The Cholesterol Test Doctors Rarely Order Might Actually Be the One That Predicts Heart Attacks The Most Effectively

If you’re over 30, you’ve probably had your cholesterol tested. You go in. They take some blood. A week later someone tells you your LDL cholesterol is either “a bit high” or “not too bad,” and depending on the mood of the universe you may or may not leave with a prescription for statins. So, it’s slightly unsettling to discover that the test millions of people rely on to assess their risk of heart disease might not actually be the best one available.

A new study from Northwestern University Feinberg School of Medicine in US, published in JAMA, suggests that another blood test (one most people have never heard of) could do a better job of predicting heart attacks and strokes. The test is called Apolipoprotein B (or apoB). According to the researchers, it may actually be the more accurate way to measure cardiovascular risk.

The Problem With “Bad Cholesterol”

For decades doctors have focused on something called LDL Cholesterol, often referred to as “bad cholesterol.” The idea is simple enough: too much LDL floating around in your bloodstream can end up sticking to artery walls, slowly building up plaque. Eventually, that plaque can narrow or block arteries entirely, which is the sort of development that tends to result in either a heart attack or a stroke... two outcomes that most people try to avoid.

So LDL became the number doctors watched most closely. The problem, according to the new research, is that LDL may not tell the whole story. It turns out cholesterol doesn’t travel through the blood by itself. Instead, it hitches rides inside tiny particles. Think of them as microscopic delivery vans carrying cholesterol around your body. And LDL testing measures the amount of cholesterol inside those vans.

But it doesn’t actually count how many vans there are. That’s where apoB comes in. The apoB test measures the number of cholesterol-carrying particles circulating in the bloodstream. Each one contains a molecule called apolipoprotein B, which makes it possible to count them. In practical terms, this matters because a person can have a normal amount of cholesterol overall but still have a large number of particles carrying it. And each particle has the potential to wedge itself into an artery wall. So, more particles can mean higher risk, even if the cholesterol level itself doesn’t look alarming.

"We found that apoB testing to intensify cholesterol-lowering medication would prevent more heart attacks and strokes than current practice, and that these health benefits were achieved at a cost that represents good value for U.S. health care payers," said study lead author Ciaran Kohli-Lynch, assistant professor of preventive medicine in the division of epidemiology at Northwestern University Feinberg School of Medicine.

What Was The Research Method?

The researchers created a large simulation involving about 250,000 adults in the United States who were eligible for statin therapy but had not yet developed cardiovascular disease. The model compared three strategies for deciding when patients should receive stronger cholesterol-lowering treatment:

1. Using LDL cholesterol levels
2. Using non-HDL cholesterol levels
3. Using apoB levels

If a patient’s numbers remained above the target level, doctors in the simulation intensified treatment: first by increasing statin strength, and then by adding another medication called Ezetimibe. The researchers then followed the simulated patients over a lifetime, tracking outcomes such as heart attacks, strokes, life expectancy, quality of life, and healthcare costs.

The apoB-guided strategy performed better than the others. It prevented more heart attacks and strokes, improved overall health outcomes, and did so in a way that researchers considered cost-effective for the healthcare system.

Source:

https://jamanetwork.com/journals/jama/article-abstract/2847303

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