What You Need To Know About The New “Bad” Cholesterol

For more than a decade, researchers have known that relying on old-fashioned cholesterol blood tests for measuring your risk for heart disease is less reliable than many doctors believe. Unfortunately, the physicians you may visit – including cardiologists – aren’t yet relying on this discovery. Here’s what you need to ask your doctor…

Key Takeaways

• Recent studies reveal complexities in cholesterol's role in heart health, showing that measuring traditional metrics like high “bad” LDL levels may not be enough to predict heart health.
• An ApoB test is more accurate for assessing heart disease risk because it measures the particles that carry potentially harmful cholesterol to arteries.
• Despite its benefits, ApoB testing has not been widely adopted by doctors, yet it’s easy to obtain.

What Is ApoB?

Apolipoprotein B (ApoB) is a protein that plays a crucial role in lipid (fat) metabolism and cardiovascular health. It is a primary component of lipoproteins, particles in the blood that transport cholesterol and other lipids throughout the body.

Specifically, ApoB is a critical structural protein found in low-density lipoproteins (LDL), very-low-density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL). According to a wide range of experts, doctors should test your blood not only for “bad” LDL cholesterol but also for ApoB if they want to accurately assess your chances of suffering heart problems.

Testing for ApoB

The ApoB test analyzes the number of cholesterol-carrying particles ferrying potentially harmful LDL cholesterol around your body in your blood. Studies show that your ApoB number better indicates whether you need to worry about your arteries clogging up with plaque and blocking blood flow to your heart than a plain old cholesterol reading. The ApoB proteins can lead LDL cholesterol to stick to artery walls, forming plaques that block blood from getting nutrients and oxygen to the heart muscle.[1]

Of course, getting doctors to use additional blood tests to figure out your heart health is a slow slog.

Within medical circles, the argument from several medical researchers for using ApoB instead of the same old cholesterol tests has been growing louder and more widespread for at least ten years. According to Allan Sniderman, M.D., who has been studying ApoB and heart health, a test for ApoB is cheap (between 20 and 100 dollars) and would help people better understand how concerned they should be about their health risk.

ApoB Beats LDL Cholesterol Testing Hands Down

Dr. Sniderman insists, “The debate is over” when it comes to deciding on the most accurate test[2]. ApoB is the winner, he says.

And he’s got solid evidence on his side: “The standard cholesterol blood test that is used today is considered by mainstream doctors to be about 85 percent accurate in predicting who is most likely to have blocked arteries that threaten heart health.” And that means 15 percent of its predictions of future heart trouble are wrong, according to researcher Brian Ference, M.D., of the University of Cambridge in the United Kingdom.[3]

That 15 percent represents millions of people with misleading results!

As we noted before, ApoB tests are more accurate because they measure the amount of delivery proteins in the blood that can carry potentially artery-clogging LDL (bad cholesterol) to artery walls. This clever little test is like a super-smart traffic camera that counts the number of delivery trucks on the highway.

In contrast, when your doctor gives you the standard cholesterol test, you learn how much LDL cholesterol you have and how much HDL (“good”) cholesterol is in your blood. Still, it doesn’t indicate much about the number of LDL particles that could be chauffeured to the walls of your arteries.

The Truth About LDL and HDL Cholesterol

If you look at some of the recent studies into cholesterol, you can see that there’s a lot about it that we still don’t understand. For instance, it’s generally believed that while LDL cholesterol endangers health, HDL cholesterol can provide some protection from heart problems.

However, a study by Oregon Health & Science University researchers muddies that idea. In this research, the scientists found that while HDL lowered the risk of heart attacks and death in white people, it didn’t have the same benefits for black people.

Plus, in this study, which involved more than 23,000 Americans (a lot of people!), having a high HDL level didn’t lower anybody’s risk of having non-fatal heart disease, regardless of race or gender.[4]

So, for anyone who’s been reassured by their cholesterol test that showed high HDLs and low LDLs, your reassurance may be misplaced. This kind of research presents another reason for finding out what your ApoB measurement is.

Getting An ApoB Test

Unfortunately, even folks pushing for widespread use of the ApoB tests know it’s not an easy sell – and they’re pessimistic about its future use. Most doctors, accustomed to the usual cholesterol tests, still refuse to use ApoB blood tests regularly. As Dr. Sniderman admits, “I go from depression to worse depression.”

In other words, you can’t count on your doctor. But you can ask your doctor to order an ApoB test. We’d encourage it, especially if you have concerns about cardiovascular risk, a family history of heart disease, or other related health problems.

You might mention that you want a more accurate assessment of your cardiovascular risk than what traditional cholesterol tests provide. If you’ve already had inconclusive cholesterol tests or if you have additional risk factors (such as high blood pressure, diabetes, or a family history of heart disease), make sure to discuss these as well.

If your healthcare provider agrees that an ApoB test is appropriate, they will provide a prescription or order for the test. This prescription will typically be sent directly to a laboratory, or you may receive a physical copy to take to the lab.

The ApoB test is a blood test similar to other cholesterol tests. Depending on the lab's protocol or your healthcare provider's instructions, you may be asked to fast for nine to 12 hours before the test.

Some companies offer direct-to-consumer testing, where you can order an ApoB test online and have your blood drawn at a local lab without needing a doctor’s prescription. However, following up with a healthcare provider to interpret the results is important.

The ApoB test is one of several new ways to monitor your heart health. Medical researchers are pointing to everything from retinal scans such as QUARTZ to checking your earwax-- no kidding, it really works!

Our Takeaway

The most important advice is to follow a heart-healthy lifestyle.

This begins with an anti-inflammatory diet rich in whole, organic foods, including fruits, vegetables, whole grains, lean meats, and healthy oils such as olive oil and coconut oil. Avoid processed foods—even vegetables and fruit—as much as possible.

It also includes sufficient sleep and regular exercise—even just walking an extra 500 steps a day can lower your risk of heart problems and help keep your cholesterol and blood pressure in the normal range.

Summary

For over a decade, experts have recognized that traditional cholesterol tests may not be the most reliable indicator of heart disease risk. A more accurate alternative, the ApoB test, measures the number of cholesterol-carrying particles, providing better insight into the potential for artery-clogging and heart issues. Despite strong evidence supporting ApoB testing, it has yet to gain widespread use among physicians, leaving millions of people with potentially misleading cholesterol readings.