How important is Apo B?

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Most of us realize how important it is to control your cholesterol level, especially if you have additional risks for the development of heart disease. Of course, it’s not necessarily the total cholesterol that has to be controlled. Rather, it is cholesterol’s most important components, the “bad cholesterol” (HDL), and “good cholesterol” (LDL). Depending upon gender and age, HDL level should be at least 40-55 mg/dl. Depending on the risk of developing a future heart attack, LDL should be kept less than 70-100 mg/dl.

HDL levels are determined primarily by genetics (blame you parents for this one). LDL levels are determined by a combination of genetics and lifestyles (eating and exercise habits). Abnormal LDL levels are much easier to control than abnormal HDL levels.

Drug therapy is aimed primarily (but not exclusively) at lowering LDL to the recommended level of 70-100 mg/dl. But is this good enough?

After many years of research, it turns out that apolipoprotein B, Apo B for short, is a much more reliable predictor than LDL of the risk of developing heart attacks, and it also provides a much better assessment of cholesterol therapy.

In abbreviated form, the reason is as follows: The risk of LDL is not expressed by the usual measurement of how much LDL is in your blood stream. Rather, it’s the number of LDL particles in a given volume of blood that determines the risk, and this depends on how large the particles are. Small particles are much more dangerous than large particles. The Apo B measurement is a fair estimate of the LDL particle number and thus a better estimate of cholesterol risk and of progress of therapy.

The use of Apo B has already been adopted in Canada, but to my knowledge has not yet been adopted by our own National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by other “guidelines makers” in the US.

We appear to be years behind in the treatment of a condition that is the number one killer in the US! As a country that boasts of having the best medical system in the world, why have we not taken this simple step?

Many doctors, including yours truly, are already using Apo B as a guide. But in recent weeks I have gotten numerous complaints from patients who have received bills from their labs because insurance companies (mainly HMO’s and alike) stopped paying for the Apo B lab test. This is absurd.

Both patients and physicians must fight this non-payment trend. The physicians must fight it because this trend impedes their duty and ability to treat effectively, and the public must fight it because this trend will yield suboptimal medical outcomes.

Let your political representatives know that you care and want to change.