Test for ‘bad cholesterol’ proteins could better predict heart disease risk
Researchers in Sweden and the US suggest measuring levels of lipoproteins may be a more accurate risk predictor.
A test that assesses certain particles in the blood could predict a person’s risk of developing heart disease more accurately than measuring cholesterol, according to a study.
Switching the focus on detecting the level of proteins associated with so-called “bad cholesterol” could “potentially save lives”, researchers said.
Cholesterol, a fatty substance mostly made by the liver and found in certain foods, is essential for maintaining healthy cells, but having too much in the blood can increase the risk of heart disease and stroke.
In the UK, if doctors suspect a person is at risk of heart disease, they will usually check the patient’s blood pressure and family history, as well as taking a blood sample to measure the amount of different types of fat in the blood, including cholesterol.
However, researchers in Sweden and the US suggest measuring levels of lipoproteins – particles comprising protein and fat that transport cholesterol and other fats in the bloodstream – may be a more accurate risk predictor.
There are four main classes of lipoprotein, three of which have a special protein on their surface called apolipoprotein B (apoB).
They are known as “bad cholesterol” as they can deposit cholesterol in the walls of blood vessels when found in large numbers.
The fourth class helps remove excess cholesterol from the blood and transports it back to the liver, often known as “good cholesterol”.
Jakub Morze, postdoctoral fellow at Chalmers University of Technology in Gothenburg, said: “This is the largest study of its kind to date and the results show for the first time the relative importance of the three major families of lipoprotein for the potential risk of heart disease.
“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.”
For the study, academics analysed blood samples from 207,368 people in the UK Biobank with no history of heart disease.
“We found that apoB is the best marker when testing for risk of heart disease,” Mr Morze added.
“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 12 patients, standard cholesterol tests may underestimate heart disease risk, which is important to consider, since 20 – 40% of all first-time occurrences of CVD are fatal.
“By switching to apoB testing, we can improve that accuracy and potentially save lives.”
Clemens Wittenbecher, assistant professor of precision medicine and diagnostics at Chalmers University of Technology, said the results, published in the European Heart Journal, show that “apoB particle count could eventually replace the standard blood cholesterol test”.
He added 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,” Prof Wittenbecher said.
