"You might be at risk for a cardiac event….”
This is one of the most concerning statements a doctor can make to a patient. In a world full of processed foods and sedentary lifestyles, cardiac health can catch many patients off guard.
As a practitioner, you encourage patients to eat healthy, stay active, and avoid smoking. Yet, many of us know someone who followed this advice but still experienced a heart attack.
It’s concerning. But there’s hope.
The ApoB/ApoA1 ratio may be a helpful indicator of coronary heart health. It can be calculated with a simple blood test that compares the concentration of low-density lipoprotein (Apolipoprotein B) and high-density lipoprotein (Apolipoprotein A1.)
When the ratio is above the desired value of 0.6, it may suggest a higher risk for cardiovascular concerns. Continue reading to learn how to use this test in your clinic.
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Understanding Cholesterol
To understand why these two proteins can provide us with such valuable information, it is important first to understand the commonly misunderstood topic of cholesterol. Many patients might think that high cholesterol is bad and low cholesterol is good. But it’s not as simple as that.
Cholesterol is an organic compound that is necessary for your body to create things such as hormones, vitamin D, and even certain compounds needed for digestion. Yet, problems can arise when our body has more of certain types of cholesterol than is necessary to create these various compounds.
The Importance of Lipoproteins
Cholesterol, all by itself, cannot dissolve in the blood. It must be carried through the bloodstream by transporters called lipoproteins (Lipoproteins = Lipids + Proteins). Testing lipoproteins can show varying patterns that may correlate with the risk of cardiovascular concerns. High LDL, VLDL, and triglyceride levels are often associated with an increased risk of atherosclerosis and heart health issues. High HDL is often correlated with reduced cholesterol levels and lower cardiovascular risk.
Understanding the ApoB/ApoA1 Proteins
Apolipoprotein A1 (ApoA1) is the primary protein associated with “Good Cholesterol” high-density lipoprotein (HDL) particles. ApoA1 helps transport excess cholesterol throughout the body to the liver. ApoA1 is often interpreted as a ratio with apolipoprotein B (ApoB).
Apolipoprotein B (ApoB) are proteins found in lipoprotein particles that may contribute to artery-clogging. “Bad Cholesterol” (LDL) can form with a protein to send the excess cholesterol directly to the arteries, where it can bind with other molecules in the body to form a plaque that coats our blood vessels. Each bit of plaque can make it harder for your heart to pump blood throughout the body.
To understand why ApoB/ApoA1 might be a better measure of cardiovascular risk than simply using an LDL-Cholesterol or HDL/LDL ratio as a marker, we have to go a layer deeper and look at the multiple types of LDL.
LDL-Cholesterol: The Four Types
There are four subclasses of LDL-Cholesterol, which are labeled LDL I-IV. The smaller the size and greater the density of an LDL molecule, the more it may impact cardiovascular health. These LDL molecules, which fall under the LDL III and LDL IV labels, are described as small-dense LDL (sd-LDL).
The main issue with simply testing LDL-Cholesterol levels is that each particle contains different levels of cholesterol, and this value does not tell us which subclass of particle we are dealing with.
Your body more easily removes the less dense LDL particles, so by including them in LDL-cholesterol values, you might gain an inaccurate picture of the actual cardiovascular risk. On the other hand, the sd-LDL are often considered the main contributors to the creation of atherosclerotic plaque.
A way to address this is by looking at the total number of LDL particles instead of total LDL-cholesterol value. The more total particles, the more sd-LDL particles there may be in the body, and therefore the greater the potential cardiovascular risk.
Since there is a single ApoB in each LDL particle, we can use that value to estimate the number of LDL particles, and therefore the potential cardiovascular risk without having to pursue more specialized tests.
This is why the ApoB/ApoA1 ratio may help a provider understand the balance of “good” versus “bad” cholesterol in the body, and when the amount of bad cholesterol begins to rise above the good cholesterol, it may indicate increased risk.
By keeping a watchful eye on this ratio, and seeing how various types of exercise or diets affect it, a doctor can help identify what kind of fitness and nutrition regimen might be beneficial for you as an individual.
The challenge lies in the fact that no two patients are the same. An ideal diet and exercise regimen for one patient may not work for another. The only way to know which works best is through trial and error, but with access to information such as your ApoB/ApoA1 ratio, providers can help guide their patients to a place where the risk of heart attack (and other cardiovascular events) may not seem as daunting.
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