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Epic Code LAB1230583 Apolipoprotein B, Serum

Reporting Name

Apolipoprotein B, S

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Clinical Information

Apolipoprotein B (ApoB) is the primary protein component of low-density lipoprotein (LDL). The amount of cholesterol contained within LDL varies, but each LDL contains exactly one ApoB protein. Therefore, ApoB is a more reliable indicator of circulating LDL compared to LDL cholesterol (LDL-C). ApoB has been demonstrated to perform equally with LDL particles measured by nuclear magnetic resonance spectroscopy.(1)

 

ApoB is strongly associated with increased risk of developing cardiovascular disease (CVD) and often outperforms LDL-C at predicting risk of coronary heart disease.(2-4) Patients with acceptable non-high-density lipoprotein cholesterol (HDL-C) or LDL-C but elevated ApoB remain at higher risk of developing CVD; conversely, patients with acceptably low ApoB but moderate non-HDL-C or LDL-C elevations are at a reduced risk for CVD.(5,6)

 

Finally, in 7 different placebo-controlled randomized clinical trials, on-statin reduction of ApoB was more closely related to CVD risk reduction than non-HDL-C or LDL-C.(7)

Useful For

Assessment of cardiovascular risk

 

Follow-up studies in individuals with basic lipid measures inconsistent with risk factors or clinical presentation

 

Definitive studies of cardiac risk factors in individuals with significant family histories of coronary artery disease or other increased risk factors

 

Confirmation of suspected abetalipoproteinemia or hypobetalipoproteinemia

Specimen Type

Serum


Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial. Send refrigerated.


Laboratory Test Directory Note:

COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 8 days
  Frozen  60 days
  Ambient  24 hours

Reject Due To

Gross hemolysis Reject
Gross lipemia OK
Gross icterus Reject

Day(s) Performed

Monday through Sunday

Reference Values

<2 years: Not established

 

2-17 years:

Acceptable: <90 mg/dL

Borderline high: 90-109 mg/dL

High: ≥110 mg/dL

 

>18 years:

Desirable: <90 mg/dL

Above Desirable: 90-99 mg/dL

Borderline high: 100-119 mg/dL

High: 120-139 mg/dL

Very high: ≥140 mg/dL

Interpretation

Elevated apolipoprotein B (ApoB) confers increased risk of atherosclerotic cardiovascular disease, even in a context of acceptable low-density lipoprotein cholesterol.

 

Extremely low values of ApoB (<48 mg/dL) are related to malabsorption of food lipids and can lead to polyneuropathy.

Cautions

In very rare cases, gammopathy, type IgM (Waldenstrom macroglobulinemia) in particular, may cause unreliable results.

Clinical Reference

1. Cole TG, Contois JH, Csako G, et al: Association of apolipoprotein B and nuclear magnetic resonance spectroscopy-derived LDL particle number with outcomes in 25 clinical studies: assessment by the AACC Lipoprotein and Vascular Diseases Division Working Group on best practices. Clin Chem. 2013;59:752-770

2. Sierra-Johnson J, Fisher RM, Romero-Corral A, et al: Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: findings from a multi-ethnic US population. Eur Heart J. 2009;30(6):710-717

3. Steffen BT, Guan W, Remaley AT, et al: Use of lipoprotein particle measures for assessing coronary heart disease risk Post-American Heart Association / American College of Cardiology Guidelines: The Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35:448-454

4. Thompson A, Danesh J: Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies. J Intern Med. 2006;259:481-492

5. Mora S, Buring JE, Ridker PM: Discordance of low-density lipoprotein (LDL) cholesterol with alternative LDL-related measures and future coronary events. Circulation. 2014;129:553-561

6. Pencina MJ, D'Agostino RB, Zdrojewski T, et al: Apolipoprotein B improves risk assessment of future coronary heart disease in the Framingham Heart Study beyond LDL-C and non-HDL-C. Eur J Prev Cardiol. 2015 Oct;22(10):1321-7. doi: 10.1177/2047487315569411

7. Thanassoulis G, Williams K, Ye K, et al: Relations of change in plasma levels of LDL-C, non-HDL-C and apoB with risk reduction from statin therapy: a meta-analysis of randomized trials. J Am Heart Assoc. 2014;3:e000759

8. Jacobson TA, Ito MK, Maki KC, et al: National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1-executive summary. J Clin Lipidol. 2014 Sep-Oct;8(5):473-488

9. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011 Dec;128 Suppl 5:S213-S256

10. Contois JH, McConnell JP, Sethi AA, et al: Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices. Clinical Chemistry. 2009:55:3:407-419

Method Name

Automated Turbidimetric Immunoassay

Method Description

Anti-apolipoprotein B antibodies react with the antigen in the sample to form antigen:antibody complexes, which, following agglutination, can be measured turbidimetrically.(Package Insert: Tina-quant Apolipoprotein B. Roche Diagnostics; 07/2020)

Report Available

1 to 3 days

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

82172

LOINC Code Information

Test ID Test Order Name Order LOINC Value
APOLB Apolipoprotein B, S 1884-6

 

Result ID Test Result Name Result LOINC Value
APOLB Apolipoprotein B, S 1884-6

Forms

If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.