A Better Test for “Bad Cholesterol”

A Better Test for “Bad Cholesterol”

Chapter 27 in my book, There’s An Elephant in the Room—Exposing Hidden Truths in the Science of Health (now available on Kindle and audio) focuses on heart disease and the cholesterol lie. “Study after study shows that high cholesterol reduces our risk for brain disease, reduces the risk of heart disease, and increases longevity. High levels of dietary fat are essential.” Reducing cholesterol with statin drugs is one of the worst medical recommendations we can be advised if we want to have a long, healthy life. An article written by Epoch Times reporter Cara Michelle Miller sheds light on a new test that provides much better insight into heart disease risk.

Looking Beyond Cholesterol Levels

“Standard cholesterol tests focus largely on low-density lipoprotein (LDL), the so-called bad cholesterol, along with high-density lipoprotein (HDL) cholesterol.”

Higher levels of LDL cholesterol in the blood were thought to be linked to an increased risk of heart attacks and strokes, and for decades, clinicians have used LDL as their primary guide for treatment. However, LDL is not a cholesterol molecule at all. It carries the cholesterol. Cholesterol is like a passenger hailing a taxi cab. The taxi cab is the LDL. Coronary heart disease has more to do with oxidized LDL (think rust on the taxi cab) not the actual cholesterol (the passenger in the cab). How does the LDL become oxidized. Glucose molecules attach themselves to the LDL and change the carrier’s shape resulting in the production of free radicals and inflammation. So, heart disease risk is not about the amount of cholesterol present. It depends on the number of bad cholesterol carriers. These oxidized LDL particles are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD).

A new test provides insight into the number of bad LDL cholesterol carriers that exist. The test measures apolipoprotein B (apoB), a protein that sits on every particle that carries cholesterol through the bloodstream. Unlike standard cholesterol tests, which measure how much cholesterol is circulating, an apoB test counts the actual number of those harmful particles. Side note: apoB is actually a glycoprotein with sugars glycosylated onto the protein structure. 

“Two people can have the same [low-density lipoprotein] cholesterol level, but the one with more apoB-containing particles may be at higher cardiovascular risk,” said Yiyi Zhang, an assistant professor at Columbia University Medical Center and an author of a recent study on the blood marker. “Because each particle carries exactly one apoB protein attached to it, measuring apoB gives a direct count of how many harmful, or atherogenic, particles—those capable of burrowing into artery walls and depositing plaque—are circulating in the blood.”

A More Precise Guide to Treatment

Beyond helping identify risks that might otherwise be missed, apoB can help doctors decide how aggressively to treat that risk, and a new study suggests that it does so more cost-effectively than current practice. In a study published in JAMA Network, Kohli-Lynch and colleagues used a computer model simulating about 250,000 U.S. adults eligible for statins to compare three ways of guiding cholesterol-lowering treatment: by LDL cholesterol, non-HDL cholesterol, and apoB.

They found that using apoB to guide treatment decisions gave the greatest overall benefit. It led to more treatment intensification when needed, which in turn prevented more heart attacks and strokes. The apoB-guided approach also produced more years of life in good health than the other approaches.

Blind Spot in Younger Adults

ApoB tests may be especially useful for assessing heart disease risks in younger adults. A study published in JAMA Network Open, Zhang and colleagues followed more than 10,000 adults for roughly two decades, drawing on data from three large U.S. cohort studies. They examined how well different cholesterol markers predicted future heart attacks and strokes.

Higher apoB levels were associated with greater heart disease risk and strokes across all age groups. However, the marker was especially informative in younger adults ages 18 to 39, where the risk gap between high and low apoB levels was four times greater than in older adults. In younger adults, a one-standard-deviation increase in apoB was linked to a 53 percent higher risk of ASCVD, compared with a 13 percent higher risk in adults ages 40 and older.

“We found that apoB may be more informative in younger adults,” Zhang said. “If apoB is elevated in young adulthood, those extra particles may be contributing to atherosclerosis decades before a heart attack or stroke occurs.” Adding apoB to standard risk equations modestly improved the ability to identify which younger adults would go on to develop cardiovascular disease, helping distinguish people who might otherwise look similar based on traditional cholesterol tests alone.

Why ApoB Isn’t Used More Widely–Yet

ApoB tests are relatively inexpensive—about $60 through major lab providers—but they are still not part of routine cholesterol screening. One reason is that the test usually has to be ordered separately. It is not included in a standard lipid panel. There is also the question of habit. For decades, clinicians have relied on LDL cholesterol to assess risk and guide treatment. Shifting to a different approach can take time, even as evidence continues to build. Being aware of these issues can help guide any medical intervention you may consider.