This episode explores the clinical utility of ApoB testing in cardiovascular risk assessment, contrasting it with traditional LDL and non-HDL cholesterol measurements. The discussion begins by highlighting the differing contexts of primary care versus specialized lipidology practices, where the comprehensive lipid panel including ApoB is routinely employed for initial evaluations, new treatments, and therapeutic response monitoring. More significantly, the conversation delves into the phenomenon of discordance between ApoB and other lipid markers, even in seemingly healthy individuals, emphasizing the value of ApoB as a superior predictor of risk in such cases. For instance, the presenters discuss a study by Anne-Marie Navarre highlighting this discordance in metabolically healthy individuals with high ApoB despite normal LDL cholesterol. While acknowledging the clinical value of non-HDL cholesterol, the experts ultimately favor ApoB in cases of discordance, although they note that even advanced tests like NMR can show discrepancies with ApoB. The episode concludes by addressing concerns about the accessibility and cost of ApoB testing, insurance coverage issues, and the ongoing efforts to establish ApoB as a primary treatment target in clinical guidelines.
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