Apolipoprotein B is the predominant apolipoprotein attached to LDL. It is part of every non-HDL lipoprotein (VLDL, IDL, LDL). ApoB is the scientifically accepted gold standard measurement for LDL particle number. An accurate and reliable measurement of apoB is of great benefit in monitoring efficacy of statin therapy. In fact, the ADA and the ACC released a consensus statement in 2008 that recommends guiding therapy for cardiometabolic risk patients with apoB measurements.

ApoB Ultra: When a patient has elevated triglycerides, apoB measurements may be skewed to the high side because of the presence of apoB-containing chylomicrons and VLDLs. Only Berkeley HeartLab performs an ultracentrifugation procedure that removes the influence of chylomicrons and VLDLs and reports this highly accurate measurement as apoB Ultra.

Clinical Implications:

Elevated apoB (>120 mg/dL) may signify two to three-fold increased cardiovascular disease risk even when LDL-cholesterol is within normal range. Several decades of scientific literature support the measurement of apoB as the most accurate indication of the amount of atherogenic particles. ApoB is therefore an excellent metric for monitoring response to statin therapy.

Treatment considerations:

• Common first-line pharmacological considerations:
  • Statins
• Additional pharmacological considerations:
  • Cholesterol absorption inhibitors
  • Nicotinic acid
  • Bile acid sequestrants
  • Fibrates
• Lifestyle changes:
  • Fat-restricted, cardioprotective diet
  • Weight loss
  • Regular exercise

Combination therapy including statins and nicotinic acid and/or fibrates can be effective in patients with excess apoB and small dense LDL disorder.

For more information and detailed references, please refer to our Clinical Implications Reference Manual.