Study Finds New Blood Test Could Improve Heart Disease Prevention

For nearly six decades, measuring cholesterol levels in the blood has been the cornerstone of identifying individuals at high risk for cardiovascular disease (CVD). Traditionally, the focus has been on overall cholesterol levels—specifically, the distinction between “good” and “bad” cholesterol. However, a groundbreaking study, led by a team of researchers from Chalmers University of Technology in Sweden and Harvard University in the U.S., has unveiled a more accurate method of assessing heart disease risk. This new approach, which focuses on the particles that carry cholesterol rather than the cholesterol itself, could significantly improve how we predict and prevent heart disease, ultimately saving lives.

The study, published in the European Heart Journal, is titled “The relative importance of particle count, type, and size of apoB-containing lipoproteins in the development of coronary artery disease.” The findings have profound implications for how we approach heart disease risk, emphasizing the critical role of lipoprotein markers over traditional cholesterol measurements. This innovative research could reshape preventive health strategies, providing a more precise and reliable tool for identifying individuals at risk of heart attacks and strokes.

The Global Burden of Cardiovascular Disease

Cardiovascular diseases, including heart disease and stroke, are the leading causes of death worldwide, according to the World Health Organization (WHO). The vast majority of these cases are preventable, with lifestyle factors such as smoking, poor diet, and lack of exercise playing a significant role in the development of the disease. Early detection of at-risk individuals is crucial, as it enables timely intervention through lifestyle modifications or medical treatments that can reduce the risk of life-threatening events such as heart attacks.

The study from Chalmers University and Harvard University provides compelling evidence that the traditional method of measuring cholesterol may not always be the most accurate way to assess an individual’s true risk. By focusing on the actual particles that carry cholesterol in the blood, the researchers offer a more precise alternative to the longstanding cholesterol test.

Cholesterol: The Double-Edged Sword

Cholesterol is a type of lipid, or fat, that is essential for the body’s normal function. It plays a crucial role in building cell membranes, producing hormones, and synthesizing vitamin D. However, when cholesterol levels become too high, particularly in the form of low-density lipoprotein (LDL) or “bad” cholesterol, it can lead to the buildup of fatty deposits, known as plaques, in the arteries. These plaques can narrow and block blood vessels, increasing the risk of heart attack and stroke.

The key to understanding cholesterol lies not only in its concentration but in how it is carried through the bloodstream. Cholesterol cannot travel on its own—it requires lipoproteins, specialized particles that act as carriers. There are several different types of lipoproteins, each with its own function and role in health.

• Low-Density Lipoprotein (LDL), or “bad cholesterol,” is responsible for transporting cholesterol to cells. However, when present in excess, LDL can deposit cholesterol in the walls of arteries, contributing to the formation of plaques.
• High-Density Lipoprotein (HDL), or “good cholesterol,” helps remove excess cholesterol from the bloodstream and transport it back to the liver for processing. This is why HDL is considered beneficial—it works to clear cholesterol from the arteries, reducing the risk of plaque buildup.
• Very Low-Density Lipoprotein (VLDL) and Intermediate-Density Lipoprotein (IDL) are other types of lipoproteins involved in cholesterol transport. Both are considered less beneficial and contribute to the accumulation of cholesterol in blood vessels.

However, understanding the full picture of cholesterol and its role in cardiovascular disease requires more than just measuring overall cholesterol levels. The focus must shift to the lipoproteins themselves—specifically, the particles that carry the “bad cholesterol.”

The Lipoprotein Shift: Moving Beyond Cholesterol Levels

For decades, physicians have relied on blood tests that measure total cholesterol levels, as well as the ratio of LDL (bad) to HDL (good) cholesterol, to assess the risk of heart disease. However, cholesterol tests often fail to capture the nuances of lipoprotein behavior. For example, two individuals with the same total cholesterol levels may have different risks for heart disease based on the type, number, and size of the lipoprotein particles in their blood.

This gap in understanding is what led the research team to investigate the role of lipoproteins more thoroughly. In their study, the team focused on a specific protein—apolipoprotein B (apoB)—which is present on all the “bad cholesterol” carriers. Unlike traditional cholesterol tests that only measure total cholesterol levels, measuring apoB provides a direct count of the actual number of “bad cholesterol” particles in the blood.

