ApoB targets and the new JAMA paper

The 2026 JAMA paper is a 24,000-person cohort comparing ApoB to LDL-C as predictors of incident MI. It replicates what Sniderman has been arguing since 2019: ApoB tracks risk slightly better than LDL-C, particularly in patients with discordant lipids (high triglycerides, normal LDL). The methodology is solid — pre-registered, multi-site, properly adjusted.

The novelty is more about scale than direction. P. Arenwald summarized it as 'confirmation, not revelation' — useful for shifting clinical practice but not a paradigm change. For a typical patient: if your LDL and ApoB agree, this paper changes nothing for you. If they disagree, ApoB is the more reliable target.