6
Evaluation and Diagnosis
3.3. Measurement of Apolipoprotein B
COR LOE
Recommendations
2a B-NR
1. In adults on LLT, particularly those with ASCVD, CKM
syndrome, type 2 diabetes, and/or elevated TG, measurement
of apoB is reasonable to guide decisions regarding further
therapeutic intensification once LDL-C and/or non–HDL-C
goals are achieved.
2b B-NR
2. In adults not on LLT, measurement of apoB may be reasonable
to enhance ASCVD risk assessment, guide decisions about
initiation of LLT, and characterize inherited lipid disorders.
3.4. Measurement of Lipoprotein (a)
COR LOE
Recommendations
1 B-NR
1. In all adults, measurement of Lp(a) concentration is
recommended at least once for ASCVD risk assessment.
1 B-NR
2. In individuals with FH, premature ASCVD, or high Lp(a),
cascade testing of first-degree family members for high Lp(a)
concentration is recommended to identify those at increased
ASCVD risk.
1 B-NR
3. For individuals undergoing measurement of Lp(a), use of
laboratories employing assays that are insensitive to apo(a)
isoforms and traceable to official reference standard materials
is recommended to more accurately measure Lp(a) and
characterize ASCVD risk.
3.2. Measurement of TC, LDL-C, HDL-C, Triglycerides, and
Non–HDL-C
COR LOE
Recommendations
1 B-NR
5. In adults and children who have undergone a standard
lipid profile, reporting of non–HDL-C is recommended
for ASCVD risk assessment and to guide initiation and
monitoring of LLT.
3: No
Benefit
B-NR
6. In adults and children, routine advanced lipoprotein
testing (eg, gradient gel electrophoresis, density gradient
ultracentrifugation, nuclear magnetic resonance spectroscopy,
ion mobility analysis) to assess lipoprotein subclasses and
parameters such as LDL particle size is not recommended to
estimate ASCVD risk and guide initiation of LLT.
(cont'd)
