What are considerations for apolipoprotein B (apoB) testing?

Updated: Jul 08, 2021
  • Author: Georges Elhomsy, MD, ECNU, FACE; Chief Editor: Eric B Staros, MD  more...
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Familial hypercholesterolemia is a rare disease caused by a mutation in the apoB gene code. Patients with the homozygous mutation tend to develop cardiovascular disease in childhood.

Overnight fasting might not be necessary to evaluate apoB levels, but most laboratories recommend it.

Some evidence has shown that the capacity of the apoB/apoA-I ratio in assessing cardiovascular risk is strong and may be better than the use of apoB alone.

A prospective cohort study by Xiao et al indicated that as a risk factor, the apoB/apoA1 ratio is more strongly associated with abdominal aortic aneurysm (AAA) then with coronary heart disease (CHD), despite the relationship of both conditions to atherosclerosis. In addition, apoA1 was found to have a greater protective effect against AAA than CHD. [9]

A study by Perak et al indicated that in young people in the United States, there has been a favorable, downward trend in levels of apoB. The report, which involved 26,047 youths aged 6-19 years, found that between 2005-2006 and 2013-2014, the mean level of apoB in fasting adolescents fell from 70 mg/dL to 67 mg/dL. In addition, the investigators, who looked at lipid and apolipoprotein levels from 1999-2000 to 2015-2016, determined that by the end of the review period, ideal levels of all lipids and apoB were present in 46.8% of adolescents. [10]

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