Harvard Heart Letter

Better heart attack prediction from new cholesterol tests?

Two simple tests could someday elbow aside, or at least complement, today's standard cholesterol tests.

A multibillion-dollar industry rests on the squishy, fat-filled particle known as low-density lipoprotein (LDL), the so-called bad cholesterol. LDL is the foundation on which the current cholesterol guidelines were built. It is the focus of millions of yearly blood tests. And it is the main target of cholesterol-lowering statins, for which Americans shelled out nearly $20 billion in 2005.

It's also not a perfect standard. Not everyone with high LDL has a heart attack, and up to half of all heart attacks happen to people with normal LDL. That's why researchers are exploring other tests that might offer a clearer picture of heart disease risk. One test tallies up what's called non-HDL cholesterol using the standard cholesterol test. Another measures levels of apolipoprotein B (APP-oh-LIP-oh-PRO-teen), a protein that is part of LDL and other equally bad actors. Both tests are based on the growing understanding that cholesterol-carrying particles other than LDL can also be bad for the arteries.

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