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Cardio Profile Extensive
Complete lipids, Lipoprotein(a), Apolipoprotein B/A1, kidney function and blood sugar. Advanced cardiovascular risk analysis.
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Heart and vessels · Blood
Apo B/A1 ratio
Calculated ratio between the protein of the harmful cholesterol particles and that of HDL; adds little to the separate values.
At a glance
- Measured in blood
- In 1 test panel
- No special preparation
Explanation
Apo B/A1 ratio: what is measured?
The laboratory calculates the ratio by dividing apolipoprotein B (ApoB) by apolipoprotein A1 (ApoA1), two proteins that are measured separately. ApoB sits on every particle that can cause hardening of the arteries (LDL, VLDL, IDL and lipoprotein(a)), so the value reflects the number of those particles. ApoA1 is the main protein of HDL, which actually removes cholesterol. A higher ratio means many harmful particles relative to the removal capacity.
What can it detect?
- An unfavorable ratio between harmful cholesterol particles and HDL, which fits a higher risk of cardiovascular disease
- A lipid pattern with overweight, type 2 diabetes or high triglycerides, in which LDL cholesterol can underestimate the risk
Result
What does the result mean?
Apo B/A1 ratio too high
A high ratio means a lot of ApoB relative to ApoA1: many harmful cholesterol particles, little HDL, or both. This fits a higher risk of hardening of the arteries, a heart attack and a stroke. The ratio does not show which of the two values is abnormal; the separate ApoB and ApoA1 values and the standard lipid profile do. A high ratio causes no symptoms.
Apo B/A1 ratio too low
A low ratio means few harmful particles relative to HDL and usually fits a favorable profile, due to predisposition, a healthy lifestyle or the use of cholesterol-lowering medicines. Here too, the ratio hides the separate values: a temporarily low ApoB due to an acute illness also gives a 'favorable' outcome. A low ratio does not compensate for smoking, high blood pressure or diabetes and causes no symptoms.
After an abnormal result
With an abnormal ratio, the GP looks at the underlying ApoB and ApoA1 values, the lipid profile and the overall risk profile, and acts on these with lifestyle advice, a repeat measurement or treatment of a raised LDL or non-HDL. The ratio itself does not lead to separate follow-up.
Reliability
How reliable is the test?
The ratio is a derived value and adds little to the measured ApoB and ApoA1 values. In the Netherlands, the risk of cardiovascular disease is estimated with SCORE2 based on non-HDL cholesterol; according to the multidisciplinary guideline on cardiovascular risk management, non-HDL gives the same information without an extra measurement. There are no Dutch cut-off values for the ratio; limits on a result come from research abroad or from the laboratory. One value is not a diagnosis.
What can affect the result?
- All factors that affect ApoB or ApoA1 carry through into the ratio: acute illness, pregnancy, thyroid function, kidney and liver disease, alcohol, smoking and medicines such as estrogens, beta blockers and cholesterol-lowering medicines.
- During and for a few weeks after an infection, surgery or heart attack, both proteins are temporarily lowered, which makes the ratio hard to interpret.
- Laboratories use different measurement methods for ApoB and ApoA1; preferably compare results within the same laboratory.
Who it is for
Who is the test useful for?
Useful for
The ratio is only calculated if ApoB and ApoA1 have been measured anyway, for example in an extended cardiovascular package; as a stand-alone test it adds little. Anyone who wants their risk of cardiovascular disease estimated gets more from the standard lipid profile with non-HDL cholesterol, together with blood pressure, smoking status, age and sex. With high triglycerides, overweight or diabetes, ApoB itself can give useful extra information; the ratio adds little to that.
How common is it?
There are no Dutch figures on this ratio, because the ratio is not routinely calculated. The underlying pattern of many harmful cholesterol particles and little HDL is common with overweight and type 2 diabetes. In 2024, more than 1.6 million people in the Netherlands were known to their GP with a lipid metabolism disorder.
No figures for this ratio; VZinfo (RIVM) for lipid metabolism disorders, 2024
Drawbacks and risks
- Online, the ratio is often presented as a 'better' heart risk test, while it adds little to the separate values and the standard lipid profile; an abnormal outcome can lead to unnecessary worry.
- Without the complete lipid profile, the ratio cannot be interpreted, which can lead to unnecessary follow-up testing.
Get tested
Apo B/A1 ratio: test panels
Apo B/A1 ratio is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and resultsMore explanations
Other tests: Heart and vessels
- Apolipoprotein A1
- Apolipoprotein A2
- Apolipoprotein B
- Cholesterol, total
- Cholesterol/HDL ratio
- DHA
- EPA
- HDL cholesterol
- HDL-LDL risk index
- Homocysteine
- LDL cholesterol
- Lipoprotein(a)