Cardiovascular diseases continue to be the leading cause of death worldwide, underscoring the importance of early detection and prevention. Traditionally, heart health assessments have focused on measuring low-density lipoprotein (LDL) cholesterol—commonly referred to as “bad cholesterol”—due to its role in plaque formation within the arteries. However, recent advancements in medical research are introducing more precise biomarkers, such as apolipoprotein B (ApoB) and lipoprotein(a), that provide deeper insights into cardiovascular risk.
Dr. Vikranth Gongidi, a cardiologist with Premier Cardiology, explained the evolution of these tests: “Previously, individuals undergoing blood work were asked to fast to measure their LDL levels, which are linked to plaque buildup that can lead to heart attacks, strokes, and even kidney failure. However, recent advancements allow for more accurate measurements of LDL, and the process no longer requires fasting.”
While LDL has long been considered a key indicator of cardiovascular risk, traditional methods of measuring it have their limitations. Individuals with normal LDL levels can still experience cardiovascular events due to other lipid abnormalities that go undetected by standard tests. Additionally, these tests fail to account for the number or size of LDL particles, which can vary widely between individuals and influence cardiovascular risk independently of cholesterol content.
“When a person with normal LDL levels suffers a stroke or heart attack, we are often left wondering why, since they didn’t have high cholesterol,” Dr. Gongidi said. “This is where newer tests, like those measuring ApoB and lipoprotein(a), come into play.”
Apolipoprotein B (ApoB) is a structural protein found in all atherogenic lipoproteins, including LDL. These lipoproteins are known to create fatty deposits in arteries. Unlike traditional cholesterol tests, ApoB provides a direct count of the number of atherogenic particles circulating in the bloodstream, offering a more accurate picture of cardiovascular risk. Research has shown that the number of LDL particles is more closely correlated with cardiovascular risk than the cholesterol content within them.
Lipoprotein(a), or Lp(a), is another significant marker in cardiovascular health. Similar to LDL, Lp(a) contains an additional protein called apolipoprotein(a), which increases its tendency to form harmful plaque and blood clots. Elevated levels of lipoprotein(a) are primarily determined by genetic factors and are linked to a heightened risk of atherosclerosis, coronary artery disease, and aortic valve stenosis.
Dr. Gongidi recommended that everyone undergo a one-time screening for lipoprotein(a) as a baseline, especially since elevated levels can signal an increased risk of heart attacks and strokes. “If a patient’s lipoprotein(a) level exceeds 75, it indicates a higher risk for cardiovascular events,” he explained. “In such cases, we often begin treatment with medications like statins to lower LDL levels and manage the risk of plaque buildup.”
Statins, which are most effective when started early, can significantly reduce the risk of heart attacks in individuals aged 30 to 50 with elevated lipoprotein(a) levels, potentially lowering their heart attack risk by up to 20 years. As Dr. Gongidi emphasized, “I don’t want to wait until a patient has a heart attack to begin treatment. Statins work best when they are initiated early.”
While lipoprotein(a) testing is generally a one-time event, ApoB should be tested annually due to its sensitivity and ability to provide a more detailed analysis of cardiovascular risk.
Integrating ApoB and lipoprotein(a) testing into routine cardiovascular screenings allows for a more comprehensive assessment, particularly for individuals with complex lipid profiles or genetic predispositions to heart disease. However, Dr. Gongidi noted that most primary care doctors may not order these advanced tests during a standard physical. “If you are concerned about your cardiovascular health, be sure to request these tests specifically,” he advised. “If any results are elevated, follow up with a cardiologist for further evaluation and treatment.”
Beyond cholesterol and lipid tests, maintaining good heart health requires a holistic approach. The American Heart Association provides several key measures for improving and preserving cardiovascular health:
Eat a Balanced Diet: Focus on whole foods, fruits, vegetables, lean proteins, and healthy fats like those found in olive oil and canola oil.
Stay Active: Adults should aim for 2.5 hours of vigorous physical activity per week, while children should get at least 60 minutes of activity every day.
Quit Smoking: Smoking, including e-cigarettes and vaping, remains the leading preventable cause of death in the U.S., contributing to nearly a third of all deaths from heart disease.
Get Adequate Sleep: Adults should get 7-9 hours per night, while children need between 8 and 16 hours depending on age.
Manage Weight: Keeping a healthy body mass index (BMI) below 25 is optimal for heart health.
Control Cholesterol: High levels of non-HDL cholesterol can increase the risk of heart disease.
Monitor Blood Sugar: Long-term high blood sugar levels can damage your heart, kidneys, eyes, and nerves.
Control Blood Pressure: Aim for a blood pressure reading of less than 120/80 mmHg.
By incorporating these habits along with advanced testing, individuals can better manage their cardiovascular health and reduce the risk of future heart-related events.
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