The Apo-B/Apo A-1 Ratio Predicts Severity of Coronary Artery Disease
I get asked all the time about whether folks should be on a statin, or whether their lipid panel is trouble. They tell me their total cholesterol. Their doctor just told them to be on a statin. What should they do? Now, I say, “Let’s look at your lipids and see if you really are at risk. Turns out, your total cholesterol just isn’t the issue at all.” The HUNT Study from Norway has thrown a significant monkey wrench into the whole affair be discovering that women who have cholesterol above 200 live longer than women below 200. So, why are we treating you to lower your level below 200? What are your real risks?
Along comes the Singulex company and starts with a new test I hadn’t seen before, the Apo – B / Apo A-1 ratio. Sounds like a lot of excessive slicing and dicing. So, I did some reading and here is what I found out.
Apo – B is essentially the docking protein of the LDL particle. Got that? It’s the site of binding the LDL particle to a fat cell. Simple. And just what is the LDL particle doing? It is essentially carrying extra fat you have manufactured in your liver, to your fat cell for storage. You make extra fat when you eat too many carbohydrates. Through most of human history, we had extra, easily available carbohydrates only a couple of times a year: most notable at the end of the harvest season when the fruit trees and the grains were ripening, and we could eat like a pig. At that time, you want your LDLs to go up, delivering fat to your fat cells. Easy as pie. What happens when you stop eating carbs? Not quite as easy, but even better than than pie. Your LDLs start to change size and shape, and your HDL’s start to climb. And your triglycerides fall like a rock.
When you stop eating carbohydrates, your liver doesn’t have to manufacture triglycerides. Net effect is that you make fewer and fewer LDL particles, but they get bigger and bigger and fluffier and fluffier. And harmless. This unpacks the lunacy of measuring total cholesterol and using that as criteria for being on a statin. The analogy I make is “having a pickup truck full of basketballs would be, (What, 50 basketballs?) is much safer than having a 5 gallon bucket full of golf balls, (500 golf balls?) Golf balls are deadly, basketballs are harmless. It is only the small, dense, dangerous, LDLs that cause heart disease.
Back to the Apo – B / Apo A-1 ratio. The Apo A-1 protein is the docking protein on the HDL particle. It sucks lipids out of stuffed white cells in the walls of arteries that are trying to clean up the mess of small dense, LDLs. If those white cells die, they turn into a lipid pool that sets off all sorts of inflammation and becomes the basis for plaque. You want HDLs. They are your friend. You want more Apo A-1 Protein. Get it?
What the the ratio do? Turns out, it is the MOST accurate ratio for predicting risk for heart disease. You want less than 0.6. It means your HDL is climbing higher. That’s the bottom number, the denominator. And your LDL is falling, that’s the top number. And it takes into account the size and fluffiness of both particles. That’s it. It’s what you want to know to keep yourself safe.
How can you change it? Simple as pie. Aka, no pie. No sugar, no carbs. More fat and carbs in the form of “above-ground vegetables”. You now have a marker you can demonstrate is getting better and better with your eating.
WWW.What will work for me. I love having data that gets to the “heart of it”. With data, and knowing how to interpret it, I can drive my own metabolism. There is lots of research now showing it is the best. Upshot for me. Eat less carbs, more eggs and spinach.
1. Your Apo B protein is what?
The docking protein on your LDL particle. The more LDLs you have, the more Apo B you will have. In other words, as LDLS get smaller and denser and more numerous, your Apo B goes up.
2. You Apo A – 1 is what?
The docking protein on your HDL particle. That’s the good one. You want more HDLs.
3. How do you raise your HDLs?
4. So, explain in your words what the Apo B / Apo A-1 ratio is?
It is the bad cholesterol particle count divided by the good particle count. When it gets below 0.6, you’re good. Any lowering is on the path to good.
5. I need to keep my cholesterol count below 200. T or F
False, false, false. Read the HUNT study. Look at your ratio. Get a cardiac calcium scan. And if you can’t stop eating ice-cream, well, maybe you should be on a statin.