How important is the ApoB/A Ratio?

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Alexis
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How important is the ApoB/A Ratio?

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I haven't posted on here in while -- I'm not sure why, given that this site is like an oasis of sanity on the internet!

I recently had some bloodwork done and I was fairly pleased with the results -- especially the ApoA: ApoB ratio, which I understand is powerfully predictive of cardiovascular disease. Given my Apoe4 status, I am obv especially keen to keep CV disease in check. The doctor's comments were also encouraging (although my total cholesterol was a little too high at 5.4mmol/L).

However, the Peter Attia community have weakened my confidence in these results, as they follow Peter in minimising the importance of the apoA/B ratio and instead argue the apoB count is all that matters. I'm really not sure what to believe at this point. More importantly, I'm not sure if my results suggest I need to take radical action or just tweak what I'm doing in terms of diet and exercise.

Here are my results -- any insights from this community would be appreciated.
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TheresaB
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Re: How important is the ApoB/A Ratio?

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Alexis wrote: Sun Nov 27, 2022 7:01 am I recently had some bloodwork done and I was fairly pleased with the results -- especially the ApoA: ApoB ratio, which I understand is powerfully predictive of cardiovascular disease. Given my Apoe4 status, I am obv especially keen to keep CV disease in check. The doctor's comments were also encouraging (although my total cholesterol was a little too high at 5.4mmol/L).
That looks like a good Apo B to Apo A1 ratio to me. But HOW important is that ratio? I can’t answer that. What I will say is the body is a system of interdependent functions and fixating any one biomarker is of little consequence without taking the overall body of tests into consideration. If a doctor fixates on one biomarker without evaluating other biomarkers, I’d be suspicious.
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Alexis
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Re: How important is the ApoB/A Ratio?

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Thanks Teresa; I fully agree with you — fortunately the doctor who analysed my results did give me a much fuller picture and didn’t just focus on the apoB ratio.

I guess I wasn’t very clear in my original post — apologies.

What I’m more interested is whether the ApoB-ApoA ratio is more significant than the ApoB result alone.

Attia seems to argue that ApoB is the most important biomarker for preventing cv disease, all else being equal. More important than the ratio, in fact.

I’m trying to understand whether his view is contrary to the prevailing wisdom on these biomarkers.
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Re: How important is the ApoB/A Ratio?

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Alexis wrote: Mon Nov 28, 2022 4:09 pm What I’m more interested is whether the ApoB-ApoA ratio is more significant than the ApoB result alone.
For most people in the population, maybe. ApoB is essentially LDL cholesterol. ApoE4s have higher levels of LDL than 3s or 2s because we're cholesterol conservers. You can't compare levels across genotypes, APOE status should be taken into consideration.

You may want to listen (or read the extensive shownotes) to our part 2 Podcast with Dr Goodenowe https://www.apoe4.info/ep003-dayan-goodenowe/

In it he explains the liver makes most of the cholesterol and distributes the LDL particles, that's what's being measured. The cells will absorb the cholesterol that they need from the blood supply, but since we're more efficient at holding on to it, we have more in the blood supply that hasn't been pulled by our cells. He also explains that none of the cholesterol from your liver and blood supply gets to the brain. Your brain makes all its own cholesterol and all its own transportation of cholesterol.

Personally, I don't think LDL levels are the issue, it's when the LDL becomes small, dense and oxidized that it produces the damaging inflammation. But I don't profess to know more than Dr Attia (I'm a fan).
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Re: How important is the ApoB/A Ratio?

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Thanks so much — I will listen the podcast.

My LDL is a little high (3.4 mmol). I didn’t realise there was an a connection to apoe4.
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