk profile of each patient.
Where ApoB testing fits into routine care depends on several factors, including cost and clinical context. The ApoB assay tends to be modestly more expensive than a standard LDL test, which means it may not replace LDL testing across all settings in the near term. Yet its value is evident in specific patient groups where standard lipid metrics fail to tell the full story. In these cases, ApoB testing can clarify risk and inform choices about lifestyle interventions, statin therapy, and the intensity of lipid-lowering strategies. The evolving data suggest that incorporating ApoB into risk assessment can elevate precision in preventive cardiology, aligning treatment recommendations more closely with each patient’s true atherogenic burden.
As the medical community continues to compare ApoB with traditional lipid markers, clinicians in North America and beyond are weighing practical considerations such as reimbursement guidelines, accessibility of testing, and integration into existing risk models. For patients, the takeaway is to discuss ApoB testing with a healthcare provider, especially if there are risk factors like a family history of heart disease, metabolic syndrome, diabetes, or elevated triglycerides. Informed conversations can help determine whether ApoB testing should factor into screening and prevention plans.
[citation needed for study details, attribution to Intermountain Health researchers presented at the American College of Cardiology conference, New Orleans, as reported in professional conferences and medical literature]