Most people assume that a normal cholesterol test or lipid profile means their heart is in the clear. However, experts warn that cholesterol levels alone do not tell the whole story when it comes to cardiovascular risk. In fact, some people with seemingly normal lipid profiles can still suffer heart attacks because standard cholesterol panels do not measure all the markers linked to heart disease. One such marker is Apolipoprotein B (ApoB), which can provide a more detailed picture of the number of harmful particles circulating in the bloodstream.
Dr Jeremy London, a board-certified cardiothoracic surgeon with over 25 years of experience, is explaining why having normal cholesterol levels does not necessarily mean a person is free from heart disease risk. In an Instagram video shared on June 13, he breaks down the difference between LDL-C and ApoB, and why these two markers can paint very different pictures of cardiovascular health.
Difference between LDL-C and ApoB
According to Dr London, while LDL cholesterol and ApoB are closely related and tell different parts of the same story, ApoB is the more accurate indicator of cardiovascular risk. He explains that most routine cholesterol tests measure LDL-C, which reflects the total amount of cholesterol being carried by low-density lipoprotein (LDL) particles in the bloodstream. However, LDL-C does not reveal how many potentially harmful particles are actually circulating in the blood.
The heart surgeon notes, “They both tell the same story, but ApoB is actually a better indicator of your overall cardiovascular risk. Most standard cholesterol panels measure LDL-C: the total amount of cholesterol carried by LDL particles in your blood. But LDL-C doesn’t tell you how many particles are actually in circulation.”
He explains that Apolipoprotein B (ApoB) provides this crucial piece of information. Every atherogenic, or artery-clogging, particle in the bloodstream carries exactly one ApoB molecule. As a result, an ApoB test can accurately reflect the total number of harmful particles circulating in the blood. Dr London highlights, “Every atherogenic particle – LDL, VLDL, IDL – carries exactly one ApoB protein. So ApoB is a direct count of the particles themselves.”
The truck load analogy
To illustrate the difference between the two markers, Dr London uses a simple trucking analogy. Imagine cholesterol being transported throughout your body in trucks. In this scenario, ApoB represents the number of trucks on the road, while LDL-C represents the amount of cholesterol cargo being carried inside those trucks.
The heart surgeon explains, “Think of LDL particles as trucks on a highway. LDL-C is the total weight of cargo across all the trucks. ApoB is the number of trucks on the road. You can have the same total cargo load distributed across very different numbers of trucks. Someone with small, dense LDL particles might have a normal LDL-C but a high ApoB – lots of trucks, lighter loads. And it’s the trucks that do the damage. Each particle is an opportunity to penetrate the arterial wall and initiate plaque formation.”
Why this matters
Dr London notes that this trucking analogy helps explain an important reality: a person can have normal LDL cholesterol levels while still carrying a high number of dangerous particles in their bloodstream. According to him, this is one reason why some people with seemingly normal LDL-C results can still experience a heart attack or other cardiovascular events.
He explains, “Research increasingly shows that ApoB is a stronger predictor of cardiovascular risk than LDL-C – particularly in people with metabolic syndrome, insulin resistance, or high triglycerides, where particle number and cholesterol content diverge the most. This is why the American Heart Association has included ApoB in their new recommendations. So, I think it’s important to get it checked. You can get your primary care physician to check it for you and there’s a lot of options online.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. It is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.
