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Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices
Open accessAbstract
Background: Low-density lipoprotein cholesterol (LDL-C) has been the cornerstone measurement for assessing cardiovascular risk for nearly 20 years. Content: Recent data demonstrate that apolipoprotein B (apo B) is a better measure of circulating LDL particle number (LDL-P) concentration and is a more reliable indicator of risk than LDL-C, and there is growing support for the idea that addition of apo B measurement to the routine lipid panel for assessing and monitoring patients at risk for cardiovascular disease (CVD) would enhance patient management. In this report, we review the studies of apo B and LDL-P reported to date, discuss potential advantages of their measurement over that of LDL-C, and present information related to standardization. Conclusions: In line with recently adopted Canadian guidelines, the addition of apo B represents a logical next step to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) and other guidelines in the US. Considering that it has taken years to educate physicians and patients regarding the use of LDL-C, changing perceptions and practices will not be easy. Thus, it appears prudent to consider using apo B along with LDL-C to assess LDL-related risk for an interim period until the superiority of apo B is generally recognized.
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“ApoB can be measured in the nonfasting state because even at peak postprandial concentrations, the number of chylomicron-apoB48 particles in healthy individuals is usually < 1% and the number of VLDL-apoB100 particles is < 10% of the number of LDL-apoB100 particles [12].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [12]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“It is the structural protein for all non-HDL lipoproteins and exists as 2 isoforms: apoB100, the major isoform in VLDL, IDL, LDL, and Lp(a), and apoB48 in chylomicrons and chylomicron remnants [12].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [12]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Taken together with the evidence that apoB can be measured more accurately, more precisely, and more selectively than LDL-C or non-HDL-C,1,29–31”
From Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention (2024) · cites this paper as [30]
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“Measurement of apolipoprotein B (apoB), the major protein component of LDL, or advanced measurement of LDLP (not yet widely available) can also be used to assess the number of LDL particles [10,12].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [12]
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“ApoB can be measured in the nonfasting state because even at peak postprandial concentrations, the number of chylomicron-apoB48 particles in healthy individuals is usually < 1% and the number of VLDL-apoB100 particles is < 10% of the number of LDL-apoB100 particles [12].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [12]
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“Since each atherogenic particle contains one molecule of apoB, concentrations of apoB are therefore considered to be a direct measure of the total number of lipoproteins causing cardiovascular disease, that is, LDL, remnants, and Lp(a) [12].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [12]
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Metadata
- Authors
- Contois, J. H., McConnell, J. P., Sethi, A. A., Csako, G., Devaraj, S., Hoefner, D. M., & Warnick, G. R.
- Affiliations
- Maine Standards Company, Windham, ME
- Mayo Clinic (US)
- National Institutes of Health (US)
- National Institutes of Health, Bethesda, MD
- University of California Davis Medical Center (US)
- Marshfield Clinic (US)
- Berkeley HeartLab Inc, Alameda, CA
- Corresponding author
- Contois, John H
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-03-01
- Volume
- 55
- Issue
- 3
- Pages
- 407-419
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- OpenAlex
- W2107424758
- Cited by
- 326
- References
- 97
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 7 · 2023: 16 · 2022: 12 · 2021: 24 · 2020: 25 · 2019: 16 · 2018: 22 · 2017: 17 · 2016: 14 · 2015: 16 · 2014: 28 · 2013: 25 · 2012: 24
- FWCI
- 29.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NIH
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
- Keywords
- apolipoprotein B, LDL particle number, LDL cholesterol, cardiovascular risk, lipid profile, Canadian guidelines, cardiovascular risk assessment
- MeSH terms
- Apolipoproteins B, Cardiovascular Diseases, Humans, Risk Factors, Clinical Chemistry Tests
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