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Cardiometabolic Biomarkers
Advanced Lipid Biomarkers and Heart Health
This is a detailed subject, and what it means for your situation depends on your history and your imaging. Dr. Glowney is glad to work through it with you.
What the advanced lipid markers measure.
Maintaining optimal cardiovascular health is important for longevity and overall well-being. Comprehensive lipid panels and associated biomarkers, such as ApoA, ApoB, and Lp(a), provide useful information about an individual's cardiovascular risk profile and metabolic status. While traditional cholesterol measurements, including total cholesterol, LDL, HDL, and triglycerides, offer critical information, they do not present the complete picture of an individual's cardiovascular health.
Including advanced biomarkers, such as ApoA-I, ApoB, and Lp(a), gives a more detailed understanding of an individual's risk for developing cardiovascular disease. ApoA-I, the primary structural protein of HDL, is involved in reverse cholesterol transport, where excess cholesterol is removed from peripheral tissues and transported to the liver for excretion. High levels of ApoA-I are associated with a lower risk of coronary heart disease, but in one large analysis ApoA-I added no predictive information beyond HDL cholesterol (van Capelleveen et al., 2017).
ApoB, on the other hand, represents all atherogenic particles, including LDL, VLDL, and IDL. Each of these particles carries a single ApoB molecule, making ApoB an accurate measure of the total number of atherogenic lipoproteins. Elevated ApoB levels indicate a higher number of cholesterol-carrying particles capable of penetrating arterial walls and initiating atherosclerosis, irrespective of LDL cholesterol levels. Because ApoB counts all atherogenic particles, it is often regarded as a superior marker of cardiovascular risk compared to LDL cholesterol alone (Barter et al., 2006).
Lipoprotein(a), or Lp(a), is a unique lipoprotein that includes an ApoB molecule along with an additional Apo(a) protein. Large genetic and population studies support a causal link between Lp(a) and cardiovascular disease, and high Lp(a) is associated with calcification of the aortic valve (Kronenberg et al., 2022). Elevated Lp(a) levels are primarily genetically determined and challenging to manage with traditional lipid-lowering therapies.
When assessed with traditional cholesterol panels, these advanced biomarkers provide a more comprehensive understanding of an individual's cardiometabolic health. Understanding how these markers relate to each other can help clinicians target prevention, for example by managing other risk factors more intensively when Lp(a) is high (Lechner et al., 2020; Kronenberg et al., 2022).
Clinical use and links to aging.
The measurement and interpretation of these advanced lipid biomarkers have important clinical implications. Clinicians can use this information to identify people at higher risk who may benefit from more intensive prevention and treatment (Lechner et al., 2020; Barter et al., 2006).
Research also links lipoprotein particle profiles to longevity (Heijmans et al., 2006). Understanding how lipid profiles and related proteins affect cardiovascular and metabolic health helps clinicians care for their patients.
Comprehensive lipid panels and associated biomarkers, such as ApoA, ApoB, and Lp(a), provide a broad assessment of an individual's cardiovascular risk and metabolic health. Adding these markers to routine testing can help clinicians tailor prevention to each patient.
Treatment and emerging technology.
The measurement and interpretation of these advanced lipid biomarkers can have significant clinical implications. Statins, fibrates, and ezetimibe have little or no effect on Lp(a) levels (Xie et al., 2025), and Lp(a) is an independent risk factor for cardiovascular disease (Tsimikas, 2017). Developing targeted therapies to address elevated Lp(a) levels is an area of ongoing research and clinical importance.
Researchers are studying artificial intelligence and biosensors as ways to combine traditional and digital biomarkers in diagnostics (Arya et al., 2023).
The comprehensive assessment of lipid profiles and associated biomarkers, including ApoA, ApoB, and Lp(a), provides useful information about an individual's cardiovascular risk and metabolic health.
References
Sources cited.
- Arya, S. S., Dias, S. B., Jelinek, H. F., Hadjileontiadis, L. J., & Pappa, A. M. (2023). The convergence of traditional and digital biomarkers through AI-assisted biosensing: A new era in translational diagnostics? Biosensors and Bioelectronics, 235, 115387. https://doi.org/10.1016/j.bios.2023.115387
- Barter, P. J., Ballantyne, C. M., Carmena, R., Castro Cabezas, M., Chapman, M. J., Couture, P., de Graaf, J., Durrington, P. N., Faergeman, O., Frohlich, J., Furberg, C. D., Gagne, C., Haffner, S. M., Humphries, S. E., Jungner, I., Krauss, R. M., Kwiterovich, P., Marcovina, S., Packard, C. J., ... Williams, K. M. (2006). Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: Report of the thirty-person/ten-country panel. Journal of Internal Medicine, 259(3), 247–258. https://doi.org/10.1111/j.1365-2796.2006.01616.x
- Heijmans, B. T., Beekman, M., Houwing-Duistermaat, J. J., Cobain, M. R., Powell, J., Blauw, G. J., van der Ouderaa, F., Westendorp, R. G., & Slagboom, P. E. (2006). Lipoprotein particle profiles mark familial and sporadic human longevity. PLoS Medicine, 3(12), e495. https://doi.org/10.1371/journal.pmed.0030495
- Kronenberg, F., Mora, S., Stroes, E. S. G., Ference, B. A., Arsenault, B. J., Berglund, L., Dweck, M. R., Koschinsky, M., Lambert, G., Mach, F., McNeal, C. J., Moriarty, P. M., Natarajan, P., Nordestgaard, B. G., Parhofer, K. G., Virani, S. S., von Eckardstein, A., Watts, G. F., Stock, J. K., ... Catapano, A. L. (2022). Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: A European Atherosclerosis Society consensus statement. European Heart Journal, 43(39), 3925–3946. https://doi.org/10.1093/eurheartj/ehac361
- Lechner, K., McKenzie, A. L., Kränkel, N., von Schacky, C., Worm, N., Nixdorff, U., Lechner, B., Scherr, J., Weingärtner, O., & Krauss, R. M. (2020). High-risk atherosclerosis and metabolic phenotype: The roles of ectopic adiposity, atherogenic dyslipidemia, and inflammation. Metabolic Syndrome and Related Disorders, 18(4), 176–185. https://doi.org/10.1089/met.2019.0115
- Tsimikas, S. (2017). A test in context: Lipoprotein(a): Diagnosis, prognosis, controversies, and emerging therapies. Journal of the American College of Cardiology, 69(6), 692–711. https://doi.org/10.1016/j.jacc.2016.11.042
- van Capelleveen, J. C., Bochem, A. E., Boekholdt, S. M., Mora, S., Hoogeveen, R. C., Ballantyne, C. M., Ridker, P. M., Sun, W., Barter, P. J., Tall, A. R., Zwinderman, A. H., Kastelein, J. J. P., Wareham, N. J., Khaw, K. T., & Hovingh, G. K. (2017). Association of high-density lipoprotein-cholesterol versus apolipoprotein A-I with risk of coronary heart disease: The European Prospective Investigation Into Cancer-Norfolk Prospective Population Study, the Atherosclerosis Risk in Communities Study, and the Women's Health Study. Journal of the American Heart Association, 6(8), e006636. https://doi.org/10.1161/JAHA.117.006636
- Xie, S., Galimberti, F., Olmastroni, E., Carugo, S., Catapano, A. L., Casula, M., & META-LIPID Group. (2025). Effect of lipid-lowering therapies on lipoprotein(a) levels: A comprehensive meta-analysis of randomized controlled trials. Atherosclerosis, 408, 120420. https://doi.org/10.1016/j.atherosclerosis.2025.120420
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