A blood test measuring apolipoprotein B (apoB) may be more effective than standard LDL cholesterol testing for determining who needs more intensive treatment to prevent heart attacks and strokes, according to research published in JAMA.
Researchers at Northwestern University created a computer simulation representing 250,000 US adults eligible for statin therapy who did not already have cardiovascular disease. The model compared three approaches for guiding treatment: LDL cholesterol, non-HDL cholesterol, and apoB testing, each with specific target goals.
The results showed that using apoB to guide treatment consistently performed better than both LDL and non-HDL approaches, preventing more cardiovascular events whilst remaining cost-effective for the healthcare system. This represents the first comprehensive analysis demonstrating that apoB-guided cholesterol treatment is also economically viable.
Lead author Ciaran Kohli-Lynch, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine, explained that whilst standard cholesterol tests provide useful information, they do not fully capture cardiovascular risk. ApoB measures the total number of cholesterol-carrying particles that can contribute to plaque buildup, making it a more direct indicator of risk.
Over time, cholesterol-carrying particles become trapped inside artery walls, accumulating into plaques that restrict blood flow and increase the risk of heart attacks and strokes. Heart disease remains the leading cause of death in the United States.
Despite growing evidence supporting apoB, the test is not commonly used in routine care, partly because it requires additional testing beyond standard cholesterol panels. The findings are particularly relevant following updated guidelines from the American Heart Association and other organisations recommending that many people begin cholesterol-lowering therapy at younger ages.
Source: Science Daily / Northwestern University (JAMA, 2026)
