Two Additional Resources
See the results of a Google Search Apolipoprotein B (Apo B).
And please carefully review:
Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice [PubMed Abstract] [Full-Text HTML] [Full Text PDF]. Circulation. 2024 Jul 2;150(1):62-79. doi: 10.1161/CIRCULATIONAHA.124.068885. Epub 2024 Jul 1.
There are 101 similar articles in PubMed.
The above article has been cited 21 times in PubMed.
Note to myself and to my readers: Although the above article is outstanding, clinicians need only review the following which occurs at the end of this comprehensive article.
SUMMARY OF RESULTS AND APOB TARGETS
The totality of data suggests that apoB may be a superior marker not only of risk of ASCVD but also of the benefit of lipid-lowering therapy compared with LDL-C. ApoB testing has practical benefits, including that patients do not need to fast, and is more accurate than LDL-C testing in patients with high triglyceride or very low LDL-C levels. Guidelines are increasingly recommending more aggressive lipid reduction; therefore, obtaining precise lipid measurements is essential. This has led many to call for the preferential use of apoB over LDL-C testing. However, consistent recommendations for how clinicians should use apoB results are lacking, and different guidelines have provided variable apoB targets for given LDL-C levels.Some guidelines have compared population- or study-specific percentiles of LDL-C and apoB to identify equivalent levels. Whereas this approach has a benefit of potentially identifying similar numbers of individuals for treatment, variability across populations in the distribution of LDL-C and apoB could lead to continued variability in global guidelines for optimal apoB targets. Discordance analyses have confirmed that people with metabolic syndrome or hypertriglyceridemia are at highest risk of discordantly high apoB levels and reinforce current guideline recommendations to measure apoB in these populations. However, variability across analyses in how discordance was defined limits their use in guiding clinical management. Nevertheless, all discordance analyses demonstrated that regardless of LDL-C levels, those with elevated apoB levels are at increased risk of ASCVD, reinforcing the importance of measurement of apoB.Percentage Reductions in ApoB
Given this, trial data appear to be most useful in developing clinical recommendations for how to implement apoB data to guide treatment recommendations. In terms of proportional reduction, all the lipid-lowering therapy included appeared to reduce apoB levels slightly less than LDL-C levels. Thus, if targeting a ≥50% LDL-C reduction (as recommended by many guidelines) with statins, ezetimibe, PSCK-9i, inclisiran, or bempedoic acid, a comparable apoB reduction would be 40% to 45%.ApoB Treatment Targets
To guide treatment targets, the trial data provide a straightforward path. Because the on-treatment LDL-C levels and on-treatment apoB levels were nearly identical, the same number can be used for apoB as LDL-C. Thus, if a target LDL-C level is <70 mg/dL, the target apoB level should also be <70 mg/dL (0.70 g/L). In high-risk patients with a target of LDL-C level <55 mg/dL, the corresponding goal for apoB should be <55 mg/dL (0.55 g/L). This simple approach can be communicated easily to patients and treating physicians and could eliminate confusion between guidelines.CONCLUSIONS
ApoB testing offers a standardized, accurate, and cost-effective measurement of the total number of atherogenic lipoprotein particles in plasma, providing a more accurate assessment of ASCVD risk and effectiveness of lipid-lowering therapy. Unlike LDL-C testing, apoB testing is particularly advantageous in patients with discordant lipid profiles, such as those with high triglyceride levels, or in patients with insulin resistance, who are more likely to have cholesterol-depleted apoB particles. ApoB testing is also more accurate when the levels of LDL-C are lower, a common situation in clinical practice when guidelines suggest more aggressive treatment targets. Despite this, apoB testing faces barriers to widespread adoption in clinical practice, primarily due to the absence of consistent guidance on its interpretation and application. To address these challenges and on the basis of evidence in RCTs, this review suggests the use of the same number for LDL-C as for apoB when establishing treatment targets. Simplification of the interpretation of apoB values, by aligning apoB targets with LDL-C levels, could enhance its integration into routine practice. The use of apoB levels in clinical decision-making holds promise for more accurate ASCVD risk prediction and tailored lipid-lowering strategies.
Today, I review, link to, embed, and excerpt from Metabolic Mind‘s ApoB Explained: What Your LDL Test Doesn’t Tell You.
All that follows is from the above resource.
ApoB Explained: What Your LDL Test Doesn’t Tell You
Jan 7, 2026 #MetabolicMind #KetogenicTherapy #HeartHealth
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