Research indicates that apolipoprotein B testing outperforms standard LDL cholesterol tests in predicting risk and guiding therapy.
A study published in the Journal of the American Medical Association (JAMA) suggests that apolipoprotein B (apoB) testing is more effective and cost-efficient than standard cholesterol tests for guiding treatment to prevent heart attacks and strokes.
The research found that using apoB testing to guide cholesterol-lowering therapy outperformed low-density lipoprotein (LDL) and non-high-density lipoprotein (non-HDL) cholesterol assessments. According to the study, intensifying medication based on apoB levels could prevent more cardiovascular events than current practices.
“We found that apoB testing to intensify cholesterol-lowering medication would prevent more heart attacks and strokes than current practice, and that these health benefits were achieved at a cost that represents good value for US healthcare payers,” says Ciaran Kohli-Lynch, PhD, assistant professor of preventive medicine in the division of epidemiology at Northwestern University Feinberg School of Medicine, in a release.
Measuring Risk Through Particle Count
For years, clinicians have relied on LDL, often referred to as “bad cholesterol,” to determine when to start or increase statin treatment. However, these traditional tests may not provide a full picture of a patient’s cardiovascular risk.
The apoB test measures the total number of harmful, cholesterol-carrying particles in the blood. When these small particles become trapped in the arteries, they form plaques that can lead to blockages, heart attacks, and strokes.
“Research strongly shows that apolipoprotein B (apoB) is better at identifying who is at risk, because it counts the total number of harmful particles in the blood,” says Kohli-Lynch in a release.
Despite the evidence supporting its use, apoB testing is not currently part of routine care in the US. This is attributed in part to the additional cost and the requirement for a separate blood test beyond the standard cholesterol panel.
Simulation Shows Improved Outcomes
To evaluate the value of the test, researchers used a computer simulation model representing 250,000 US adults who were eligible for statins but had no existing cardiovascular disease. The model compared three different strategies for guiding treatment: LDL goals, non-HDL goals, and apoB goals.
The simulation tracked lifetime outcomes, including life expectancy, quality of life, and healthcare costs. The apoB-guided strategy improved population health and saved more lives more cost-effectively than the other two methods.
The findings arrive as the American Heart Association (AHA) and other medical organizations have issued updated guidelines recommending that cholesterol-lowering therapy begin at younger ages for many patients.
“This means it is increasingly important to accurately identify who would benefit most from intensive treatment,” says Kohli-Lynch in a release.
The study was supported by an AHA Career Development Award. Other contributors to the research include John Wikins and Samuel Luebbe.
ID 132938154 © Jarun011 | Dreamstime.com
Related Reading:
Lipoprotein Profiling May Be Diagnostic Key for Heart Disease Risk
Roche Lp(a) Test Gets FDA Clearance for Cardiovascular Risk Assessment
Preexisting High Cholesterol in Pregnancy Linked to Elevated CV Risk
