For nearly 60 years, doctors have used cholesterol tests to figure out who might be at high risk for heart disease.
But now, a large international study led by researchers from Chalmers University of Technology in Sweden and Harvard University in the United States has found a better way.
Instead of just measuring cholesterol, the study shows that measuring certain particles that carry cholesterol in the blood gives a clearer picture of a person’s risk of heart problems.
This new approach could help doctors prevent more heart attacks and save more lives.
Heart disease is the number one cause of death worldwide, according to the World Health Organization.
Many of these deaths could be avoided by making healthier lifestyle choices—like quitting smoking, eating better, and staying active. Still, early detection is key.
The sooner doctors know someone is at risk, the sooner they can step in to help.
Cholesterol is a waxy, fat-like substance that the body needs in small amounts. It helps build cells and produce hormones and vitamins. But too much cholesterol can be dangerous.
When it builds up in the blood vessels, it can form hard deposits called plaques.
These plaques can block blood flow or even break open and cause a blood clot. If a clot blocks a blood vessel that feeds the heart or brain, it can cause a heart attack or stroke.
In the blood, cholesterol travels inside tiny particles called lipoproteins.
Some lipoproteins carry cholesterol to the body’s cells—these are known as “bad cholesterol” carriers. Others help remove cholesterol and take it back to the liver—these are known as “good cholesterol” carriers.
Currently, blood tests only look at the total amount of cholesterol. But this doesn’t always give the full story. That’s because the real danger comes from the number of particles carrying the bad cholesterol—not just how much cholesterol is in them.
To explore this, the researchers studied blood samples from over 200,000 people in the UK who had no history of heart disease. They followed these people for up to 15 years to see who later developed heart problems. They also used computer tools and deep learning to measure different kinds of lipoproteins in the blood.
The study found that one particle in particular, called apolipoprotein B or apoB, is the best warning sign. ApoB is found on all the bad cholesterol carriers. So measuring apoB gives a good estimate of how many of these risky particles are floating around in the blood. The more particles you have, the higher your risk of heart disease.
Standard cholesterol tests work well for most people. But for about one in twelve patients, those tests might miss the danger. That’s a big concern, especially because many heart attacks are deadly the first time they happen. By switching to apoB testing, doctors could better identify high-risk patients and act sooner.
The study also looked at another particle called lipoprotein(a), which is also linked to heart disease. This particle is mostly determined by your genes.
While most people have low levels of it, some have very high levels, which puts them at much higher risk. The researchers say doctors should test for both apoB and lipoprotein(a) to get a more complete picture of a person’s risk.
This new blood test is already available and isn’t expensive. The researchers believe it could eventually replace the traditional cholesterol test around the world. By improving how we measure risk, we could help more people avoid heart disease, stay healthy, and live longer lives.
This study shows that looking beyond traditional cholesterol tests can make a big difference. Instead of just measuring cholesterol, doctors should consider how many cholesterol-carrying particles are in the blood. That number is a much better predictor of heart disease.
The researchers also highlight the importance of lipoprotein(a), which is often overlooked but could be a major risk factor for some people.
By combining both apoB and lipoprotein(a) tests, healthcare providers could greatly improve heart disease prevention strategies. Overall, this research offers a promising new direction for saving lives through smarter and simpler blood tests.
The study is published in European Heart Journal.
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