All Checked Up
March 30, 2026
This article looks at how useful Apolipoproteins and Lipoprotein (a) are in determining the risk of heart diseases and whether they should be routinely measured
It is widely accepted Cholesterol is a good measure for determining the risk certain cardiovascular diseases. High levels of Cholesterol have been linked to increased risk of cardiovascular disease in particular the bad cholesterol known as Low density lipoproteins (LDL). But did you know there are many different types of cholesterol like molecules that can also influence our risk of heart disease.
First lets recap what Cholesterol is. Cholesterol is a fat chemical made by the cells in your body. It is classified as a lipid. There are many different types of lipids that include fats, waxes, sterols and fat-soluble vitamins.
Cholesterol has many uses. It is important in building hormones and acting as a lining in our cells. It is transported around the body by particles called lipoproteins. There are many different lipoproteins. The two main types are Low-Density Lipoproteins (LDL) and High-Density Lipoproteins (HDL). But we also have others that have been shown to play a role in our risk of cardiovascular disease and we will go through some here.
Lipoprotein (a) is an LDL-like particle produced in the liver that contains Apolipoprotein (a) and Apolipoprotein B. Numerous studies have found increased levels of Lipoprotein (a) (greater than 75nmol/L*) are associated with an increased risk of cardiovascular diseases such as heart attacks, strokes, and heart disease. It is suggested up to 20% of the population have an increased level of Lipoprotein (a).
It is thought Lipoprotein (a) increases the risk of heart attacks by interfering with clotting mechanisms and therefore promoting clot development on the inner surface of blood vessels.
Once you know your levels of Lipoprotein (a), you do not usually need to test for it again. This is because it is predominately genetically related with little influence from environmental factors. However, it is still important to continually monitor the other identified risk factors.
Studies have also found variations in Lipoprotein (a) across different ethnicities, with Africans having the highest Lipoprotein (a) levels, and Chinese having the lowest.
Apolipoproteins are proteins that combine with lipids (fats) to form a transport molecule called lipoproteins. They serve as the vehicle for transporting lipids around the body There are six major classes of apolipoproteins: A, B, C, D, E and H
Apolipoprotein A comes in two forms Apolipoprotein A-I (apo A-I) and Apolipoprotein A-II (apo A-II). Apo A-I is generally present 3 times more than apo A-II.
Apo A-I is the major protein component in our good cholesterol (HDL). The amount of apo A-I can be measured directly and tends to rise and fall with HDL levels. Low levels of apo A-I increase the risk of developing heart disease and peripheral vascular disease. Apo A-I levels are useful in evaluating the risk of heart disease particularly when HDL levels are low. They can also interact with another subset of Apolipoprotein, apo E, to change triglyceride levels in those suffering from heart disease.
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In contrast, Apolipoprotein (Apo B) is the main apolipoprotein of the bad cholesterol (LDL). Therefore, high levels appear to relate to an increased risk of heart disease. Elevated levels may be due to a high-fat diet and/or decreased clearing of bad cholesterol from the blood. Diet and exercise changes that lower LDL levels (and increase HDL, the “good” cholesterol) will lower your apo B levels and decrease your risk of heart disease.
Apolipoprotein B and the apo B/apo A1 ratios are thought to be a better marker of risk of heart and disease than any cholesterol index. An increased ratio is a good predictor of stroke in if you have previously had a transient ischaemic attack (mini-stroke).
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