Cardiovascular diseases remain the leading cause of mortality worldwide, making early detection and prevention vital. Traditionally, heart assessments have had a focus on low-density lipoprotein cholesterol, commonly known as “bad cholesterol,” due to its role in plaque formation within the arteries. New advancements in medical research are shifting the focus to more precise biomarkers such as apolipoprotein B and lipoprotein (a), which give a deeper understanding of cardiovascular risk.
“In the past anyone who has had blood work done has been asked to fast because we are checking for LDL or your bad cholesterol level, which we know leads to plaque buildup that eventually causes strokes and heart attacks and even kidney failure,” said Dr. Vikranth Gongidi, cardiologist with Premier Cardiology. “But the way we measured it was basically by estimating different things in the blood. Now we have more accurate ways of measuring the actual LDL numbers, and it doesn’t even require fasting.”
While LDL has always been a key indicator of cardiovascular risk, previous ways of measuring it have had significant limitations. Individuals with normal LDL levels can still experience cardiovascular events due to other underlying lipid abnormalities. Additionally, the standard LDL tests do not account for the number or size of the LDL particles, which can vary greatly between individuals and influence cardiovascular risk independently of cholesterol content.
“When a person with normal LDL ends up having a stroke or heart attack, we try to figure out why, since they didn’t have high cholesterol,” Dr. Gongidi continued. “That’s where these newer tests come into play.
“ApoB and lipoprotein (a) tests originally came from genetic studies of families who had hyper cholesterol. We are finding that LDL is like a little ball and ApoB is like a little blanket around that ball. The lipoprotein (a) is the LDL itself with a little sticky attachment to it.
“When you have ApoB and lipoprotein, things get very aggressive and inflammatory because LDL is not able to cross the blood barrier and stick to things in the artery. But the ApoB and lipoprotein (a) can stick into the cell walls on the artery, causing the buildup of cholesterol.”
ApoB is a structural protein found in all atherogenic lipoproteins including LDL. Atherogenic lipoproteins are those that tend to create fatty deposits in arteries. ApoB provides a direct count of the number of atherogenic particles circulating in the bloodstream. The distinction is crucial because cardiovascular risk correlates more closely with the number of LDL particles than with their cholesterol content.
Emerging heart screening techniques now recognize ApoB testing as a more accurate risk marker. High levels of ApoB indicate an increased number of atherogenic particles, leading to a higher risk for plaque accumulation and subsequent cardiovascular events.
Lipoprotein(a) is similar to LDL, but it contains an additional protein called apolipoprotein(a), which increases its tendency to form harmful plaque and blood clots. Elevated lipoprotein levels are primarily determined by genetic factors and are associated with increased risk of atherosclerosis, coronary artery disease and aortic valve stenosis.
“Usually these tests are ordered together, but since the lipoprotein(a) is a genetic condition, it is recommended by the American College of Cardiology that everyone should have a one-time screening as a baseline,” said Dr. Gongidi. “If it’s high, meaning anything over 75, we know that those patients are at a higher risk of developing future heart attacks and strokes.
“If I have a patient with a lipoprotein(a) number higher than 75, I check their general health to make sure everything else is OK and I may put them on a medication like a statin to bring the LDL down closer to 70 or below. I start treating them like they already have blockages because I don’t like to wait until a patient has a heart attack to treat them.
“Statins work best when they start early on,” Dr. Gongidi continued. “So, a person who is 30 to 50 years old with elevated numbers can keep their numbers low for the next 20 years, reducing their heart attack risk drastically. That’s why I think everybody needs to get this testing done, even if they feel healthy.”
While the lipoprotein(a) test is a once-in-a-lifetime event, the ApoB should be tested once a year because its more sensitive and specific and shows exactly what is going on in your blood.
Integrating ApoB and lipoprotein(a) into routine cardiovascular screening provides a more comprehensive risk assessment, particularly in individuals with complex lipid profiles or genetic predispositions to heart disease.
“Most primary care doctors won’t order these advanced blood tests during a routine physical, so make sure to ask for them specifically. “Dr. Gongidi advised. “If one comes back elevated, consult a cardiologist for monitoring and/or treatment.”
But there’s more to good heart health than just cholesterol. The American Heart Association identifies key measures for improving and maintaining cardiovascular health:
Eat better – aim for an overall healthy eating pattern that includes whole foods, fruits, vegetables, lean protein, nuts, seeds, and cooking in non-tropical oils such as olive and canola.
Be more active – adults should get 2 ½ hours of vigorous physical activity per week. Kids should have 60 minutes every day.
Quit tobacco – use of inhaled nicotine delivery products, which includes traditional cigarettes, e-cigarettes and vaping, is the leading cause of preventable death in the US, including about a third of all deaths from heart disease.
Get healthy sleep – adults need 7 to 9 hours of sleep each night. Children require 10 to 16 hours for ages 5 and under, 9 to 12 hours for ages 6-12, and 8 to 10 hours for ages 13-18.
Manage weight – maintaining a healthy weight has many advantages. A body mass index of less than 25 is optimal, but less than 18.5 is considered underweight.
Control cholesterol – high levels on non-HDL cholesterol can lead to heart disease.
Manage blood sugar – over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves.
Manage blood pressure – Levels less than 120-80 is optimal.
Dr. Vikranth Gongidi is a graduate of the University of North Carolina, Chapel Hill, and he completed his internal medicine internship and residency at Botsford Hospital in Farmington Hill, Michigan. His cardiology fellowship was completed at the University of Medicine and Dentistry of New Jersey in Stratford. His practice, Premier Cardiology, is located at 787 37th St. Suite 250, Vero Beach. Call 772-494-0794 or visit premiercardiologyvb.com for more information or to book an appointment.