Patient Guide · Heart Health · Plain Language
Lp(a) and ApoB: Two Cholesterol Tests Your Standard Panel Misses
By Brian Paquette, DO, MPH
Your regular cholesterol test leaves out two useful numbers. One, called apoB, counts the particles that carry cholesterol into your arteries. The other, called Lp(a), checks for a type of particle you inherit from your parents. Here is what each one tells you, who should get them, and what it means if you carry APOE ε4.
The short answer
Should you ask your doctor for these tests?
For most adults, yes. Here is why:
| LP(A) | Get it checked once in your life. National heart guidelines now recommend this for every adult.[1] |
| APOB | Ask about it if you have diabetes, high triglycerides, extra weight around the middle, kidney disease, or heart disease, especially if your LDL cholesterol already looks good.[1] |
| NEW DRUGS | Not available yet. The first large study of a drug to lower Lp(a) did not prevent heart attacks or strokes. Other studies are still going.[7] |
If your Lp(a) is high, the best step today is to lower your other risks more aggressively.
First, a picture
Cholesterol does not float freely in your blood. It travels inside tiny particles, a bit like passengers riding in cars. Your standard cholesterol test mostly measures how many passengers there are. But damage to artery walls depends more on how many cars are on the road.
| Test | In the car picture | What it tells you |
| LDL cholesterol (standard panel) | How many passengers | A good estimate most of the time |
| ApoB | How many cars | A more accurate count of the particles that can damage arteries.[2] |
| Lp(a) | One special kind of car | A sticky particle you inherit. It is several times more harmful than an ordinary LDL particle.[4] |
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