What are ApoB and lipoprotein(a), and should I be tested?

ApoB and lipoprotein(a) are blood tests that measure heart disease risk more precisely than a standard cholesterol test. ApoB counts the particles that build up in artery walls. Lipoprotein(a) is an inherited risk factor that is raised in about 1 in 5 people. The Online GP by The Wellness offers both within doctor-led blood panels in Marylebone.

Key points

• Lipoprotein(a) is raised in around 1 in 5 people and is mostly determined by genes, so one test usually shows your lifelong level.

• In a UK cohort of more than 26,000 people with results, 17.6% had a lipoprotein(a) level in the increased-risk range, according to a 2026 review.

• In about 20% of people, LDL cholesterol looks normal while ApoB is raised, so their real risk is higher than a standard test suggests.

• The 2026 American Heart Association and American College of Cardiology guideline recommends every adult has lipoprotein(a) measured at least once.

• The first large outcome trials of medicines that lower lipoprotein(a) are reporting from late 2026.

What is ApoB?

ApoB, or apolipoprotein B, is a protein carried on every particle that can deposit cholesterol in artery walls, including LDL. Measuring ApoB counts those harmful particles directly. Two people with the same LDL cholesterol can have very different ApoB levels, and the person with more particles carries more risk.
ApoB is especially useful for people with diabetes, raised triglycerides, excess weight around the waist or metabolic syndrome. In these groups, a standard cholesterol test can underestimate risk.
Commentary on the 2026 American Heart Association and American College of Cardiology cholesterol guideline notes that in about 20% of people LDL cholesterol appears normal while ApoB is raised.

What is lipoprotein(a)?

Lipoprotein(a), written Lp(a), is a cholesterol-carrying particle with an extra protein attached that makes it particularly harmful to arteries and heart valves. Its level is largely inherited and changes little through life. High levels raise the risk of heart attack, stroke and narrowing of the aortic valve, even when other cholesterol results look normal.
A 2026 review of lipoprotein(a) in cardiovascular health describes it as raised in one in five people and a neglected biomarker. In a UK cohort of 26,619 people with results, 17.6% fell in the increased-risk range.
Lifestyle changes have little effect on lipoprotein(a). Knowing your level still matters, because doctors then manage every other risk factor more firmly.
Ask a doctor on WhatsApp about ApoB and lipoprotein(a) testing.

Who should have ApoB and lipoprotein(a) tested?

Adults with a family history of heart attack or stroke at a young age, people with high cholesterol that does not respond as expected, and anyone with diabetes or metabolic risk benefit most from testing. The 2026 American guideline recommends testing lipoprotein(a) at least once in every adult.
HEART UK, the cholesterol charity, published a consensus statement in 2019 recommending lipoprotein(a) measurement in people with a personal or family history of premature cardiovascular disease and those with familial high cholesterol.
People of South Asian and African heritage should pay particular attention. Lipoprotein(a) levels and their effect on heart risk vary between populations.
"Lipoprotein(a) is the test I most often wish patients had done twenty years earlier," says Dr Adel Elalfy, Head of Primary Care at The Online GP by The Wellness. "It is one blood test, usually once in a lifetime, and it can change how seriously we treat everything else."

What happens if my results are high?

If your ApoB or lipoprotein(a) is high, the doctor reviews your overall cardiovascular risk and agrees a plan. This may include lifestyle changes, treatment to lower ApoB and LDL cholesterol, closer blood pressure control, and, where appropriate, referral to a lipid specialist or cardiologist.
Medicines that specifically lower lipoprotein(a) are in late-stage trials. A 2026 review of new lipoprotein(a) therapies reports five agents in advanced development, with the first large outcome trial results due in late 2026.
A high lipoprotein(a) result is also useful information for your family. Because the level is inherited, close relatives may want to be tested too. Book family testing on WhatsApp.

How do these tests fit into a wider heart check?

ApoB and lipoprotein(a) work best alongside a full cholesterol profile, blood sugar, kidney function, blood pressure and family history. Together they give a far clearer picture of heart risk than any single number. The doctor brings these results together into one plan.
Our guide to what a full private blood test should include explains how the panels differ. If you have not had your blood pressure checked recently, our guide to undiagnosed high blood pressure is a useful next read.

How much does ApoB and lipoprotein(a) testing cost?

The Executive Physical at The Online GP by The Wellness starts from £2,995 and is the most comprehensive assessment the clinic offers. Blood panels start at Longevity+ from £1,395, Advanced Health from £650 and Core Wellness from £350.
The doctor confirms which panel includes ApoB and lipoprotein(a) before you book, and every result is read by a GMC-registered doctor. Book a heart-focused blood panel on WhatsApp.

Can a doctor tell me if I need these tests?

Yes. The Online GP by The Wellness offers a free suitability review. Send your age, family history, any recent cholesterol results and current medicines on WhatsApp. A doctor either recommends testing or tells you plainly that your current results are enough.
Start your free suitability review on WhatsApp.

Frequently asked questions

Is lipoprotein(a) the same as LDL cholesterol?

No. Lipoprotein(a) is a separate particle with an extra protein attached. A standard cholesterol test does not measure it, so it must be requested specifically.

Can diet lower lipoprotein(a)?

Diet and exercise have little effect on lipoprotein(a), which is mainly set by genes. They still lower overall heart risk, which matters more when lipoprotein(a) is high.

How often should lipoprotein(a) be tested?

Most people need lipoprotein(a) tested only once, because the level stays stable through life. ApoB is usually rechecked to monitor treatment.

Is ApoB better than LDL cholesterol?

ApoB counts every harmful cholesterol particle and often predicts risk more accurately, particularly in people with diabetes or raised triglycerides. Doctors usually look at both.

Sources

• Lipoprotein(a), the neglected risk factor in cardiovascular health, review published 2026

• Novel lipoprotein(a) therapies, a comprehensive review, Current Atherosclerosis Reports, August 2026

• HEART UK consensus statement on lipoprotein(a), Atherosclerosis, 2019

• American Heart Association and American College of Cardiology cholesterol guideline, 2026
  
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