If you are concerned about your risk of developing cardiovascular disease, you’ll usually get a specific blood test to look at your cholesterol levels to see where things stand. At least, that’s how it has worked in the medical world for nearly 60 years.
But new research suggests that a cholesterol test may not actually be the best way to identify those who are at high risk of developing cardiovascular disease. Instead, there’s a different blood test that could be much better—and potentially save more lives. It’s just not used all that often.
Here’s what the study found, plus how to actually get this test.
Meet the experts: Cheng-Han Chen, MD, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA; Nicholas A. Marston, MD, MPH, study co-author and assistant professor of medicine at Brigham and Women’s Hospital; Ragavendra Baliga, MBBS, a cardiologist at The Ohio State University Wexner Medical Center
What did the study find?
For the study, which was published in the European Heart Journal, researchers analyzed blood samples from more than 200,000 people in the UK Biobank who had no history of heart disease to look for the number and size of cholesterol-carrying lipoproteins in the blood. (Lipoproteins are proteins that combine with and transport fat in the blood.)
The researchers specifically focused on lipoproteins that carry a protein called apoB—that protein is typically linked with LDL or “bad cholesterol.” The researchers followed the participants for up to 15 years, looking at lipoprotein types and sizes that were most strongly linked to future heart attacks. They then compared that information with a separate Swedish cohort study to see how “bad cholesterol” lipoproteins lead to the development of heart disease.
The researchers discovered that apoB is the best way to test for heart disease, since measuring this protein actually indicates the total number of “bad cholesterol” particles better than your standard cholesterol test. Ultimately, they found that measuring a combination of apoB and a lipoprotein called Lp(a) gives the most accurate results.
“LDL cholesterol is an important contributor to this risk, but does not tell the whole story,” says Nicholas A. Marston, MD, MPH, study co-author and assistant professor of medicine at Brigham and Women’s Hospital.
Why is this new test better at screening for heart disease?
Currently, doctors often determine someone’s heart disease risk by looking at the levels of LDL (“bad cholesterol”) particles in their blood. This is just done by a blood test that analyzes cholesterol levels, explains Cheng-Han Chen, MD, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA.
But cholesterol can’t circulate in the blood or cause damage without a lipoprotein carrier, Dr. Chen points out. As a result, focusing on the lipoproteins that can carry “bad cholesterol” may be a more accurate way to tell a person’s future cardiovascular disease risk.
“ApoB appears to be the most accurate measure of cardio risk when compared to the traditional methods of measuring LDL, HDL (“good cholesterol”), and other types we use,” Dr. Chen says.
What is “bad cholesterol” and apoB?
“Bad cholesterol” is another term for LDL cholesterol. “LDL cholesterol is the most common form of cholesterol and is known to cause heart disease,” Marston says.
Again, apoB is a type of protein that’s typically linked with LDL or “bad cholesterol.”
“ApoB [is] a more accurate count of harmful particles,” says Ragavendra Baliga, MBBS, a cardiologist at The Ohio State University Wexner Medical Center.
Where can I get one of these tests?
The tests currently exist, and you can get one. “It’s not part of the normal cholesterol panel, but it is readily available at most testing laboratories,” Dr. Chen says. “Doctors would have to order this testing panel on top of what we currently use.”
However, it’s not common. “I’ve never, ever ordered apoB,” Dr. Baliga says.
Still, Dr. Chen says if your doctor determine it’s needed, it is possible to get one. “If we are especially concerned or if the patient is especially concerned, we can add this test on to get more information,” he says.
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