Non-HDL-C and Apolipoprotein B

• No doubt, Atherosclerotic Cardiovascular Disease (ASCVD) risk rises as the levels of Low-density Lipoprotein Cholesterol (LDL-C) and Non-high-density Lipoprotein Cholesterol (non HDL-C) increase, and that the risk decreases as the levels of LDL-C and non-HDL-C decrease.

• It is not that LDL-C or non-HDL-C is ‘wrong’. They are merely less precise than ApoB, and precision should matter in clinical care.

• Lab should report non-HDL-C in all; ApoB in selected cases.

• LAI recommendations 2020

• Elevated ApoB is a Moderate Nonconventional risk factor (a level >110 mg/dL) of ApoB corresponds to (an LDL-C >130 mg/dL).

• To assess ASCVD risk, it is preferable to estimate serum ApoB in patients with diabetes, metabolic syndrome, obesity, high TG concentration or very low LDL-C levels.

• ApoB measurement is recommended in high-risk subjects after LDL-C and non-HDL-C goals have been achieved. Discordant elevated ApoB levels may identify individuals who have high residual cholesterol risk. This may warrant intensive statin therapy and the use of Nonstatin drugs.

• Efforts should be made to gradually change the perception of the importance of ApoB amongst physicians, patients and laboratories. Laboratories should standardize their methods.

• It would take time and efforts to introduce ApoB estimation to be included in the standard lipid panel, initial and follow-up.

• The standard lipid panel for future screening, diagnosis and follow-up is likely to be TC, TG and apoB.