A new 'bad cholesterol' test more accurately prevents coronary heart disease.

A study shows that analyzing two lipoprotein markers in the blood provides more accurate information about the risk of heart disease. This is because the test measures the amount of "bad cholesterol" transport proteins, whereas conventional tests do not.

One of the main indicators and risk factors for coronary heart disease is high blood cholesterol. This fatty molecule helps in cell formation and vitamin production and hormones.

However, when its presence is high, it tends to accumulate in the artery walls and form deposits known as atheromatous plaques; blockages that, if broken, form a clot that results in a heart attack or stroke.

A new study, published in the European Heart Journal, offers an alternative test for detect this possible accumulation of fat early in the bloodstream.

Using a blood test, researchers measure the amount of apolipoprotein B (apoB), which are the molecules responsible for depositing cholesterol in the walls of blood vessels, and thus the risk of suffer from cardiovascular disease.

“In generally healthy adult populations, apoB levels above 100 mg/dL are associated with a substantial increase in cardiogenic events,” the lead author of this study and researcher at Chalmer University of Technology (Sweden) told SINC. Jakub Morze.

A more accurate test than conventional ones

When evaluating the possible existence of heart disease, doctors measure the amount of LDL cholesterol —the harmful one — through an analysis.

However, since cholesterol cannot circulate or cause damage without its carrier lipoproteins, Morze's team turned to evaluating the amount of apolipoprotein B as an inhibitor of cholesterol.most accurate indicator coronary risk.

“ApoB integrates information from both LDL cholesterol and triglycerides by directly measuring the number of circulating atherogenic particles,” explains the first author of this research.

This means that when this molecule is analyzed, it is possible to know which fat particles can clog arteries without needing to know the quantity.  

In fact, until now it was not clear whether two patients with the same level of 'bad cholesterol' had the same risk of heart disease. It was necessary to specify the type of carrier lipoprotein, as well as its size and quantity in blood.

Fifteen years of research

Scientists analyzed blood samples from more than 200 people from the UK Biobank no history of heart disease.

They focused specifically on lipoproteins that carried apoB and followed patients for 15 years to see what type of proteins were most closely related to heart attacks.

They found that apoB is the best marker for assessing coronary heart disease risk, as it indicates the total number of LDL cholesterol particles and offers greater accuracy than standard measurements.

This does not mean that conventional testing is not effective, but, in approximately one in twelve patients, may underestimate the risk of possible heart-related events, the study details.

Previously, laboratory methods for measuring ApoB were complex, so quantifying cholesterol levels was preferred. “Today, it's technically possible because assays are standardized and cost-effective, but they face a long-standing preference that's been in place for more than 50 years,” says Morze.

Early detection is relevant because between 20% and 40% of initial cases of coronary artery disease are fatal, so by changing the type of tests, "we can improve that accuracy and save lifes", argues the researcher.

Another marker of vascular risk

The study also observed that another type of LDL cholesterol protein, called lipoprotein (a) It is a relevant component to identify coronary risk.

As Morze explained to SINC, this molecule is capable of damaging the walls of arteries and causing them to become inflamed. “Lipoprotein(a) is structurally similar to LDL, as it transports cholesterol, but it contains an additional surface protein, apolipoprotein(a), which promotes vascular inflammation and endothelial dysfunction,” says the scientist.

Likewise, this type of protein “can alter fibrinolysis,” a natural process by which the body dissolves blood clots; and thus increase the risk of developing blood clots in the future.

Few people have high levels of lipoprotein (a), as they are genetically inherited in most cases, and represent less than 1% of the total of 'bad cholesterol' transport proteins in the general population.

However, screening is still necessary because some patients have very high values, which could lead to an increased cardiovascular risk. 

Reference: Morze, J. et al. ApoB-containing lipoproteins: count, type, size, and risk of coronary artery disease. European Heart Journal. 2025

Source: Sinc Agency

Rights: Creative Commons.

Main picture: Researchers measure the amount of apolipoprotein B (apoB) through a blood test / Freepik