Written by Johnny Nguyen
Most of us know that LDL cholesterol is the “bad” kind and that HDL is the good kind, but this conventional focus on only these cholesterol categories is incomplete and can often be misleading (1).
Cholesterol molecules are carried by different lipoproteins. The American Diabetes Association and the American College of Cardiology endorse assessment of these lipoproteins for superior prediction of cardiovascular disease. For example, apo-B (apolipoprotein-B), a primary lipoprotein in LDL cholesterol, is a much stronger predictor of cardiovascular risk than LDL level or total cholesterols (2).
ApoA-1 (apolipoprotein A-1), on the other hand, is a major lipoprotein in the good cholesterol HDL. It’s the beneficial “roto-rooter” for your arteries. ApoA-1 promotes efflux of fat and cholesterol out of the arterial walls and to the liver for excretion — a sort of “fat remover.”*
So looking solely at LDL or HDL doesn’t tell the entire story; it’s important to have a blood test that breaks down the subfractions of these cholesterols. And among the important things you want to know is the ratio of apoB/apoA-1.
Why is it important to know the ratios of these subfractions? Because a major study published in Lancet shows that apoB/apoA-1 ratio is the strongest among ALL modifiable predictors for myocardial infarction, or heart attacks (3).
Another reason to know: your LDL doesn’t reflect the actual ratios of these subfractions. In other words, you can have seemingly great LDL cholesterols but your apoB/apoA-1 can be darn bad, and you’re one step away from a fatal heart attack. Or, you can have higher “bad” LDL but great apoB/apoA-1 ratios and be healthy (4).
You can decrease total apoB level and lower the ratio of apoB/apoA-1, yet not change your LDL number. That’s why LDL alone doesn’t tell the story. You should get a more thorough assay to know more about your heart health. (See below for some resources.)
And, you guessed it, these positive changes can be accomplished (along with nutrition) through exercise:
- An inverse association exists between exercise and apoB/apoA-1 ratio (Simonsson M, 2007). More exercise = improved ratio.
- Exercise also lowers total amount of harmful apoB (O’Donovan G, 2005). Exercise lowers this subfraction independent of others.
- Higher levels of beneficial apoA-1 is associated with endurance exercise (Olchawa B, 2004).
- ApoB/apoA-1 ratio is seen to improve significantly with fitness improvement in one year (Holme I, 2007). In sedentary men who started exercising and become fit, their subfraction ratio improves within one year.
There are many important markers of health to measure and know, but the point of this article is to encourage you to care more about numbers beyond the conventional HDL and LDL. Here are some resources, if you’re interested in a thorough analysis of your cholesterols and other cardiometabolic factors. These services can give you vital data that may be useful to your own doctor, as well as to your trainer who ought to know how to structure or modify an exercise program as a result:
www.wellnessfx.com and/or www.bhlinc.com
* When there’s damage to arterial walls (and we inevitably experience this damage at varying degrees through food choices, stress and disease), white blood cells move in for healing. White blood cells can become “fat-overload” and transform into foam cells, die, and contribute to artheroma (arterial plaque). So removing or minimizing low density cholesterols such as apo-B is one factor to lowering cardiovascular risk. There are other factors, of course, but this post focuses on cholesterol subfractions.
1. Genest J Jr, McNamara JR, Ordovas JM, Jenner JL, Silberman SR, Anderson KM, Wilson PW, Salem DN, Schaefer EJ. Lipoprotein cholesterol, apolipoprotein A-I and B and lipoprotein (a) abnormalities in men with premature coronary artery disease. J Am Coll Cardiol. 1992; 19: 792–802.
2. Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2008; 51: 1512–1524.
3. Yusuf S., et al. The Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952.
4. Holme I., et al., ApoB but not LDL-cholesterol is reduced by exercise training in overweight healthy men. Results from 1-year randomized Oslo Diet and Exercise Study. J Intern Med. 2007;262(2):235-243.