I wanted to bring your attention to a couple of blood tests that everyone should have but most have never heard of, let alone undergone. I’m talking about Lipoprotein A and Apolipoprotein B.
Lipoprotein A (LpA) is a genetically determined risk factor for earlier, more aggressive atherosclerotic disease. You can think of LpA as being an extra protein that attaches itself to LDL (bad cholesterol), making it much more toxic — almost like a heat-seeking missile in terms of finding its way into artery walls.
This risk factor is genetic, meaning there is nothing you can do to modify your LpA number.
So why bother even checking it? Because we can get around the impact of LpA by dropping your LDL even further — so that even though your LDL is more toxic, at least there’s way less of it around.
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There are medications in development for lowering LpA, but it will be some time before they are commercially available. Current trials are focused on making sure they are safe — and that lowering LpA actually makes a difference in patient outcomes, above and beyond lowering LDL.
LpA is a once-in-a-lifetime test. If your LpA is elevated, first-degree relatives, including children, should be electively screened for this risk factor.
But please know that even very high LpA levels are not an emergency. And as with all other risk factors, LpA is a risk factor, not a disease guarantee. This is merely a signal that we have to think of you slightly differently – and consider more aggressive cholesterol management and more liberal use of screening tests like coronary calcium scanning.
Apolipoprotein B: What Your LDL Number Isn’t Telling You
Apolipoprotein B (ApoB) is not genetically determined, meaning it is modifiable. ApoB helps us get a deeper understanding of your LDL result.
When we check your LDL, the results are reported as some value, let’s say 130 mg/dL. Both the number and the units are important. Milligram (mg) is a unit of weight, and deciliter (dL) is a unit of volume.
So if you want to be completely transparent, what I can truly say about that 130 mg/dL LDL value is that if we were to draw a deciliter of blood out of your arm, scrape out the LDL, and put it on a scale, it would weigh 130 mg.
Why is this even important?
Because LDL is not one type of particle but a family of particles. Big particles. Small particles. And everything in between.
And what you don’t want is a whole bunch of small particles.
Why? Because you will need a lot more of them to add up to 130 mg. Meaning you will have many more LDL particles floating around your bloodstream than is reflected in the total weight of LDL. More particles mean a higher statistical likelihood that one of those particles will bump into an artery wall.
And those particles are smaller — so it’s easier for them to sneak into artery walls.
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Why ApoB Changes the Conversation
That LDL value of 130 mg/dL tells us nothing about the composition of your LDL family. This is where ApoB comes in.
ApoB is a protein that is attached to every single LDL particle — regardless of size.
So what we are looking for is a discrepancy between LDL and ApoB values.
- Normal LDL but high ApoB means you have lots of small particles.
- Somewhat elevated LDL but low ApoB? This means your LDL family contains mostly big particles, and that the total LDL is less concerning.
ApoB should ideally fall below 90 mg/dL for all of us and under 70 mg/dL if we have documented heart or vascular disease. Studies have shown that ApoB levels under 55 mg/dL are associated with regression of blockages (this typically requires multiple medications to achieve). LDL should also be under 55 mg/dL if our goal is to achieve this effect.
What This Means for You
Knowing what your goal ApoB level should be means little if you’ve never had this parameter checked.
Just like LpA, the ApoB test is not urgent, but knowing what it is can help provide more nuance regarding risk. After all, you’re not in this to make LDL numbers perfect. You’re in this to reduce risk – all of it.
To reinforce one point — LpA can’t change (at least not yet), so it is a once-in-a-lifetime test. ApoB can change, including in response to lifestyle changes. So rechecking it periodically is important, and reaching ApoB goals should be part of your prevention checklist.
Regardless of whether your LpA or ApoB levels are elevated, your first and best defense is eating in a way that helps lower LDL. This means getting plenty of whole food fiber, healthy fats, and plant sterols from your diet.
At Step One Foods, we know that getting the right amounts of these nutrients from the right foods is not easy — so we created a solution that allows you to do this without having to think too much about it.
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