When it comes to heart health, many people focus on total cholesterol or HDL, often referred to as “good cholesterol.” However, these metrics might not provide the full picture of your cardiovascular risk. According to leading experts, two critical tests—apoB and Lp(a)—are far more predictive of your risk for atherosclerotic cardiovascular disease (ASCVD).
Why ApoB Matters
ApoB, short for apolipoprotein B, is a protein that forms part of LDL and other lipoproteins contributing to plaque buildup in arteries. The higher your apoB levels, the greater your risk of heart attack or stroke.
Experts recommend an ideal apoB level of 30–40 mg/dL, similar to levels seen in children. Levels above 60 mg/dL indicate increased risk. Fortunately, apoB can often be reduced through dietary changes, such as swapping saturated fats for monounsaturated fats found in olive oil, macadamia nuts, and avocados. Exercise and managing triglycerides can also help.
If lifestyle changes aren’t enough, medications such as PCSK9 inhibitors, ezetimibe, or bempedoic acid can effectively lower apoB. Testing for apoB is simple and affordable, costing around $15 to $20.
The Importance of Lp(a)
Lp(a), or lipoprotein(a), is another crucial marker, particularly for individuals with a family history of heart disease. Elevated Lp(a) levels are a hereditary risk factor affecting up to 10% of the population, with a higher prevalence in individuals of African descent.
Unlike apoB, Lp(a) levels are not influenced by diet or lifestyle. While PCSK9 inhibitors may reduce Lp(a) by about 30%, their effectiveness in preventing cardiovascular events is not yet established. Therefore, the best approach is aggressive management of other risk factors, such as keeping apoB, blood pressure, and insulin levels in check, maintaining a healthy weight, and quitting smoking.
Both apoB and Lp(a) tests provide valuable insights into heart health. If you’re concerned about your risk, ask your doctor to include these tests in your next blood panel. Early detection and proactive management can make a significant difference in preventing serious heart conditions.