For nearly 60 years, doctors have relied on measuring cholesterol levels in the blood to identify people at high risk of cardiovascular disease.
But a major new study from Chalmers University of Technology in Sweden and Harvard University in the US suggests there may be a better way.
The researchers found that testing for two specific markers in a simple blood test can more accurately predict heart disease risk than the standard cholesterol test—and could potentially save lives.
Cardiovascular diseases are the world’s leading cause of death, according to the World Health Organization. Many cases could be prevented by improving diet, quitting smoking, exercising, and other healthy habits. Detecting risk early is key to preventing serious outcomes like heart attacks or strokes.
Cholesterol is a fat-like substance in the blood that the body needs to build cells and make certain hormones. But too much “bad cholesterol” can build up inside blood vessels, forming plaques that can block blood flow.
If a plaque ruptures, it can cause a heart attack or stroke. Cholesterol travels through the blood in particles called lipoproteins. Most “bad cholesterol” is carried by lipoproteins containing a protein called apolipoprotein B (apoB). In contrast, “good cholesterol” is carried by different particles that help remove cholesterol from the bloodstream.
Currently, heart disease risk is estimated by measuring the amount of cholesterol in the blood. But since cholesterol cannot travel without its lipoprotein carrier, scientists believe counting these carrier particles may give a more accurate picture of risk.
This study is the largest to date to examine the three main families of cholesterol-carrying lipoproteins and their link to heart disease.
Researchers studied blood samples from over 200,000 people in the UK Biobank who had no history of heart disease, measuring both the number and size of different “bad cholesterol” particles. They followed participants for up to 15 years to see who went on to have heart attacks. They confirmed their results in a separate Swedish study.
The results were clear: apoB was the most accurate marker for predicting heart disease risk. Because apoB reflects the total number of harmful particles, it gave a more precise risk estimate than standard cholesterol tests.
While current tests generally work well, they may underestimate risk in about 1 in 12 people—a serious concern since many first-time heart attacks or strokes are fatal. Switching to apoB testing could help catch high-risk individuals earlier.
The researchers also highlighted another important marker: lipoprotein(a). This type of “bad cholesterol” is inherited genetically and usually makes up less than 1% of harmful particles in most people.
However, in some individuals, levels are extremely high, greatly increasing heart disease risk. Measuring both apoB and lipoprotein(a) could give the most complete picture of cholesterol-related risk.
According to the authors, blood tests for apoB and lipoprotein(a) are already available, inexpensive, and simple to implement. They believe these markers could eventually replace standard cholesterol testing in healthcare worldwide, offering more accurate detection of people at risk and potentially preventing many deaths.
If you care about heart health, please read studies about blood thinners that may not prevent stroke in people with heartbeat problems and this diabetes drug may protect heart health in older veterans.
If you care about heart health, please read studies about why light-to-moderate drinking is linked to better heart health and reconsidering the long-term use of high blood pressure beta blockers after a heart attack.
The study is published in European Heart Journal.
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