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Ney Carter Borges: Non-HDL Cholesterol vs ApoB Both Matter for ASCVD Risk
Ney Carter Borges/LinkedIn
May 17, 2026, 16:01

Ney Carter Borges: Non-HDL Cholesterol vs ApoB Both Matter for ASCVD Risk

Ney Carter Borges, Member Cardiologist of Global Physician Association at Cleveland Clinic Florida, shared a post on LinkedIn about a recent article by Camilla Ditlev Lindhart Johannesen et al. published in JAMA Cardiology, adding:

“Non-HDL Cholesterol vs ApoB: Both Matter for ASCVD Risk

A contemporary cohort analysis from the Copenhagen General Population Study evaluated 94,398 statin-naïve individuals over a median follow-up of 13.2 years to determine whether non-HDL cholesterol or apolipoprotein B (apoB) provides superior prediction of atherosclerotic cardiovascular disease (ASCVD).

The investigators demonstrated that both biomarkers independently predicted myocardial infarction (MI) and ASCVD events. For each 1-standard deviation increase, non-HDL cholesterol was associated with a 16% higher ASCVD risk (HR 1.16; 95% CI 1.13–1.19), while apoB showed a comparable 14% increase (HR 1.14; 95% CI 1.12–1.17).

A particularly important finding emerged from discordance analyses. Individuals with elevated apoB despite lower non-HDL cholesterol still exhibited significantly higher cardiovascular risk, and the reverse pattern was equally true.

Patients with concordantly elevated non-HDL cholesterol and apoB had the greatest risk burden, with MI risk increasing by 69% (HR 1.69; 95% CI 1.53–1.85).

These findings reinforce the biological concept that both cholesterol content and lipoprotein particle number contribute to atherogenesis. ApoB reflects the number of circulating atherogenic particles, whereas non-HDL cholesterol better captures total cholesterol carried within these particles.

The study suggests that relying on only one marker may overlook clinically relevant residual risk.

From a practical cardiometabolic perspective, the data support combined assessment of non-HDL cholesterol and apoB, particularly in patients with metabolic syndrome, diabetes, hypertriglyceridemia, obesity, or discordant lipid profiles.

The authors conclude that there is no ‘one-marker-fits-all’ solution for ASCVD risk stratification and that integrated lipid assessment may improve future preventive strategies and guideline refinement.”

Title: Non-HDL Cholesterol and Apolipoprotein B Measures and Risk of Atherosclerotic Cardiovascular Disease

Authors: Camilla Ditlev Lindhart Johannesen, Anne Langsted, Borge Gronne Nordestgaard, Martin Bodtker Mortensen

Ney Carter Borges: Non-HDL Cholesterol vs ApoB Both Matter for ASCVD Risk

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Anne Langsted Børge Grønne Nordestgaard Camilla Ditlev Lindhart Johannesen Health Hematology Hemostasis Hemostasis News Hemostasis Today Martin Bodtker Mortensen Medicine Ney Carter Borges
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