Physiological Bases for the Superiority of Apolipoprotein B Over Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol as a Marker of Cardiovascular Risk
Related Experiment Video
Updated: Aug 26, 2025
Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
Published on: October 12, 2017
Tamara Glavinovic1, George Thanassoulis2, Jacqueline de Graaf3
1Division of Nephrology, Department of Medicine McGill University Health Centre Montreal Quebec Canada.
Insights
Apolipoprotein B (apoB) is a superior cardiovascular risk marker compared to LDL-C. Understanding apoB
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Atherosclerosis Research
Background:
- European guidelines now favor apolipoprotein B (apoB) over LDL-C for cardiovascular risk assessment.
- Growing evidence supports apoB's superiority in predicting cardiovascular events.
- Atherogenic apoB-lipoprotein particles (remnants, VLDL, LDL) are key drivers of cardiovascular risk.
Purpose of the Study:
- To explain the physiological mechanisms behind apoB's superior cardiovascular risk prediction.
- To clarify why apoB is more accurate than LDL-C and non-HDL-C.
- To provide a framework for understanding apoB's role in dyslipidemias.
Main Methods:
- Review of the nature and number of different apoB-lipoprotein particles.
- Analysis of mechanisms governing VLDL and LDL particle numbers.
- Examination of mechanisms controlling cholesterol mass within apoB particles.
- Brief outline of major apoB dyslipoproteinemias.
Main Results:
- Low-density lipoprotein (LDL) particles are typically the primary determinants of cardiovascular risk.
- Triglyceride and LDL-C concentrations can sometimes obscure the true cardiovascular risk.
- The total number of apoB particles, not just cholesterol content, dictates cardiovascular risk, except in specific dyslipidemias.
- Discordance between cholesterol mass (LDL-C, non-HDL-C) and particle number (apoB) explains apoB's superior predictive power.
Conclusions:
- Apolipoprotein B (apoB) offers a more accurate measure of cardiovascular risk than LDL-C or non-HDL-C.
- Understanding the physiological basis of apoB particle quantification is crucial for risk assessment.
- This review provides a physiological framework for clinicians to appreciate apoB's role in cardiovascular disease.
Abstract:
In 2019, the European Society of Cardiology/European Atherosclerosis Society stated that apolipoprotein B (apoB) was a more accurate marker of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol. Since then, the evidence has continued to mount in favor of apoB. This review explicates the physiological mechanisms responsible for the superiority of apoB as a marker of the cardiovascular risk attributable to the atherogenic apoB lipoprotein particles chylomicron remnants, very low-density lipoprotein, and low-density lipoprotein particles. First, the nature and relative numbers of these different apoB particles will be outlined. This will make clear why low-density lipoprotein particles are almost always the major determinants of cardiovascular risk and why the concentrations of triglycerides and LDL-C may obscure this relation. Next, the mechanisms that govern the number of very low-density lipoprotein and low-density lipoprotein particles will be outlined because, except for dysbetalipoproteinemia, the total number of apoB particles determines cardiovascular risk, Then, the mechanisms that govern the cholesterol mass within very low-density lipoprotein and low-density lipoprotein particles will be reviewed because these are responsible for the discordance between the mass of cholesterol within apoB particles, measured either as LDL-C or non-high-density lipoprotein cholesterol, and the number of apoB particles measured as apoB, which creates the superior predictive power of apoB over LDL-C and non-high-density lipoprotein cholesterol. Finally, the major apoB dyslipoproteinemias will be briefly outlined. Our objective is to provide a physiological framework for health care givers to understand why apoB is a more accurate marker of cardiovascular risk than LDL-C or non-high-density lipoprotein cholesterol.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:31Lipid-derived Compounds in the Human Body
Fat-soluble Vitamins
Fat-soluble vitamins, including vitamins A, D, E, and K, are required in minimal quantities, but their deficiencies can lead to severely abnormal physiological conditions. For example, vitamin A deficiency can cause night blindness, dry skin,...
01:29Cholesterol: Significance and Regulation
Considering cholesterol and...
01:30Coronary Artery Disease I: Introduction