AIIMS-trained doctor explains not just LDL cholesterol, these two markers can predict heart attack risk

Doctors say advanced lipid tests like Apo B and Lp(a) can identify heart disease risk earlier than standard cholesterol checks. (Image: Pexels)

When discussions around heart health come up, LDL cholesterol often takes centre stage. High LDL levels are commonly linked to an increased risk of heart attacks. However, cardiometabolic risk is more complex than a single number.

Even people with LDL cholesterol levels within the normal range can face a significant risk of heart disease. According to doctors, additional lipid markers can offer deeper insight into cardiovascular risk—especially in individuals with metabolic issues or a family history of heart disease.

Recently, Dr Priyanka Sehrawat, who trained at AIIMS, on Instagram has brought attention to two markers that don't get much notice. These markers can help doctors predict the risk of heart attacks with more accuracy.

1. Apolipoprotein B (Apo B)

You'll find Apolipoprotein B, or Apo B for short, on the outside of lipoproteins that can cause atherosclerosis. These include LDL and VLDL. LDL cholesterol tells us how much cholesterol is in the blood. Apo B, on the other hand, shows us how many harmful particles carrying cholesterol are moving through our bloodstream.

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When someone has more Apo B, it means they have more particles that can get into artery walls. These particles can help form plaque. This can happen even when LDL cholesterol levels look normal.

Dr Sehrawat points out that Apo B gives us a peek at how many atherogenic particles are in the body. This often ties in with problems in the body's metabolism.

What counts as a high Apo B level?

The American Heart Association says Apo B levels over 90 mg/dL link to higher heart disease risk. Levels at or above 130 mg/dL show a high chance of having a heart attack.

2. Serum Lipoprotein(a) [Lp(a)]

Lipoprotein(a), or Lp(a), looks a lot like LDL cholesterol but has an extra protein called apolipoprotein(a). This added part makes Lp(a) dangerous. It can form plaque, cause inflammation, and help blood clots form.

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A post shared by Dr.Priyanka Sehrawat (@docpriyankasehrawat)

Dr Sehrawat explains that Lp(a) levels are largely genetically determined and can help identify inherited cardiovascular risk. Individuals with a family history of heart attacks or premature heart disease may particularly benefit from testing this marker.

What counts as a high Lp(a) level?

The US National Library of Medicine says Lp(a) levels over 50 mg/dL are linked to a higher risk of heart disease.

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How to get these tests

You can measure both Apo B and Lipoprotein(a) with basic blood tests at most diagnostic labs. Most of the time, you need to fast before these tests, but some labs might let you take them without fasting.

These tests aren't part of the usual lipid checks, so you might need to ask for them after talking to your doctor.

Frequently Asked Questions (FAQs) on Markers That Predict Heart Risks

Apolipoprotein B (Apo B) and Serum Lipoprotein(a) [Lp(a)] are two key markers that can help predict heart risks.

Apo B indicates the number of harmful particles carrying cholesterol in your bloodstream, which can lead to plaque formation in artery walls.

Apo B levels over 90 mg/dL are linked to higher heart disease risk, with levels at or above 130 mg/dL showing a high chance of having a heart attack.

Lp(a) is similar to LDL cholesterol but has an extra protein called apolipoprotein(a), making it more dangerous as it can form plaque, cause inflammation, and help blood clots form.

Lp(a) levels over 50 mg/dL are linked to a higher risk of heart disease.

Both markers can be measured with basic blood tests available at most diagnostic labs. You might need to fast before these tests, and it's best to consult your doctor to request these specific tests.