Blood Test May Predict Heart Disease Better Than LDL Cholesterol

A growing number of doctors say the apoB test provides a more comprehensive assessment of cholesterol-related heart disease risk.

Published on Feb. 8, 2026

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Recent research suggests that the apolipoprotein B (apoB) blood test may be a better predictor of heart disease risk than the standard LDL cholesterol test. ApoB measures the number of harmful lipoproteins that contribute to plaque buildup, while LDL only measures the cholesterol content. Doctors like Ann Marie Navar and Samia Mora recommend that all adults be screened for apoB, as it can detect elevated heart disease risk even when LDL levels appear normal.

Why it matters

Heart disease is the leading cause of death in the U.S., and current cholesterol screening methods may not fully capture an individual's risk. The apoB test provides a more direct measure of the harmful particles that contribute to plaque formation and cardiovascular issues. Wider adoption of this test could lead to earlier detection and prevention of heart disease.

The details

The apoB protein attaches to harmful fat particles in the blood, so testing for it captures the overall number of plaque-producing compounds. This is different from the standard LDL cholesterol test, which only measures the cholesterol content of those particles. Factors like being overweight or having diabetes can create a mismatch between normal LDL and elevated apoB, putting someone at higher heart disease risk even if their LDL appears normal. While the American Heart Association doesn't currently recommend routine apoB testing, some doctors believe it should be part of standard cholesterol screening.

  • The 2024 study on low apoB testing rates was sponsored by drugmaker Regeneron and published in The American Journal of Preventive Cardiology.

The players

Dr. Ann Marie Navar

A preventive cardiologist at UT Southwestern Medical Center in Dallas who routinely checks apoB levels in her patients.

Dr. Samia Mora

A cardiologist and the director of the Center for Lipid Metabolomics at Brigham and Women's Hospital who recommends testing apoB at least once to ensure it aligns with LDL screening results.

Dr. Thomas Dayspring

A fellow of the National Lipid Association and a renowned cholesterol expert who believes apoB is the best metric for cardiovascular risk assessment.

Dr. Jeffrey Berger

A preventive cardiologist at NYU Langone who says apoB offers a practical way to assess cholesterol burden and plaque formation.

Dr. Michael Shapiro

The chair of the American Heart Association Council on Lipidology, Lipoprotein, Metabolism & Thrombosis, who typically uses apoB testing in select patients.

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What they’re saying

“ApoB is by far the best metric that every human should get tested for when they do their cardiovascular risk assessments.”

— Dr. Thomas Dayspring, Fellow of the National Lipid Association and renowned cholesterol expert (Proof with Simon Hill podcast)

“ApoB offers a practical and comprehensive way to basically assess cholesterol burden, which is involved in the accumulation of bad cholesterol and plaque formation.”

— Dr. Jeffrey Berger, Preventive cardiologist at NYU Langone (nbcnews.com)

The takeaway

This research highlights the potential limitations of relying solely on LDL cholesterol testing to assess heart disease risk. Wider adoption of the apoB test could lead to earlier detection and prevention of cardiovascular issues, especially for individuals with normal LDL but elevated levels of harmful lipoproteins.