ApoA1 / ApoV ratio

Why is it needed?

This test evaluates the balance between’ good ‘and’ bad ‘ cholesterol and is a more accurate marker of the risk of atherosclerosis than the standard lipid profile.

What do apolipoproteins do?

ApoA1 is the main protein of high-density lipoproteins (HDL, ‘good cholesterol’):
Removes excess cholesterol from the blood vessels and transports it to the liver for elimination.
It has anti-atherosclerotic and anti-inflammatory effects.
apoB is the main protein of low-density lipoproteins (LDL, ‘bad cholesterol’):
Delivers cholesterol to the walls of blood vessels, contributing to the formation of plaques.
It is also found in very low-density lipoproteins (VLDL) and lipoprotein (a).

The ApoA1/apoB ratio reflects the balance between protective and atherogenic particles.

Symptoms of an imbalance

At a low ratio (ApoV ↑, ApoA1 ↓)

Atherosclerosis:
Angina pectoris, risk of heart attack/stroke.
Ischemia of the lower extremities (intermittent claudication).
Metabolic disorders:
Obesity, insulin resistance.
Fatty liver disease.

With a high ratio (ApoA1 ↑, ApoV ↓)

Rarely causes problems, but may indicate that:
Hyperthyroidism.
Genetic mutations (for example, ApoV deficiency).

Norms in analyses

The test is performed in blood (serum) by immunoturbidimetry.

Parameter	Standard	Pathology
ApoA1 (g / l)	1.0-2.0 (male) 1.2-2.2 (women)	<0.9 – high risk of atherosclerosis
ApoV (g / l)	0.5–1.3	>1.3-atherogenic profile
ApoA1/ApoV ratio	> 1.0 (optimum – 1.5-2.5)	< 0.8 – high cardiovascular risk

Note:

In women, ApoA1 levels are higher (due to estrogens).
In children, the norm is lower (ApoA1: 0.8-1.6 g / l, ApoV: 0.4-1.0 g/l).

When is the test scheduled?

Assessment of the risk of atherosclerosis (especially in familial hypercholesterolemia).
Monitoring of treatment with statins or fibrates.
Diagnosis of dyslipidemia (for example, low ApoA1 in metabolic syndrome).

What should I do if there are deviations?

At a low ratio (ApoA1/ApoV < 0.8)

Reducing ApoS:

Statins (rosuvastatin, atorvastatin).
PCSK9 inhibitors (alirocumab for statin resistance).

Increasing ApoA1:

Fibrates (fenofibrate).
Physical activity (aerobic training increases HDL).

Diet:

Omega-3 fatty acids (salmon, flaxseed oil).
Olive oil, avocado.

When the ratio is high (rarely requires correction)

Exclude hyperthyroidism.

Comparison with traditional lipid tests

Parameter	What it shows	Advantages of ApoA1/ApoV
LDL (cholesterol)	The amount of “bad” cholesterol	Takes into account all atherogenic particles (not only LDL, but also VLDL, LP(a))
HDL (cholesterol)	The level of ‘good’ cholesterol	Reflects the functional state of HDL (ApoA1-their main protein)

Example of risk calculation

For the patient:

ApoA1 = 1.1 g / l, apoB = 1.4 g/l.
Ratio = 1.1 / 1.4 = 0.79 (high risk).

Recommendations: Prescribe statins, change your diet.

Conclusion

🔹 The ApoA1/apoB ratio is the gold standard for evaluating the lipid profile.
🔹 Rules:

ApoA1: 1.0-2.2 g / l,
ApoV: 0.5-1.3 g / l,
Ratio: > 1.0 (ideally 1.5-2.5).
A low ratio (<0.8) is a reason for aggressive prevention of heart attack.
Correction: statins, fibrates, Mediterranean diet.

Example: If ApoV = 1.5 g / l and ApoA1 = 0.9 g/L , the risk of atherosclerosis is extremely high and urgent treatment is required.