Each week, OMRF Chief Medical Officer Dr. Judith James opens “Adam’s Journal” to answer a medical question from Adam Cohen, OMRF’s senior vice president & general counsel.
Adam’s Journal
I’ve recently read and heard about testing for something called Apo B. In particular, I’ve been told that it can be a more accurate predictor for heart attack risk than traditional cholesterol testing. Is this true?
Dr. James Prescribes
Apolipoprotein B, or Apo B, is a protein that carries cholesterol in our blood. Cholesterol is a fatty substance produced by the liver, and some foods – like fried food and processed meat – can increase the amount of cholesterol circulating in our blood.
There’s strong evidence linking higher levels of blood cholesterol, especially the type known as low-density lipoprotein (LDL) cholesterol, with risk for cardiovascular disease. Specifically, it can cause plaque build-up in our arteries and hardening of blood vessels, which can lead to heart attacks and strokes.
At the Oklahoma Medical Research Foundation, the late Dr. Petar Alaupovic helped pioneer the study of apolipoproteins. Apo B, the best-known of these compounds, is the main structural component of LDL cholesterol and other forms of cholesterol most associated with cardiovascular risk. As a result, measuring Apo B can serve as a proxy for measuring all of the so-called “bad” forms of cholesterol.
Testing Apo B levels can help predict heart attack risk, and physicians typically order it when they’re seeking an additional way to measure a person’s cardiovascular disease risk. So, it’s often used as a supplement to the traditional lipid panel, which gauges LDL cholesterol as well as a number of other forms of cholesterol and fatty compounds called triglycerides.
In a 2021 study in the journal The Lancet, researchers found that elevated levels of Apo B were associated with shorter lifespans, and the data suggested it was a stronger predictor than LDL levels. Apo B testing has also been found to be more helpful than a lipid panel at measuring cardiac risk for people with diabetes or metabolic syndrome. But whether it’s a more accurate predictor of cardiovascular disease in the general population remains an open question.
Without doubt, Apo B testing is a useful tool for assessing cardiovascular health. I would not recommend it as a substitute for a full lipid panel, but it can provide valuable additional information. Heart disease remains the leading cause of death in the U.S., and all of us should make it a priority to get screened regularly to know our risk.
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James is executive vice president and chief medical officer of the Oklahoma Medical Research Foundation. Cohen, a marathoner, is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
