Cholesterol, ApoB and Lp(a): Understanding Your Numbers
Cholesterol and related particles can slowly build up as plaque in the walls of your arteries. Over many years, that plaque raises the chance of a heart attack or stroke. Knowing your numbers helps you and your doctor decide how best to protect your heart and blood vessels.
Know your numbers
| Test | What it tells you |
|---|---|
| LDL cholesterol (“bad”) | The main driver of plaque build-up in the arteries. Lower is better. |
| ApoB (apolipoprotein B) | Counts the harmful, cholesterol-carrying particles — each one carries a single ApoB. It is especially useful when triglycerides are high, or with diabetes or extra weight, when LDL alone can underestimate risk. |
| Non-HDL cholesterol | All of the harmful cholesterol added together. It comes from the standard cholesterol panel and, like ApoB, stays reliable when triglycerides are high. |
| Triglycerides | A type of blood fat. It rises with sugar, refined carbohydrates, alcohol and extra weight. |
| HDL cholesterol (“good”) | Higher levels go along with lower risk — but medicines that raise HDL have not been shown to prevent heart attacks, so it is not a treatment target. |
| Lipoprotein(a), or Lp(a) | An inherited particle that adds to risk. Canadian guidelines recommend checking it once in your lifetime. A level of 100 nmol/L or higher (50 mg/dL or higher) means higher risk. |
Good to know: most cholesterol tests no longer need fasting. Your requisition will say if yours does.
Why Lp(a) matters
Lp(a) is a cholesterol-carrying particle you inherit from your parents, and about 1 in 5 people have a high level. It adds to the lifetime risk of plaque, heart attack, stroke, and narrowing of the aortic valve in the heart. Because it is set by your genes, diet, exercise and weight loss change it very little — which is why it only needs to be measured once. A high Lp(a) helps your doctor decide how closely to manage your other risk factors, including LDL cholesterol. Since it runs in families, close relatives may want to ask their own doctor about checking theirs.
Why age and time matter
Heart risk climbs as we get older, and the effect of cholesterol adds up year after year — the longer levels stay high, the more plaque can build. Keeping cholesterol lower over many years gives the greatest protection.
Medications and your target
Statins are the best-proven medicines for lowering cholesterol and preventing heart attack and stroke. In large studies, every 1 mmol/L drop in LDL cut major heart and stroke events by about one-fifth. Canadian guidelines use these numbers once treatment has started:
| Preventing a first heart attack or stroke | If you already have heart or blood-vessel disease | |
|---|---|---|
| LDL cholesterol | Below 2.0 mmol/L, or a drop of more than 50% | Your doctor will usually consider adding a second medicine if, on the highest statin dose you can take, LDL stays at 1.8 mmol/L or higher (ApoB 0.7 g/L or higher; non-HDL 2.4 mmol/L or higher) |
| ApoB | Below 0.8 g/L | |
| Non-HDL cholesterol | Below 2.6 mmol/L |
The usual second medicine is ezetimibe, a daily pill. Some people at higher risk may also be offered an injectable PCSK9 inhibitor. Inherited high cholesterol (familial hypercholesterolemia) is managed with its own targets. Your doctor will set the target that is right for you.
Side effects? If you notice muscle aches, tiredness or stomach upset, tell us rather than stopping on your own. Often a different statin or a different dose works well.
Taking your medicine consistently, year after year, is what protects you.
Lifestyle that helps
- Heart-healthy habits: eat more vegetables, fruit, whole grains, legumes, nuts and healthy oils; limit saturated fat, added sugar, salt and alcohol; aim for about 150 minutes of activity a week; and do not smoke.
- Weight loss: losing extra weight clearly improves triglycerides, blood pressure and blood sugar, and lowers the chance of diabetes. It lowers LDL cholesterol only modestly, though — so if your doctor has recommended a cholesterol medicine, weight loss works alongside it rather than replacing it.
Sources: Pearson GJ et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia, Can J Cardiol 2021;37:1129–50. Cholesterol Treatment Trialists’ Collaboration, Lancet 2010;376:1670–81. MyHealth Alberta (myhealth.alberta.ca).
Please note: this article reflects current medical guidance at the time of its last review (September 2026). Medical recommendations change as new evidence emerges — for the most up-to-date advice about your own health, always talk to your health-care provider, or call Health Link Alberta at 811. This information is general education, not personal medical advice. © Grace Medical Clinic, Calgary.
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