This National Lipid Association (NLA) Expert Clinical Consensus provides an overview of the physiologic and clinical considerations regarding the role of apolipoprotein B (apoB) measurement to guide clinical care based on the available scientific evidence and expert opinion. ApoB represents the total concentration of atherogenic lipoprotein particles in the circulation and more accurately reflects the atherogenic burden of lipoproteins when compared to low-density lipoprotein cholesterol (LDL-C). ApoB is a validated clinical measurement that augments the information found in a standard lipoprotein lipid panel; therefore, there is clinical value in using apoB in conjunction with a standard lipoprotein lipid profile when assessing risk and managing lipid-lowering therapy (LLT). ApoB has been shown to be superior to LDL-C in risk assessment both before and during treatment with LLT. In individuals, there can be discordance between levels of LDL-C and apoB, as well as LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C), despite high levels of population-wide correlation. When there is discordance between LDL-C and apoB, or LDL-C and non-HDL-C, atherosclerotic cardiovascular disease risk generally aligns better with apoB or non-HDL-C. Additionally, apoB can be used in tandem with standard lipoprotein lipid measurements to diagnose distinct lipoprotein phenotypes. ApoB testing can inform clinical prognosis and care, as well as enable family cascade screening, when an inherited lipoprotein syndrome is identified. The NLA and other organizations will continue to educate clinicians about the role of apoB measurement in improving clinical risk assessment and dyslipidemia management. An urgent need exists to improve access and reimbursement for apoB testing.

本国家脂质协会（NLA）专家临床共识提供了关于载脂蛋白B（apoB）测量的作用的生理和临床考虑的概述，以现有的科学证据和专家意见为基础，指导临床护理。ApoB代表血液循环中致动脉粥样硬化脂蛋白颗粒的总浓度，与低密度脂蛋白胆固醇（LDL-C）相比，能更准确地反映脂蛋白致动脉粥样硬化负担。ApoB是一种经过验证的临床测量方法，可以增加标准脂蛋白脂质组中发现的信息；因此，在评估风险和管理降脂治疗（LLT）时，将apoB与标准脂蛋白脂谱联合使用具有临床价值。在LLT治疗前和治疗期间，ApoB在风险评估方面优于LDL-C。在个体中，LDL-C和apoB，以及LDL-C和非高密度脂蛋白胆固醇（non-HDL-C）的水平可能存在不一致，尽管在整个人群中具有高度相关性。当LDL-C和apoB，或LDL-C和非hdl-c不一致时，动脉粥样硬化性心血管疾病风险通常与apoB或非hdl-c更一致。此外，apoB可以与标准脂蛋白脂质测量一起用于诊断不同的脂蛋白表型。当发现遗传性脂蛋白综合征时，ApoB检测可以告知临床预后和护理，也可以进行家族级联筛查。NLA和其他组织将继续教育临床医生apoB测量在改善临床风险评估和血脂异常管理中的作用。迫切需要改善apoB检测的准入和报销。