Cardiovascular disease

LDL-Cholesterol Tests Are Inaccurate, Measure this Instead: ApoB

by Mike Mutzel


After years of myopic focus on LDL-Cholesterol (LDL-D) testing, it’s fair to say LDL-C tests should now be retired, as they’re wrong more than 15% of the time.

Standard LDL-C tests estimate the cholesterol contained within LDL particles and become increasingly more inaccurate as your metabolic health declines.

ApoB, in contrast, better reflects the mechanism of cardiovascular disease.

Since one molecule of ApoB is found on every atherogenic particle (e.g. VLDL, IDL, LDL and Lp(a)) it can better identify risk.



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Salih, K. J. The major pathways of lipids (triglyceride and cholesterol) and lipoprotein metabolism. Zanco J Pure Appl Sci 33, 61–72 (2021).

Sniderman, A. D. et al. Apolipoprotein B Particles and Cardiovascular Disease. Jama Cardiol 4, 1287–1295 (2019).

Behbodikhah, J. et al. Apolipoprotein B and Cardiovascular Disease: Biomarker and Potential Therapeutic Target. Metabolites 11, 690 (2021).

Show Notes:

00:00 Standard LDL cholesterol measurements are estimates.

00:15 Every atherogenic lipoprotein has one ApoB100.

01:10 ApoB is causally related to atherosclerosis.

02:08 Optimal ApoB is under 60.

04:05 LDL measurements do not correlate to risk.

06:40 Biomarkers of oxidative stress are linked with risk of atherosclerosis.

07:30 Focus on ApoB levels and the ratio or ApoB to apoA1.

08:50 Many people who die of heart disease have low or normal LDL cholesterol.

10:15 Look for biomarker patterns.  

11:30 Atherogenic cholesterol is made by your liver.

12:43 Prevent oxidation and do not ingest oxidated seed oils.

15:30 Triglycerides skew LDL measures.


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