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Dr Mike Forsythe on Apolipoproteins and Refining your Cardiovascular Risk

Dr Mike Forsythe on Apolipoproteins and Refining your Cardiovascular Risk

When it comes to considering lipids, we usually think about cholesterol and triglycerides, often referred to as ‘the lipid profile’.

A standard lipid profile performed at your GP surgery will usually reveal your total cholesterol, as well as a breakdown of your ‘good’ cholesterol (HDL) and your ‘bad’ cholesterol (non-HDL, or LDL). Plugged into a calculator (the QRISK calculator) with details of your age, blood pressure, smoking status and other risk factors, you can find out your risk of having a heart attack or a stroke in the next decade and this risk is usually used to make decisions about starting cholesterol lowering medication such as statins. As useful – and sometimes terrifying – as these results are, they are a somewhat crude estimate and lack a degree of individual nuance that many find valuable. 

So how else can we assess our risk?

Apolipoproteins are, on a simplistic level, proteins that help you carry fat and cholesterol through the bloodstream. There are two varieties of apolipoprotein blood tests available here at One Day Tests, apolipoprotein A1 and apolipoprotein B. The first of these, apoA1, refers to a specific protein component of HDL cholesterol. Higher levels of apoA1 generally correspond with reduced risk of cardiovascular issues, whereas the opposite is true if the levels are lower than expected. There is evidence to suggest that apoA1 is a more sensitive marker of cardiovascular risk than HDL by itself and so knowing your apoA1 levels can give you a more refined risk than the usual lipid profile. 

Conversely, apoB levels are associated with ‘bad cholesterol’, or LDL particles. Measuring your individual level of apoB can provide a more comprehensive assessment of your lipid profile, as higher levels of apoB can suggest an increased risk of cardiovascular events in the future. 

The aim of any treatment for raised cholesterol, whether that is lifestyle or medication, is to shift the ratio of apoA1 to apoB so you have a higher proportion of the first, and a lower proportion of the second. 

Apolipoprotein measurements are not widely available, but interpreted in the context of a comprehensive lipid profile can provide invaluable additional information when it comes to assessing any future cardiovascular risk. This extra knowledge can help guide you on decisions about starting medications of making lifestyle changes as you may find that the standard risk estimations either over or underestimate your risk. 

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