According to the INTERHEART study report released in 2004 involving 52 countries and 30000 individuals, the single most important predictor of Myocardial Infarction (MI) is the ratio of two proteins in the blood - Apolipoprotein B ( ApoB in short ) & Apolipoprotein A-1 (ApoA-1) Myocardial Infarction is a manifestation of Coronary artery disease ( CAD) due to atherosclerotic plaque deposits in the artery .This ratio ( ApoB / ApoA-1) is a strong risk predictor of heart disease -,better than TG/HDL ratio and TC/HDL ratio . These Apolipoproteins are not checked in the standard lipid profile test and therefore the standard lipid profile test does not give much information in so far as the heart disease risk factor is concerned . Apolipoprotein A-1 is the major structural protein of HDL particle which is large and fluffy .It is responsible for reverse cholesterol transport in the blood stream - taking the cholesterol back to the liver from the cells. Apolipoprotein B are small dense cholesterol carriers which get easily oxidized causing inflammation in the artery and therefore , they are atherogenic particles
Similar study conducted in 2010 in the Biochemistry Department of Lady Hardinge Medical College ,New Delhi also corroborates with the INTERHEART study report and recommends that ApoB / ApoA-1 ratio be used for Indian population for assessing risk of MI. The study report is attached
Here comes the crux of this post.,where I do share my real life experience
I am a follower of LCHF diet since July 2013. Though my HbA1C level has considerably reduced with LCHF diet ( from 7.2% to 6.2%) my recent Lab report indicates that my LDL cholesterol is 138 mg/dL .My Diabetologist considers this level as a bit high and has prescribed me stain drug to reduce it to a ‘safe level’ since it is higher than the reference value of 100 mg/dL . However, I was not willing to take stain drug since I knew it caused more harm than good . I know that it is the small dense component of LDL particles which are really bad and not LDL cholesterol per se. Driven by the knowledge gathered from my web search on risk predictors for heart disease , I was searching for a clinical lab where I could get my Apolipoproteins A1 & B checked. Many clinical Labs did not even know what I was referring to. Some labs asked me to spell Apolipoprotein !!.Finally, I stumbled upon a biochemistry lab attached to the famous Narayana Hrudayala in Bangalore where I have got my blood sample tested for the lipoproteins A1 & B. The results are :
Apo A-1 = 162 mg/dL ( Ref. value : 104 to 202)
Apo B = 99 mg/dL (Ref .value : 66-133)
Apo A-1 / Apo B ratio is 0.61
Though there is no reference value available for the ratio, the doctor attached to this lab informed me that the relative risk of CAD in my case is low .
According to conventional lipid test results , my risk factor for MI is high and the doctor prescribes stain for me to reduce the risk. But actually , the risk predicted by the new bio-marker( Apo B/Apo A-1) is rather low . I attribute this low risk to the LCHF diet . My HDL and TG levels have improved in the last 10 months.( 68 & 63 mg /dL respectively) Even the increase in LDL cholesterol level is due to large buoyant LDL particles which are not atherogenic .Small dense atherogenic LDL particles have in fact been reduced by restrictions imposed by LCHF diet .We could find many scholarly articles ( if we really look for) on restriction of carbohydrates leading to reduction in small dense atherogenic LDL particles while increasing the large buoyant LDL particles which are good
LCHF works .