Apolipoprotein B: An essential cholesterol metric for atherosclerotic cardiovascular disease

Despite continued efforts to decrease cardiovascular disease (CVD) progression and optimize treatments, complication rates and prevalence are still high.1 As healthcare providers, we have the unique ability to lead interventions to promote the lowering of atherosclerotic CVD (ASCVD) risk. An assessment of apolipoprotein B (apoB) may be ideal, if not a critical measurement, to further assess and optimize CVD management. Heart disease is no stranger, and, over the last few years, it has been regarded as one of the leading causes and/or the leading cause of death in the world.1 Every year, millions of people schedule a doctor’s appointment to assess their general health. It is common to get a standard lipid panel, which encompasses total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides. This is considered the gold standard to assess for dyslipidemia and ASCVD risk.2 One measurement to assess lipoprotein-related ASCVD risk that is not included in the standard lipid panel is an apoB test. According to a recent review by Sniderman et al,3 apoB should be considered the ideal if not one of the essential measurements to assess ASCVD risk. In addition, the 2018 American Heart Association (AHA)/American College of Cardiology (ACC) cholesterol clinical practice guidelines state that apoB is a stronger indicator of atherogenicity than LDL-C alone.2 With the increasing evidence surrounding the clinical utility of apoB measurement, it is pertinent to consider its role in assessing and optimizing CVD management.