High triglycerides & ApoB

What it is

Insulin resistance raises triglycerides, lowers HDL and creates many small LDL particles. Each atherogenic particle carries one ApoB protein, so ApoB counts the particles that drive plaque, even when LDL cholesterol looks acceptable.

How it's assessed

• Standard lipid panel; a nonfasting sample is fine for most people

• ApoB or non-HDL cholesterol, especially with high triglycerides, diabetes or obesity

• Lipoprotein(a) once in adulthood

Treatment

Weight loss, less refined carbohydrate and alcohol, and more activity lower triglycerides. Statins are first-line to lower ApoB and cardiovascular risk; ezetimibe and PCSK9 inhibitors add further lowering. Icosapent ethyl reduced cardiovascular events in people with high triglycerides on statins in REDUCE-IT.

Clinical pearls

Very high triglycerides (above 500 mg/dL, and especially 1,000 mg/dL) raise pancreatitis risk and need prompt treatment.