Simple blood test could improve heart disease risk prediction

Cholesterol is essential for building cells and producing vitamins and hormones. However, elevated cholesterol levels can cause plaque buildup in blood vessels, increasing the risk of heart attacks and strokes. Cholesterol travels through the bloodstream via lipoproteins, categorized into four main classes. Three of these classes contain apolipoprotein B (apoB) and are associated with “bad cholesterol,” while the fourth class helps remove excess cholesterol, earning it the label “good cholesterol”. 

Currently, heart disease risk assessment primarily relies on measuring cholesterol levels. However, researchers are increasingly turning to the carriers of “bad cholesterol” — the lipoproteins — as potentially more reliable indicators of cardiovascular risk. 
Jakub Morze, lead author and postdoctoral fellow at Chalmers, explains: “It was previously unclear if two patients with the same total level of “bad cholesterol”, but that differ in their carrier characteristics (lipoprotein type, size, lipid content), have the same risk of heart disease. So, the aim of this study was to determine the importance of these different parameters.” 

The research team analyzed blood samples from over 200,000 individuals without previous heart disease in the UK Biobank. They measured the number and size of cholesterol-carrying lipoproteins, focusing on those containing apoB. By tracking participants for up to 15 years, they identified lipoprotein patterns most strongly linked to future heart attacks. “We found that apoB is the best marker when testing for risk of heart disease. Since apoB indicates the total number of “bad cholesterol” particles measuring it offers a more accurate test than standard cholesterol measures. That does not mean conventional tests are ineffective; they generally perform well.  

However, in about one in twelve patients, standard cholesterol tests may underestimate heart disease risk, which is important to consider, since 20 – 40 percent of all first-time occurrences of CVD are fatal. By switching to apoB testing, we can improve that accuracy and potentially save lives,” says Jakub Morze. 

Beyond apoB, the study also highlights the importance of lipoprotein(a) as another key marker. Though lipoprotein(a) constitutes less than 1 percent of all "bad cholesterol" lipoproteins in the general population, extremely high levels — often genetically inherited — can significantly elevate heart disease risk. 
“Our results indicate that apoB particle count could eventually replace the standard blood cholesterol test in research and healthcare worldwide and that lipoprotein(a) also needs to be tested for to get a better picture of lipid-related CVD risk. The blood test for these two markers is commercially available now and would be cheap and easy enough to implement,” says Clemens Wittenbecher, Assistant Professor of Precision Medicine and Diagnostics at Chalmers. 

MEDICA-tradefair.com; Source: Chalmers University of Technology