Millions of people in Germany know their cholesterol levels — but that may not be enough to assess their true risk of heart attack or stroke, according to a new study published in the Journal of the American Medical Association (JAMA).
Researchers say the standard blood fat test, which measures total cholesterol, LDL, HDL, and triglycerides, fails to capture how many harmful fat particles are actually circulating in the bloodstream. This limitation could explain why many individuals experience cardiovascular events despite having what doctors previously considered acceptable cholesterol levels.
The study highlights apolipoprotein B, or ApoB, as a more accurate predictor of heart disease risk. ApoB is a protein found on every single harmful lipoprotein particle — including LDL, VLDL, and IDL — making it a direct count of the number of atherogenic particles in circulation.
“Measuring ApoB gives a fuller picture than traditional cholesterol testing,” the report states. “It shows not just how much fat is in the blood particles, but how many of these dangerous particles are actually moving through the arteries.”
Experts note that for decades, doctors have relied on LDL cholesterol levels above 100 mg/dL as a threshold for recommending more intensive treatment. However, the findings suggest that focusing solely on LDL may miss critical risk factors, particularly since it does not account for particle number.
The research also points to nighttime influences as an underappreciated factor in cardiovascular disease, though specific details about this aspect were not elaborated in the study summary.
Cardiovascular disease remains a leading cause of death in Germany, with tens of thousands dying each year from heart attacks — many of whom had recently visited a doctor and monitored their cholesterol.
The findings could shift clinical focus toward more comprehensive lipid testing, potentially improving prevention strategies for heart attacks and strokes by identifying at-risk individuals who might otherwise be overlooked.
