ESC Cardio Talk Journal editorial: ApoB and Lp(a): core measures to assess cardiovascular risk
Oct 6, 2025
Allan Sniderman, a cardiologist and professor at McGill University, dives into the importance of ApoB and Lp(a) for cardiovascular risk assessment. He challenges traditional views on VLDL versus LDL atherogenicity, revealing that VLDL may pose greater risks than previously thought. Sniderman discusses a comprehensive study involving over 200,000 participants, elaborating on how examining particle numbers can change risk interpretations. He advocates for measuring ApoB and Lp(a) to enhance clinical insights and streamline patient care.
AI Snips
Chapters
Transcript
Episode notes
Questioning VLDL’s Alleged Dominance
- Recent studies suggested VLDL particles may be 4–5× more atherogenic than LDL on a per-particle basis.
- Allan Sniderman highlights that if true, this would challenge LDL-C, non-HDL-C, and ApoB as adequate summary risk measures.
Why Particle Number Beats Cholesterol Mass
- ApoB counts particles that carry cholesterol and triglyceride and better reflects what actually enters the arterial wall.
- Sniderman notes particle number can vary in cholesterol content, explaining why ApoB outperforms LDL-C and non-HDL-C as a risk marker.
Large UK Biobank Analysis
- Morris and colleagues analysed UK Biobank with NMR lipoprotein subclass profiling and ApoB measures in >200,000 people.
- The cohort had mean 13.7 years follow-up and 7,585 cardiovascular events, providing robust data for analysis.