Why Traditional Cholesterol Testing Is Sometimes Not Enough?
For nearly six decades, measuring blood cholesterol has been considered the gold standard for assessing the risk of heart disease. However, modern science shows that this approach is often not precise enough.
A large study conducted in more than 200,000 people, led by researchers from Chalmers University of Technology and Harvard University, delivers an important message:
👉 The number of cholesterol-carrying particles is more important than the total amount of cholesterol itself.
In other words, what matters is not how much cholesterol you have, but how many “carriers” of that cholesterol are circulating in your blood vessels.
Heart disease – the silent killer of modern society
According to data from the World Health Organization (WHO), cardiovascular diseases are the leading cause of death worldwide. A large proportion of these deaths could be prevented through early risk detection and simple preventive measures.
The problem is that in a significant number of people, risk is not recognized in time, because standard lipid profiles may appear “acceptable.”
“Good” and “bad” cholesterol – but that’s not the whole story
Cholesterol is essential for the body: it plays a role in cell structure and hormone synthesis. However, when present in excess, it accumulates in the walls of blood vessels and forms atherosclerotic plaques. If a plaque ruptures, it can lead to a heart attack or stroke.
Cholesterol does not travel alone. It is transported through the bloodstream by lipoproteins.
Three main atherogenic classes of lipoproteins — VLDL, IDL, and LDL — carry apolipoprotein B (apoB).
Because each of these particles contains exactly one apoB molecule, measuring apoB accurately reflects the total number of all “bad” particles that can damage blood vessels.
Why is apoB a more precise risk marker?
Traditional testing measures the amount of cholesterol, but not the number of particles that carry it .And each of these particles has the potential to become trapped in the arterial wall.
Research has shown that:
- apoB is the single best marker of cardiovascular risk
- because it directly reflects the total number of atherogenic (harmful) particles
👉 Two individuals may have the same level of “bad cholesterol,” but a different number of apoB particles — and therefore a different risk of heart attack.
📊 What are the desirable apoB values?
To make this information truly useful, it is important to know what is considered optimal and what indicates increased risk.
Recommended target apoB values:
- < 100 mg/dL – low cardiovascular risk
- < 90 mg/dL – moderate risk
- < 80 mg/dL – optimal, preventive target (recommended for most adults)
- < 65–70 mg/dL – high or very high risk (diabetes, previous heart attack, metabolic syndrome)
Clarification:
Lower apoB values always mean lower risk.
The difference lies only in how low apoB should be, depending on an individual’s overall cardiovascular risk.
📌 Important to know:
In approximately 1 out of 12 people, standard cholesterol testing underestimates the true risk, while apoB clearly reveals the real situation. This is clinically crucial, since 20–40% of first cardiovascular events are fatal.
Another important player: lipoprotein(a)
The study also highlighted the importance of lipoprotein(a) — a specific, genetically determined form of “bad cholesterol.”
How are lipoprotein(a) levels interpreted?
- < 30 mg/dL – desirable level
- 30–50 mg/dL – moderate risk
- > 50 mg/dL – significantly increased cardiovascular risk
- > 90–100 mg/dL – high genetic risk
⚠️ Lipoprotein(a):
- is usually measured once in a lifetime
- does not respond significantly to diet
- requires stricter target levels for apoB and LDL cholesterol
If Lp(a) is elevated, the target apoB level should be even lower, even in individuals without other risk factors.
Good news: the test is simple and accessible
Tests for apoB and lipoprotein(a):
- are performed from a standard blood sample
- are already available in laboratories
- are financially affordable
- can easily be implemented in routine preventive testing
Experts even predict that apoB may eventually replace traditional cholesterol testing as the standard risk marker.
What does this mean for you – in practice?
If you:
- have a family history of heart disease
- have excess body weight, insulin resistance or metabolic syndrome
- have “normal” cholesterol but experience symptoms or fatigue
- want true prevention, not just “good numbers”
👉 apoB and lipoprotein(a) provide a deeper and more realistic picture of your cardiovascular risk.
Source: Jakub Morze, Giorgio E M Melloni, Clemens Wittenbecher, Mika Ala-Korpela, Andrzej Rynkiewicz, Marta Guasch-Ferré, Christian T Ruff, Frank B Hu, Marc S Sabatine, Nicholas A Marston. ApoB-containing lipoproteins: count, type, size, and risk of coronary artery disease. European Heart Journal, 2025; DOI: 10.1093/eurheartj/ehaf207
💚 THE HEALTH FORMULA – prevention begins with understanding
In the HEALTH FORMULA approach, health is not reduced to a single test or a single number.
We assess functional risk, interpret results in the context of lifestyle, metabolism, and genetics — and act before disease develops.
👉 Health is built through knowledge. Vitality is preserved through prevention. And true risk becomes visible only when we look beneath the surface.
That is the essence of THE HEALTH FORMULA 💚
