Key Test to Assess Your Heart Disease Risk

Most people have their cholesterol checked each year to assess their risk of heart disease. But a growing number of cardiologists say another test — one that measures a protein called apoB — may provide a clearer picture of cardiovascular risk.

Apolipoprotein B (apoB) attaches to plaque-forming particles in the blood, including low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL), both of which contribute to heart disease.

Even when LDL levels appear normal on a standard lipid panel, apoB levels can be elevated — a situation known as “discordance.” A high apoB level indicates that the total number of plaque-producing cholesterol particles is elevated, which may increase damage to the arteries.

Each harmful lipoprotein particle contains exactly one apoB molecule. Measuring apoB provides a direct count of these particles, making it a stronger predictor of heart disease risk than simply measuring the cholesterol carried inside them. This may be especially useful for people with diabetes, obesity, or high triglycerides.

Dr. Thomas Dayspring, a fellow of the National Lipid Association and cholesterol expert, says the buildup of plaque in the arteries is best assessed using apoB testing, according to NBC News..

“ApoB is by far the best metric that every human should get tested for when they do their cardiovascular risk assessments,” Dayspring said.

Currently, the American Heart Association does not recommend routine apoB testing for everyone, except in people at high risk or who have high triglyceride levels. However, many cardiologists now suggest adding apoB testing at least once to ensure it aligns with LDL results.

There are no universally accepted target levels for apoB. In generally healthy individuals, levels below 90 mg/dL are often considered acceptable, while some experts recommend aiming closer to 70 mg/dL for optimal heart disease prevention.

Meanwhile, research from Johns Hopkins University shows that nearly 25% of eligible adults have not had their cholesterol checked in the past five years — a troubling statistic given that heart disease remains the leading cause of death for both men and women.