Apolipoprotein B (ApoB) measurement captures total atherogenic burden, including high VLDL, which can be missed by LDL particle number or LDL cholesterol measurements.

“And we know that it's actually not so much LDL, but it's more apolipoprotein B. But that tends to track with LDL just in general.”

“I believe that the context in which apob exists is hugely important”

“I think that not every elevation of apob carries the same increase of cardiovascular risk so it's not to be [Music] ignored I think that oftentimes when I've come out in the past and said things about LDL people will misconstrue what I'm saying um it's not to be ignored and context matters”

“there does there isn't always a clear relationship between LDL levels and plaque burden I think that we both agree that LDL APO containing particles which are a few more particles than LDL though ldo represents the majority of it are involved in an atherosclerotic plaque”

“how about using apoB which does this already and even more accurately?”

“you got to attack april-b if you don't good luck but the more you understand that's where biomarkers and really not understanding the only on the soudanese pathways you need token a lot more clinical chemistry”

“whereas with the apobldl side of the equation it really appears to be a stochastic problem the more of these things you have to the first order the more problems you have”

“so it's a one-time test and it helps us before we talk let's do thorough cardiovascular risk assessments no matter what your apob is and this would be one of the tests that at least the europeans have signed on to now the national lipid association other people have issued guidelines to it”

“what a number of mendelian randomizations have shown is that apob includes all the information in triglycerides ldl cholesterol and even hdl cholesterol it sums them which in the sense of vldl and ldl makes perfect sense”

“we've calculated the number of lives and heart attacks it could be avoided live saved heart attacks avoided if we switched to apob”

“the american college of clinical chemistry the european clinical chemists they have a series of reports saying apob can be measured more accurately than ldl cholesterol or non-hdl cholesterol no question”

“if if your objective is to lower Apo B Because apob plays a causitive role in atherosclerotic cardiovascular disease you have the perfect biomarker it's apob”

“an enormous driver of atherosclerosis is indeed exposure to apob on my podcast the listeners are very astute they understand that we're really talking about APO B which includes of course LDL but also pldl Etc and we say look it's really the time is the x-axis and apob concentration is the y-axis you want to minimize the area under that curve and to your point that means starting earlier and lowering apob or LDL cholesterol more”

“with the pharmacologic thing we're modulating things that either have clinical trial proof that if you lower them it's good or the mendelian uh randomization looking at genes where that drug might be doing something it works”

“by measuring APO B why I'm such a fan of measuring APO b as opposed to just measuring LP LDL particle number or LDL cholesterol number is we have one single number that captures the total concentration of apob and while that's pretty well associated with non-hdl cholesterol which is a far better surrogate than LDL cholesterol it's still better”

“but the APO B is a better predictor of risk because it captures not only the concentration of LDL and we know that it's the number of particles more than the cholesterol concentration of the particles that drives risk but also because it includes the other atherogenic particles namely the vldl because the lp little a is generally captured inside of the LDL”

“our best strategy at the moment to reduce residual risk of course is to obliterate apob concentration”

“if you want to think about preventing cardiovascular disease you have to be thinking about how do I have fewer apob particles because the more of those particles you have the more of them that are going to enter the endothelial space”

“well apob is the ball game nowadays uh it's not widely tested like it should be but anyway”

“the really good thing and what what makes apob so valuable is there is one molecule of apob per apob containing lipoprotein and this is great because it's a very easy assay for labs to do it's an IM imuno assay well standardized so we can have on our patients hey go get an apob concentration and when we get that number back we know we are actually counting the number of apob containing lipoproteins”

“ultimately this is now about five years ago we actually switched to apob which was Superior on all fronts and here's the reason why first of all there are different ways in labs to do this so lab core for example in Boston Hart have different magnets and different algorithms for how they run their ldlp so if you run an ldlp on each of those labs you'll get a different number that's a bit disturbing to me I want to know that the apob that I get at one lab is the same as the apob I get at another lab and it's standardize across all fronts but there's a more important reason why I favor apob over ldlp and that is it encompasses the total atherogenic burden and you can get burned and fooled by patients who have very high High vldl meaning they have a high burden of very low density lipoproteins even if their LDL burden is low”

“it encompasses the total atherogenic burden and you can get burned and fooled by patients who have very high High vldl meaning they have a high burden of very low density lipoproteins even if their LDL burden is low”

“you will miss that if you're looking at ldlp or ldlc you will not miss that if you're looking at apob”