The clinical utility of apoB versus LDL-C/non-HDL-C
Open accessAbstract
Background The ESC/EAS Guidelines and the EAS/EFLM consensus reports state that apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C and that apoB can be measured accurately and precisely than LDL-C or non-HDL-C. Nevertheless, EAS/EFLM called for a randomized clinical trial and a cost-effective analysis before widespread implementation of apoB. Objective To analyse these issues from the perspective of clinical utility as clinical utility would be considered by an informed patient and physician. Methods and results We highlight the biological inaccuracies as well as the laboratory inaccuracies of LDL-C/non-HDL-C versus apoB. We demonstrate why the biological variance in the cholesterol loading per apoB particle makes it impossible to design a randomized clinical trial to compare apoB to LDL-C/non-HDL-C. We further demonstrate that even in the context of the United States, adding apoB to a lipid panel would have only a trivial effect on costs. Conclusion We submit that no informed patient or physician would choose a less accurate test over a more accurate test if the more accurate test added only trivially to the total cost of care. For these reasons, the clinical utility of apoB far exceeds the clinical utility of LDL-C/non-HDL-C.
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In the USA, measuring apoB as well as a lipid panel at each visit would raise the cost of care by ∼1%.
“In the USA, measuring apoB as well as a lipid panel at each visit would raise the cost of care by ∼1%.26”
From Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention (2024) · cites this paper as [26]
Cites
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Sniderman, A. D., Dufresne, L., Pencina, K. M., Bilgic, S., Thanassoulis, G., & Pencina, M. J. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae258 · Cited by 117 · see citing works
“26 However, given that apoB is a more accurate measure of the adequacy of lipid-lowering therapy than LDL-C or non-HDL-C, 1,3–13 , 27 there In summary, the present prospective discordance analysis adds to the evidence that apoB is a more accurate marker of cardiovascular risk than LDL-C, non-HDL-C,…”
BackgroundSelf-citationApoB, LDL-C, and non-HDL-C as markers of cardiovascular risk
Sehayek, D., Cole, J., Björnson, E., Wilkins, J. T., Mortensen, M. B., Dufresne, L., Pencina, K. M., Pencina, M. J., Thanassoulis, G., & Sniderman, A. D. (2025) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2025.05.024 · Cited by 20 · see citing works
Self-citation
- Authors
- Kohli-Lynch, C. N., Thanassoulis, G., Moran, A. E., & Sniderman, A. D.
- Affiliations
- Columbia University Irving Medical Center (US)
- McGill University Health Centre (CA)
- Corresponding author
- Sniderman, Allan D.
- Venue
- Clinica Chimica Acta
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 508
- Pages
- 103-108
- ISSN
- 0009-8981 (ISSN-L)
- OpenAlex
- W3023674202
- Cited by
- 47
- References
- 7
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 12 · 2023: 6 · 2022: 7 · 2021: 7 · 2020: 3
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.gla.ac.uk
- Licence
- Locations
- Clinica Chimica Acta (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Funders
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- apolipoprotein B, LDL cholesterol, non-HDL cholesterol, cardiovascular risk assessment, lipid testing, clinical utility, diagnostic accuracy, ESC/EAS guidelines
- MeSH terms
- Apolipoproteins B, Cholesterol, Humans, Cholesterol, HDL, Cholesterol, LDL, Risk Factors, Biomarkers
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