The study, published in JAMA, found that measuring apolipoprotein B (apoB) was more effective than tracking LDL or non HDL cholesterol when deciding whether to intensify cholesterol lowering therapy, including statins and other medications.

“We found that apoB testing to intensify cholesterol-lowering medication would prevent more heart attacks and strokes than current practice, and that these health benefits were achieved at a cost that represents good value for U.S. healthcare payers,” said study lead author Ciaran Kohli-Lynch, assistant professor of preventive medicine in the division of epidemiology at Northwestern University Feinberg School of Medicine.

Kohli-Lynch said this is the first comprehensive analysis to show that using apoB to guide cholesterol treatment is also cost effective.

Heart disease remains the leading cause of death in the United States and is responsible for enormous healthcare spending. Over time, tiny cholesterol carrying particles can become trapped inside artery walls, where they build up into plaques that restrict blood flow and raise the risk of heart attacks and strokes.

Why ApoB May Be a Better Measure of Heart Disease Risk

Doctors have long relied on LDL cholesterol and non HDL cholesterol levels to decide when patients should begin or intensify cholesterol lowering treatment. While those tests provide useful information, they do not fully capture a person’s cardiovascular risk.

“Research strongly shows that apolipoprotein B (apoB) is better at identifying who is at risk, because it counts the total number of harmful particles in the blood,” explained Kohli-Lynch.

Unlike standard cholesterol tests, apoB measures the number of cholesterol carrying particles that can contribute to plaque buildup. Researchers say that makes it a more direct indicator of cardiovascular risk.

Even with growing evidence supporting apoB, the test is still not commonly used in routine care. Kohli-Lynch said one reason is that measuring apoB generally requires an additional blood test beyond the standard cholesterol panel, increasing both cost and inconvenience.

“Our study asked: Is it worth spending extra money to use apoB instead of LDL to guide treatment intensification?” Kohli-Lynch said.

Computer Model Compared Three Cholesterol Testing Strategies

To answer that question, the research team created a computer simulation representing 250,000 U.S. adults who were eligible for statin therapy but did not already have cardiovascular disease.

The model compared three approaches for guiding treatment:

• LDL cholesterol (goal <100 mg/dL)
• Non-HDL cholesterol (goal <118 mg/dL)
• ApoB (goal <78.7 mg/dL)

When patients failed to meet their target, treatment was stepped up first by using stronger statins and then by adding ezetimibe if needed.

Researchers followed each strategy over a lifetime, estimating heart attacks, strokes, life expectancy, quality of life, and healthcare costs.

The results showed that using apoB to guide treatment consistently performed better than the LDL and non HDL approaches. It improved overall health outcomes, prevented more cardiovascular events, and did so in a way the researchers determined was cost effective.

New Cholesterol Guidelines Increase the Importance of Accurate Testing

The findings come as doctors have more cholesterol lowering medications available than ever before. Earlier this year, the American Heart Association and 10 other medical organizations also released updated guidelines recommending that many people begin cholesterol lowering therapy at younger ages.

“This means it is increasingly important to accurately identify who would benefit most from intensive treatment,” Kohli-Lynch said.

Other Northwestern coauthors include Drs. John Wikins and Samuel Luebbe.

The study, titled “Cost-Effectiveness of ApoB, Non-HDL-C, and LDL-C Goals for Primary Prevention Lipid-Lowering Therapy,” was supported by the American Heart Association Career Development Award 24CDA1274989 (Dr. Kohli-Lynch).

Beyond its patriotic appearance, the image offers a rare look at a stellar system that has survived for nearly the entire history of the universe.

A 13-Billion-Year-Old Star Cluster

The featured object is NGC 6426, a globular cluster located in the outer halo of the Milky Way. Globular clusters are dense, spherical swarms of stars that remain bound together by gravity. About 150 of these ancient clusters are known to exist within our galaxy.

Most of the stars in a globular cluster are born from the same collapsing cloud of gas, so they tend to be roughly the same age. NGC 6426 is estimated to be around 13 billion years old, making it one of the oldest globular clusters in the Milky Way. Since the universe itself is about 13.7 billion years old, this cluster formed not long after the cosmos came into existence.

That extraordinary age makes NGC 6426 a valuable record of conditions in the early universe.

What the Colors in the Hubble Image Mean

The vivid colors are not simply for visual appeal. They represent different wavelengths of light collected through Hubble’s filters and processed using standard scientific techniques.

Blue highlights shorter wavelengths of visible light, while red represents longer visible wavelengths as well as some near infrared light. Because a star’s color is closely linked to its temperature, the blue stars are hotter and the red stars are cooler.

Ancient Stars Reveal the Early Universe

The stars in NGC 6426 have what astronomers call low metallicity, meaning they contain relatively small amounts of elements heavier than hydrogen and helium. This chemical makeup closely resembles the composition of the young universe, when almost all matter consisted of hydrogen and helium and heavier elements were only beginning to form inside massive stars through nuclear fusion.

Scientists have also found evidence that the cluster contains two chemically distinct populations of stars. This discovery suggests that the slightly younger stars formed after an earlier generation of massive stars ended their lives in powerful supernova explosions.

Those explosions scattered newly created heavy elements throughout the cluster, enriching the gas that later gave birth to another generation of stars. The same process gradually filled the universe with the ingredients needed to create planets and many of the elements found throughout the cosmos today.

Hubble Continues Uncovering the Milky Way’s History

NASA captured this image as part of an ongoing study of globular clusters in the Milky Way’s halo. By measuring their ages and examining their chemical composition, astronomers hope to better understand how our galaxy formed and evolved over billions of years.

For more than 30 years, the Hubble Space Telescope has transformed our view of the universe through groundbreaking discoveries. Today, its observations are complemented by NASA’s James Webb Space Telescope, which studies the cosmos in infrared light, while the Nancy Grace Roman Space Telescope, scheduled to launch in late summer, is expected to further expand our understanding of the universe.