Your cholesterol - And why standard tests are not enough

Cardiovascular disease (CVD) is the leading cause of death worldwide, silently developing over decades before showing symptoms. Cholesterol plays a crucial role in this process, yet many patients and even healthcare providers rely on outdated or incomplete testing methods to assess risk. If you’ve only had a standard lipid panel, you may be missing critical information.  Advanced markers like Apolipoprotein B (ApoB) and Lipoprotein(a) [Lp(a)] provide a much more accurate picture of your heart health.

What is Cholesterol and Why Does it Matter?

Cholesterol is a fat-like substance that the body needs for essential functions like hormone production and cell membrane integrity. It is carried in the blood stream by two primary types of lipoproteins.  These include:

Low-Density Lipoprotein (LDL)

Commonly labeled as “bad” cholesterol, LDL carries cholesterol to the cells in the body. When it is in excess, it can deposit in the artery walls, leading to atherosclerosis, a process that narrows and hardens arteries over time.

High-Density Lipoprotein (HDL)

Known as “good” cholesterol, HDL helps remove excess cholesterol from the bloodstream and arteries, returning it to the liver for processing.

A standard lipid panel measures LDL, HDL, total cholesterol, and triglycerides, but this is an incomplete way of assessing cardiovascular risk.

Why Standard Cholesterol Tests Fall Short

Traditional tests focus on the concentration of cholesterol LDL particles carry (LDL-C), but research shows that the number of LDL particles can be a stronger predictor of heart disease.

This is where ApoB and Lp(a) testing come in.

ApoB

Apolipoprotein B (ApoB) is a protein found on all potentially harmful cholesterol particles, 95% of them on LDL.  Since each LDL particle carries a ApoB molecule, measuring ApoB gives a direct measurement of the number of LDL particles circulating in your bloodstream.  The more LDL particles (ApoB), the greater risk of cholesterol depositing in artery walls.  This important because even if your LDL-C appears normal, high ApoB levels indicate a higher risk of developing atherosclerosis and heart disease.

Lp(a)

Lipoprotein(a) [Lp(a)] is a genetically determined type of LDL particle with an additional protein called apolipoprotein(a) attached to it. Unlike LDL, which can be managed with lifestyle and diet changes, Lp(a) levels are largely inherited and do not change significantly over time.  Lp(a) levels are concerning because they appear to be more atherogenic than regular LDL particles, or said another way, more likely to deposit in your artery wall.  High levels are up to 7-8x more likely to deposit in your artery wall, even in people with otherwise normal cholesterol.

Bottom Line

If you’re only checking a standard lipid panel, you might be missing the full picture of your cardiovascular risk. ApoB and Lp(a) are two of the most important markers for assessing heart disease risk, yet they are often overlooked in routine testing.

Taking a proactive approach by asking your doctor for these advanced tests could be life-saving, especially if you have risk factors for heart disease. The earlier you identify issues, the more time you have to take action and prevent heart problems before they happen.