Monitoring your cholesterol every time you have your blood drawn is good, but it may not be enough. Cardiologists warn of a figure that is much more revealing of the risk of stroke that most doctors do not even systematically ask.
When we talk about stroke prevention, the first instinct is often to check our LDL cholesterol level, nicknamed “bad” cholesterol. However, many patients suffer cardiovascular events even though their analyzes appear perfectly normal. Cardiologists are sounding the alarm: focusing only on cholesterol would amount to looking at only a small part of a complex puzzle (it is important to regularly monitor your cholesterol all the same), leaving aside more revealing indicators of the health of the arteries.
For cardiologist Dr. Heather Swales, the problem lies in the limitations of traditional lipid testing. The latter does not measure the real dangerousness of the particles circulating in our blood. You can indeed have a low cholesterol level, but have a multitude of small “sticky” particles which accumulate silently and increase the risk of obstruction without the standard examination detecting it.
The real figure to watch in addition to cholesterol, much more predictive according to experts, is that of Apolipoprotein B (or ApoB). This protein is present on all cholesterol particles potentially capable of blocking the arteries. “ApoB is a better marker than cholesterol for assessing stroke risk because it measures total atherogenic (harmful) particles.“, explains Dr. Swales interviewed by Parade magazine. Clearly, where cholesterol measures the “quantity” of fat, ApoB measures the number of dangerous “projectiles” ready to attack your vessels.
ApoB is not yet part of the “standard lipid profile” (which is often limited to total cholesterol, HDL, LDL and triglycerides). However, you can ask your doctor for a dosage (he will be able to tell you whether it is relevant or not) if your bad cholesterol level is described as “borderline” (between 1.3 and 1.6 g/L for example). In this case, ApoB serves as an arbiter and allows us to know whether these numbers hide a large amount of small, very dense particles, which are the most dangerous for the arteries and increase the risk of stroke. The dosage is also recommended to refine the risk assessment in the event of a complex metabolic profile (diabetes, abdominal obesity, high triglycerides) or a family history of early cardiovascular events despite normal cholesterol.
An ApoB level is considered “normal” in a healthy person when it is below 90 mg/dL. A higher result is often not a big deal but should not be overlooked. In addition, Dr. Jeremy London, cardiovascular surgeon, emphasizes that simple adjustments can lower ApoB: increasing fiber intake, reducing ultra-processed carbohydrates and engaging in regular physical activity. In France, if your doctor deems this dosage necessary, the examination is covered by Health Insurance and generally reimbursed up to 60% (the supplement is often covered by mutual insurance).
These cardiologists emphasize that ApoB must be accompanied by blood pressure monitoring (ideally below 120/80), because hypertension directly weakens the cerebral arteries. Sleep disorders, such as obstructive apnea or frequent awakenings, are also often overlooked warning signs that tire the heart and increase the risk of accidents. Finally, monitoring underlying pathologies such as atrial fibrillation or certain blood disorders is crucial to anticipate any major complications.
