Role of apolipoprotein B in the clinical management of cardiovascular risk in adults: An Expert Clinical Consensus from the National Lipid Association
- J Clin Lipidol. 2024 Sep-Oct;18(5):e647-e663. doi: 10.1016/j.jacl.2024.08.013.
- 1. Clinical Lipidology, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA (Dr Soffer). Electronic address: [email protected].
- 2. TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (Dr Marston).
- 3. Midwest Biomedical Research, Addison, IL, USA (Drs Maki and Kirkpatrick); Indiana University School of Public Health, Department of Applied Health Science, Bloomington, IN, USA (Dr Maki).
- 4. Lipid Clinic and Cardiovascular Risk Reduction Program, Emory Department of Medicine, Emory University, Atlanta, GA, USA (Dr Jacobson).
- 5. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA (Dr Bittner).
- 6. Departments of Medicine and Radiology, Weill Cornell Medicine, New York, NY, USA (Dr Peña).
- 7. Preventive and Genomic Cardiology, Department of Medicine, McGill University, and the McGill University Health Center Research Institute, Montréal, Québec, Canada (Dr Thanassoulis).
- 8. Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA (Dr Martin).
- 9. Midwest Biomedical Research, Addison, IL, USA (Drs Maki and Kirkpatrick); Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA (Dr Kirkpatrick).
- 10. Department of Medicine, The Aga Khan University, Karachi, Pakistan (Dr Virani); Texas Heart Institute and Baylor College of Medicine, Houston, TX, USA (Dr Virani).
- 11. Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA (Dr Dixon).
- 12. Department of Medicine, Baylor College of Medicine, Houston, TX, USA (Dr Ballantyne).
- 13. Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA (Dr Remaley).
This National Lipid Association (NLA) Expert Clinical Consensus provides an overview of the physiologic and clinical considerations regarding the role of Apolipoprotein B (apoB) measurement to guide clinical care based on the available scientific evidence and expert opinion. apoB represents the total concentration of atherogenic lipoprotein particles in the circulation and more accurately reflects the atherogenic burden of lipoproteins when compared to low-density lipoprotein Cholesterol (LDL-C). apoB is a validated clinical measurement that augments the information found in a standard lipoprotein lipid panel; therefore, there is clinical value in using apoB in conjunction with a standard lipoprotein lipid profile when assessing risk and managing lipid-lowering therapy (LLT). apoB has been shown to be superior to LDL-C in risk assessment both before and during treatment with LLT. In individuals, there can be discordance between levels of LDL-C and apoB, as well as LDL-C and non-high-density lipoprotein Cholesterol (non-HDL-C), despite high levels of population-wide correlation. When there is discordance between LDL-C and apoB, or LDL-C and non-HDL-C, atherosclerotic Cardiovascular Disease risk generally aligns better with apoB or non-HDL-C. Additionally, apoB can be used in tandem with standard lipoprotein lipid measurements to diagnose distinct lipoprotein phenotypes. apoB testing can inform clinical prognosis and care, as well as enable family cascade screening, when an inherited lipoprotein syndrome is identified. The NLA and other organizations will continue to educate clinicians about the role of apoB measurement in improving clinical risk assessment and dyslipidemia management. An urgent need exists to improve access and reimbursement for apoB testing.