Apo A1 & Apo B: How to Measure Your Cardiovascular Risk Using These 2

Hello! Today, we're going to talk about ApoA1, ApoB. Now, let's go back and take a look at a picture. But before we do, just a brief introduction. Ford Brewer with PrevMed Heart Attack Stroke Prevention. Now, this is a picture of an HDL particle and an LDL particle. The standard saying is that the only difference between these two is that LDLs are 20% or content. LDL particles are 25% or less protein. This is the protein component. And HDL particles are 50% or more protein components. And as you see, these other proteins are cholesterol and triglycerides. It's a little bit more complicated than that. In fact, the proteins that you see in these are slightly different. The proteins on LDL are called apolipoprotein B and the ones in the HDL are apolipoprotein A1. Apo, what does that mean? So again, Apo is short for apolipoprotein. Let's again, like anything else, break it down and it starts to make sense. Apo is a prefix that means from, related to, completing, or part of. Lipo or lipo means fats or oils, the cholesterol, triglycerides, fatty acids. That you saw in the lipoprotein. So again, you've got protein which is built to help the body transport blood safely. Remember, we we use the example if we poured oil into a glass of water, it would form a large bubble of oil. That large bubble would kill us. And in fact, does happen in what we call a fat embolus where people have big wrecks, break multiple bones, and fat comes out of the bone marrow and can cause, it can be just as devastating as a heart attack or stroke. That's what lipoproteins are for. Now, apolipoprotein just means the protein itself, not the entire lipoprotein complex. Now, there's another interesting thing to know about apolipoprotein. ApoA1 seems to be the protein that's connected and used for all of HDL particles. ApoB is the protein that's used for very low-density lipoproteins, low-density lipoproteins, all the bad ones. And remember, the most dangerous is the small dense version of these LDLs. How are those proteins different? They've coded the proteins ApoA1 and ApoB. There's significant differences between the two. ApoA1 is, as I said, found in HDL particles. It's cardioprotective. It helps us clear cholesterol from the artery walls. It also seems to be anti-inflammatory in effect which makes sense if you're clearing cholesterol away from those artery walls. It's also protective from dementia. So that's probably the another reason why HDL particles help improve our health are cardioprotective and dementia protective whereas LDL particles not so much. In fact, the small dense ones are a problem. There have been some interesting things that have been seen with ApoA1 mutations or single nucleotide SNPs, polymorphisms, variations in these proteins, genetic variations. There was one called ApoA1 Milano. The individuals that had this version of ApoA1 tended to live a hundred years. This was traced back to Giovanni Pomarelli who lived about an hour away from Milan. Another one which was not a healthy one E164X. 5 out of 9 of those individuals will get premature cardiovascular disease. So ApoA1 found in HDL particles. ApoB found in LDL particles. So if ApoA1 is healthy and ApoB is unhealthy, then you can actually start looking at a risk. And there's been research which indicated that that's very true. That's actually one of the things we'll look for. ApoB over ApoA, that ratio. With men, that moderate risk cut points are 0.7 and 0.89. For women, they're 0.6 and 0.79. In other words, individuals with a lower ratio, in other words, a lower ApoB and a higher ApoA1 or some combination are at lower risk. Individuals with higher cut points, females 0.8 or above or males 0.9 or above have higher risk. Thank you very much.