Millions of Americans may be relying on the wrong cholesterol test. A new Northwestern Medicine study published in JAMA found that apolipoprotein B (apoB) testing outperforms standard LDL cholesterol testing in identifying who needs more aggressive heart disease treatment — and it's cost-effective too. With updated guidelines now recommending earlier cholesterol therapy for more people, getting the right test could matter more than ever.
Millions of Americans get their LDL cholesterol checked every year, but a new study suggests that test may be leaving too many people at risk. Research from Northwestern Medicine, published in JAMA, found that apolipoprotein B (apoB) — a test that counts the actual number of harmful cholesterol-carrying particles in the blood — is a more accurate guide for deciding who needs intensified cholesterol-lowering treatment than LDL or non-HDL cholesterol.
Using a computer simulation of 250,000 U.S. adults eligible for statin therapy, researchers compared three treatment-guiding strategies: LDL, non-HDL, and apoB targets. The apoB approach consistently prevented more heart attacks and strokes and delivered better health outcomes — all at a cost deemed good value for U.S. healthcare payers. It's the first study to demonstrate both the clinical superiority and cost-effectiveness of apoB-guided treatment.
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Why it matters: With new AHA guidelines pushing for earlier cholesterol treatment in more patients, accurately identifying who truly needs intensive therapy is critical. ApoB testing could be a smarter, more precise tool — but wider adoption will require overcoming the added cost and inconvenience of an extra blood test.
