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CVD/CHD Risk Biomarkers (apoB)

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  • CVD/CHD Risk Biomarkers (apoB)

    I imagine you docs are already familiar with this study? If not:

    Evaluating the relationship between circulating lipoprotein lipids and apolipoproteins with risk of coronary heart disease: A multivariable Mendelian randomisation analysis
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089422/

    What are your thoughts? Is apoB as the primary biomarker for long term atherosclerosis risk a common understanding among yourselves and those you work with? What I find particularly interesting is this (emphasis mine):
    In multivariable MR, only apolipoprotein B (OR 1.92; 95% CI: 1.31–2.81; P < 0.001) retained a robust effect, with the estimate for LDL cholesterol (OR 0.85; 95% CI: 0.57–1.27; P = 0.44) reversing and that of triglycerides (OR 1.12; 95% CI: 1.02–1.23; P = 0.01) becoming weaker. Individual MR analyses showed a 1-standard-deviation–higher HDL cholesterol (OR 0.80; 95% CI: 0.75–0.86; P < 0.001) and apolipoprotein A-I (OR 0.83; 95% CI: 0.77–0.89; P < 0.001) to lower the risk of CHD, but these effect estimates attenuated substantially to the null on accounting for apolipoprotein B.

    I've found the Canadian MD's I've encountered to be fairly resistant to the idea of ordering apoB tests for people my age (early 30's), claiming that they only typically do so for people in their 50's; that said, our public healthcare system seems to be largely against preventative-oriented testing. I've always been confused by this as it is a marker not of accumulated insult (the way a CAC or fluoroscopy might reveal) but one of long term risk, much like a ship being off course by varying degrees. Is apoB on a standard panel for docs in the US?

    As an aside, I've been curious about this idea of discordance as it relates to bioindividuality. It's no secret that nutritional data is a mess, and as such I've experimented a bit with diet and have ended up with a relatively high sat fat (25% daily kcal), high protein, titrated carb diet (usually 60-100g a day) for a variety of reasons: I seem to sleep better, easier appetite control, easier to fast should I choose to do so, no more low-grade daily anxiety, less brainfog, and no measurable performance detriments like when I was eating <20g carb a day, etc. Obviously being concerned about risk I had blood levels checked fairly recently and I think if I hadn't bothered with apoB I may have been slightly more concerned (at 31). Didn't do CRP but more recently it was about 1.1.

    Cholesterol: 199.92
    HDL: 73.47
    LDL: 118.32
    TG: 41.62
    apoB-100: 87

  • #2
    We have previously discussed in a number of places that apoB can be very useful in sussing out someone's ASCVD risk if it's unclear based on their current standard lipid panel and risk factors.

    ApoB is not on a standard "lipid panel" test in the US, but is reasonably inexpensive . There are other problems with CAC as well. For example, it is generally much higher in athletes.

    I am unable to comment on your specific risk without knowing more, though even without the apoB test I don't really see anything of serious concern...especially given your age. I do think your diet is too high in saturated fat for health and too low in carbohydrates for performance, though you may not notice this.
    Last edited by Jordan Feigenbaum; 07-27-2021, 08:39 PM.
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