Non-HDL-C and Apolipoprotein B

Non-HDL-C and Apolipoprotein B

  • No doubt, Atherosclerotic Cardiovascular Disease (ASCVD) risk rises as the levels of Low-density Lipoprotein Cholesterol (LDL-C) and Non-high-density Lipoprotein Cholesterol (non HDL-C) increase, and that the risk decreases as the levels of LDL-C and non-HDL-C decrease.
  • It is not that LDL-C or non-HDL-C is ‘wrong’. They are merely less precise than ApoB, and precision should matter in clinical care.
  • Lab should report non-HDL-C in all; ApoB in selected cases.
  • LAI recommendations 2020
    • Elevated ApoB is a Moderate Nonconventional risk factor (a level >110 mg/dL) of ApoB corresponds to (an LDL-C >130 mg/dL).
    • To assess ASCVD risk, it is preferable to estimate serum ApoB in patients with diabetes, metabolic syndrome, obesity, high TG concentration or very low LDL-C levels.
    • ApoB measurement is recommended in high-risk subjects after LDL-C and non-HDL-C goals have been achieved. Discordant elevated ApoB levels may identify individuals who have high residual cholesterol risk. This may warrant intensive statin therapy and the use of Nonstatin drugs.
    • Efforts should be made to gradually change the perception of the importance of ApoB amongst physicians, patients and laboratories. Laboratories should standardize their methods.
    • It would take time and efforts to introduce ApoB estimation to be included in the standard lipid panel, initial and follow-up.
    • The standard lipid panel for future screening, diagnosis and follow-up is likely to be TC, TG and apoB.

Dr. SS. Iyengar

Dr. SS. Iyengar is a currently associated with Manipal Hospital (Bangalore) is an Interventional Cardiologist who values shared medical decision-making and believes that input from patients and families is as vital to the process as physician input is. He specializes in the prevention, diagnosis and interventional treatment of diseases of the heart and blood vessels such as acute heart attack, heart failure, arthymia, rhythm disturbance, valvoplasty.Having done his MBBS, MD(Medicine),DM(Cardiology) from Pune University,he further went to do his fellowship from Royal College Of Physicians (U.K).

 More FAQs by Dr. SS. Iyengar

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