In fact, recent studies have determined that the number of Apolipoprotein B particles are the most important lipid-related risk factor for CAD. These particles are critical in determining the health of one’s heart. Conducted on a large, healthy population devoid of prior heart disease or lipid-lowering therapy, the study found that increased levels of apoB particles correlate strongly with CAD risk. A one standard deviation increase in these fine particles more than doubles your risk. You have a 33% greater chance of getting coronary artery disease.
Apolipoprotein B functions as an important structural protein that is present in all atherogenic lipoproteins. This is made up of low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and intermediate-density lipoprotein (IDL). Since each apoB particle contains exactly one apoB molecule, it is a far more direct measure of the number of atherogenic particles present in the bloodstream. The study’s results highlight the importance of having a high apoB particle count as the defining feature of cardiovascular risk.
Alongside apoB, Lipoprotein(a) [Lp(a)] has become recognized as another important factor contributing to CAD risk. Several studies have demonstrated that high levels of Lp(a) are associated with an independent risk for coronary artery disease. This is still the case even when controlling for cholesterol and apoB. This underscores the importance that a greater Lp(a) count still remains as an independent risk factor for increased risk for coronary artery disease.
“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.” – Study Findings
The clinical implications of these findings are far-reaching, especially in light of emerging primary prevention strategies. Recent statements from experts in the field suggest that measuring both apoB and Lp(a) could improve risk assessment for coronary artery disease. Jakub Morze reinforced the importance these markers play in identifying high-risk patients. In their absence, such individuals could otherwise go unnoticed by routine lipid screening.
“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
These findings show that Lp(a) is more than an informative secondary marker. It is connected to higher rates of atherosclerotic cardiovascular disease. This association continues to hold true even after accounting for classic risk factors like cholesterol and apoB levels.
“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
Several experts agree that Lp(a) should be tested as a standard part of patient screening. Patrick Kee has been a longstanding advocate for this test to help identify more people at risk for 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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