Apolipoprotein B in cardiovascular risk assessment: beyond traditional lipid markers

Abstract

Apolipoprotein B (ApoB) serves as the structural backbone of triglyceride (TG)-rich lipoproteins and low-density lipoprotein (LDL) particles and plays a key role in lipid transport. A growing body of evidence indicates that circulating ApoB levels are closely associated with the development of cardiovascular diseases such as coronary atherosclerosis, and ApoB may be one of the most accurate markers for assessing atherosclerotic cardiovascular disease (ASCVD) risk. This review discusses the limitations of conventional lipid measures, including low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG), and systematically examines the advantages of ApoB as an alternative marker for cardiovascular risk assessment, as well as its independent predictive value. In addition, this review discusses the clinical utility, potential advantages, and challenges associated with ApoB, as well as the effects of currently available lipid-lowering therapies on ApoB and recent advances in the development of ApoB-targeted therapies, with the aim of informing more precise strategies for the prevention and treatment of cardiovascular disease.