LDL-C or apoB as the Best Target for Reducing Coronary Heart Disease

I was reading a medical study on treatment targets and found this fascinating insight:

"Conclusion & Future Perspective

It is usually argued that the introduction of apoB as a marker of risk and target of therapy would lead to confusion of both physicians and patients. For more than two decades, a great effort was devoted to education on the issue of the role of 'bad cholesterol' (LDL-C) in the development of atherosclerosis and the necessity of cholesterol-lowering therapy in the prevention of CVD. Thus, most authorities in this field think that it is necessary, at least for an interim period of time, to introduce apoB assessment to the routine lipid profile.

ApoB is a marker of the risk of atherogenic particles, especially LDL risk, and cannot substitute the whole lipid profile, especially at baseline examination. Thus, as this article suggests, apoB should be a part of the routine lipid panel at baseline. However, when apoB is the target, total cholesterol, LDL-C and non-HDL-C need not be measured on routine follow-up visits. Thus, apoB could unify all lipid targets representing the proatherogenic lipoprotein particle risk into one parameter.

Estimation of baseline TGs is useful, as a mild-to-moderate increase in TGs is a good marker of insulin resistance and its associated risk factors and also as a marker of increased risk of CVD.[38] Even in patients treated with statins to achieve very low levels of LDL-C of less than 70 mg/dl, high TG levels represent a considerable residual risk.[69] "

medscape.com/viewarticle/73...

The study went on to conclude...

"Several observations have shown that for many antiatherogenic roles of HDL, apoA-I is more important than HDL particle cholesterol content. Thus, in future, HDL-C assessment could probably be substituted with apoA-I assessment until better methods for the evaluation of HDL functionality are developed.

At present, the apoB:apoA-I ratio seems to be the best marker of cholesterol balance. It was shown to be the best marker of risk of MI and CVD in the AMORIS[24] and INTERHEART[72] studies, and also the best marker of treatment effects in the AFCAPS/TexCAPS study[45] and in combined data from the TNT and IDEAL studies.[48] Thus, for the future, the apoB:apoA-I ratio is a promising marker of both risk and treatment effect."

medscape.com/viewarticle/73...

In summary, the ApoB measures atherogenic particles in your bloodstream. These are the particles that cause plaque accumulation which leads to artery narrowing and increase the risk of a heart attack and stroke. LDL-C is an estimated value and also includes NON-atherogenic particles, therefore it is not the optimal lipid value as a treatment target.

The ApoB/ApoA-1 ratio provides the balance between atherogenic and and anti-atherogenic particles in your bloodstream and appears to be the optimal treatment marker.

If you are not currently measuring ApoB and ApoA-1, you should ensure you begin doing so at your next blood test. You should then ensure that you get a copy of your blood test so you can record and monitor these values over time. By checking your blood lipids on a quarterly basis, it provides you with the motivation to stick to your cardio-protective diet. Such a diet should include the avoidance of sugars and simple-carbohydrates as the weight of evidence in CVD research is beginning to lean more toward the impact of sugar than saturated fat.

That said, I spoke with a research doctor at McGill University today who indicated that although sugar is probably the main culprit in CVD, it may also depend on the individual as some people are also affected by dietary saturated fat consumption. Therefore it is NOT open season for the consumption of saturated fats, moderation should be practiced. In either case, unless you combine daily rigorous exercise with a cardio-protective diet, it won't matter what you eat. Exercise is a baseline minimum to validate the benefits of either diet noted.

Be disciplined and continue to educate yourselves.

8 Replies

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  • In UK, there are guide lines for GPs therefore NHS guide line are used. If private health insurance is available we can do some investigation or pay for special investigation on offer.

    Armed with the findings I can go to my GP but GP is unable to hep you because of guide lines. Any difficult health problems NHS is the best.

    There are health screening group who offer a number of tests on special offer and provide a report, any help available, you can ask questions but difficult to get satisfactory answers.?

    I went for test with two different groups, very well written report, according to my GP I just have to wait, if a problem develops then the GP and the NHS can help as some of the test are not available via NHS.

  • Even when tests are available on the NHS, the funding cuts by the Cameron and May governments mean that primary care centres are reluctant to do the more expensive tests often. Hospital clinics will do them but I presume they're billing the care commissioning groups for it.

    Is ApoB and ApoA-1 an expensive test? Has anyone here got tips on how to get it monitored (rather than done as a one-off) in the UK?

  • Here in Canada the tests cost $35 CAD each. I understand that many people in the UK travel to Portugal for cheaper medical tests. Consider that as an option.

  • The expense of travelling to Portugal, including the high cost of health insurance for someone with a diagnosed illness, will probably outweigh any cost saving.

  • Excellent educational writing. Thanks.

  • You're welcome.

  • Here's a follow up to my post on LDL vs ApoB:

    healthcentral.com/cholester...

    A doctor explains the flaw with the LDL-C value from Lipid tests. The only thing he did not mention is that there are other calculations for LDL-C that are more accurate for those with extremely high or low levels of triglycerides. There is the Iranian formula and the Cordova Formula. Recently I had a blood test and my LDL-C was estimated at 3.04 mmol/l. When I used the alternative formulas because my triglycerides are very low at 0.64 mmol/l, the new result was 2.49 mmol/l. That is a significant difference which if used as a treatment target could make the difference between the doctor recommending statin treatment or not.

    Basing treatment decisions on such a lipid measurement with poor accuracy is irresponsible. Yet as the doctor outlined in his article, the medical community is usually about 20 years behind the science.

  • Man made calculation, what ever it is questionable?

    We have seen in UK in engineering, the London eye cable snapping on life and the bridge swinging, problem with man made calculation. The waist to height ratio only one variable most of the time!!!!

    I go for blood test to keep in line with the system, have questioned the calculation, no one could explain this to me, even a cardiologist just accept it and move one was a response.

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