May 2026

CARDIOVASCULAR

APOB OUTPERFORMS LDL AND NON-HDL CHOLESTEROL IN GUIDING LIPID-LOWERING THERAPY

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Researchers found a blood test called apolipoprotein B could improve population health and save more lives in a cost-effective manner compared to two more commonly used measures of risk.
Featuring: Ciaran Kohli-Lynch, PhD and John T. Wilkins, MD
A new Northwestern Medicine study published in JAMA found that apolipoprotein B (apoB) outperformed LDL and non‑HDL cholesterol in guiding cholesterol-lowering therapy. This is the first comprehensive study to show that apoB-guided care is not only more effective but also cost-effective.

​The Consideration of Cost on Clinical Practice
For years, clinicians have focused on LDL and non-HDL goals to decide when to start and intensify cholesterol-lowering treatment. However, research shows that apoB better identifies patients at risk. “Research strongly shows that apolipoprotein B (apoB) is better at identifying who is at risk, because it counts the total number of harmful particles in the blood,” explained Kohli-Lynch.

Despite this evidence, apoB is not widely used in routine care.

​The study’s lead, Ciaran Kohli-Lynch, PhD, says that’s partly because of cost and convenience, which is why the team aimed to evaluate apoB cost-effectiveness.

Details of the Study’s Deep Dive
The study team used a large computer simulation model representing 250,000 U.S. adults eligible for statins but without existing cardiovascular disease.

They compared three strategies for guiding treatment:
  • LDL cholesterol (goal <100 mg/dL)
  • Non-HDL cholesterol (goal <118 mg/dL)
  • ApoB (goal <78.7 mg/dL)

​If patients didn’t meet their goal, treatment was intensified with stronger statins, then by adding ezetimibe. The model tracked outcomes for each strategy over a lifetime, finding that ApoB-guided care was a cost-effective option that outperformed the other two strategies.
Ciaran Kohli-Lynch, PhD, Assistant Professor of Preventive Medicine
John T. Wilkins, MD, Associate Professor of Cardiology

​Dr. Wilkins was a co-senior author of this study.

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