Update on the Tubby Theory from 2009

In my book Tubby Theory from Topeka, I coined a term the Tubby Factor to represent the term non-HDL-cholesterol.
I also advised a step approach to using 3 low dose lipid lowering medications
I thought it was easier for patients to remember to ask their Doctors for this number and that it was much more predictive than LDLc.
I preferred LDLp or apoB to non-HDLc but I suspected the guidelines would not accept the particle count as the new standard.
Sure enough the guidelines still use LDLc but there is more acceptance of non-HDLc.

This article, High ApoB in Young Adults Predicts Midlife Atherosclerosis 
states:

"Young adults aged 18 to 30 who had higher-than-average apolipoprotein B (apoB) levels showed an increased risk of developing coronary artery calcification (CAC) by middle age, in an analysis from the Coronary Artery Risk Development in Young Adults (CARDIA) study[1]."

"However, although some clinicians favor measuring apoB as well as traditional lipid biomarkers to help predict CVD risk, and apoB is included in some guidelines, it is not part of current ACC/AHA guidelines, and others are not convinced that studies have demonstrated that apoB adds predictive value. ."

"We take the viewpoint that apoB is a more robust biomarker of CVD risk [than LDL cholesterol and non–HDL cholesterol] based on observational studies and clinical trials such as AFCAPS/TexCaps," he told heartwire . "For all patients with metabolic syndrome and type 2 diabetes, I routinely measure either apoB or LDL particle concentration," he said, adding that "it has been shown that apoB or LDL-particle concentration is more strongly associated with CV risk than LDL cholesterol and non–HDL cholesterol in most studies."

'However, Dr Scott Grundy] told heartwire that although there's no question that apoB is a better predictor of atherosclerosis and heart attack than LDL cholesterol, "it's much more difficult to show that apoB is a better predictor than non–HDL cholesterol."

"Furthermore, non–HDL is easily measured in a clinical lab, whereas apoB requires an extra test (an immunoassay) with added cost. "Should we all start going out and measuring apoB? I think the answer is 'No,' " according to Grundy.

It is also not clear if an apoB target treatment goal would be better than a non–HDL goal, he continued. This may be moot, though, since "the latest [ACC/AHA] guidelines [have eliminated treatment targets and] say that you come up with a certain level of risk and treat [the patient] with a statin and don't ever measure cholesterol again."


"For now, "these data suggest a dose-response association between apoB in young adults and the presence of midlife CAC independent of baseline traditional CVD risk factors," the researchers conclude, adding that "further follow-up is warranted to determine if apoB measurement in young adulthood is a marker of later CHD risk as well."


 Page 147 and page 148 of The Tubby Theory from Topeka which I wrote in 2009 and published in 2010.

Back Cover of my book, The Tubby Theory from Topeka.
I am with my son, now a medical student who helped me write the book.