Apolipoprotein B Testing for Residual Cardiovascular Risk Assessment

Introduction to ApoB Testing

Apolipoprotein B (apoB) is a superior marker of residual cardiovascular risk in statin-treated patients compared to LDL-C alone, providing unique information about residual risk, according to the American College of Cardiology 1

The American College of Cardiology suggests that apoB testing should be prioritized in patients with clearly established cardiovascular risk to guide residual risk discussions, particularly in secondary prevention patients and those with elevated triglycerides and/or low HDL-C 1
If apoB is elevated despite LDL-C of 81 mg/dL, this should prompt a discussion about residual risk and options for further intensification, including lifestyle improvements and consideration of add-on therapy such as ezetimibe, as recommended by the American College of Cardiology and the American Heart Association 1, 2

For patients with clinical atherosclerotic cardiovascular disease who are at "very high risk", if on maximal statin therapy with LDL-C ≥70 mg/dL, adding ezetimibe is reasonable, according to the 2019 ACC/AHA Guideline Framework 2