By analyzing blood samples from over 200,000 individuals in the UK Biobank—who were free from heart disease at the start of the study—the researchers were able to explore how variations in lipoprotein number, type, and size influenced the development of coronary artery disease over a period of up to 15 years. The results revealed that the total number of apoB-containing lipoproteins (which carry “bad cholesterol”) was the most important factor in predicting future heart disease risk. In fact, measuring the number of apoB particles provided more accurate risk assessments than traditional cholesterol tests.

Why ApoB Testing is a Game Changer

The results of the study suggest that apoB testing is a much more reliable marker for heart disease risk than measuring cholesterol levels alone. The researchers found that, in about one in twelve patients, standard cholesterol tests might underestimate heart disease risk. This is particularly concerning because approximately 20–40% of first-time occurrences of cardiovascular disease are fatal. By incorporating apoB testing into routine screenings, it is possible to catch these high-risk individuals earlier, potentially saving lives.

ApoB testing measures the total number of “bad cholesterol” particles, which directly correlates with the amount of cholesterol that can accumulate in the arterial walls. Because the number of these particles is a better predictor of plaque buildup and heart disease than the total cholesterol content alone, this method offers a more accurate and individualized risk assessment.

“It was previously unclear if two patients with the same total level of ‘bad cholesterol,’ but that differ in their carrier characteristics (lipoprotein type, size, lipid content), have the same risk of heart disease,” said Jakub Morze, the lead author of the study. “The aim of this study was to determine the importance of these different parameters, and our findings suggest that apoB is the most reliable marker for heart disease risk.”

The Importance of Lipoprotein(a)

Another crucial finding from the study involves lipoprotein(a), a specific type of “bad cholesterol” lipoprotein that has largely been overlooked in traditional tests. Lipoprotein(a) is genetically determined, and while it represents less than 1% of the total “bad cholesterol” lipoproteins in the general population, elevated levels can significantly increase heart disease risk.

While lipoprotein(a) is present in low concentrations in most individuals, its levels can be extremely high in some people due to genetic factors. These elevated levels are associated with a dramatically increased risk of cardiovascular events. The study’s findings indicate that measuring lipoprotein(a) alongside apoB particles could provide a more comprehensive understanding of lipid-related heart disease risk.

“We found that lipoprotein(a) levels are an important part of the puzzle and should be included in heart disease risk assessments,” said Clemens Wittenbecher, an assistant professor of Precision Medicine and Diagnostics at Chalmers. “By incorporating testing for both apoB and lipoprotein(a), we can get a better picture of an individual’s risk for cardiovascular disease.”

A Simple and Affordable Solution for the Future

One of the most exciting aspects of this breakthrough is that the blood test for both apoB and lipoprotein(a) is already commercially available. These tests are relatively inexpensive, easy to administer, and can be integrated into existing healthcare systems. This means that widespread adoption of these new biomarkers for heart disease risk could be achieved quickly, offering a simple yet powerful tool for early detection and prevention.

By replacing traditional cholesterol tests with apoB and lipoprotein(a) testing, healthcare providers would be able to identify high-risk individuals with greater accuracy, leading to more targeted interventions and better outcomes. This could have a significant impact on reducing the global burden of cardiovascular disease, which remains a leading cause of death worldwide.

Conclusion: A Step Toward Better Heart Health

The findings from this groundbreaking study mark a significant step forward in our understanding of cardiovascular disease risk. By shifting the focus from traditional cholesterol measurements to lipoprotein markers, scientists and healthcare providers can now offer more accurate, individualized risk assessments. This innovative approach not only promises to improve the accuracy of heart disease prediction but also holds the potential to save countless lives by enabling earlier, more effective interventions.

As we continue to learn more about the complex mechanisms that contribute to cardiovascular disease, the importance of precision medicine becomes increasingly clear. The ability to identify at-risk individuals with greater certainty, using simple and affordable tests, represents a crucial advance in the fight against heart disease.

With ongoing research and widespread implementation of these new testing methods, the future of cardiovascular health looks brighter, offering hope for millions of individuals at risk of heart disease worldwide.

Reference: Nicholas Marston et al, ApoB-containing lipoproteins: count, type, size and risk of coronary artery disease, European Heart Journal (2025). DOI: 10.1093/eurheartj/ehaf207