# ApoB-to-LDL discordance

Whether your particle count (ApoB) and your cholesterol mass (LDL cholesterol) tell the same story; for most people they do, and when they do not, the particle count is the number the cohorts followed.

Type: index · Unit: category · Domain: Cardio-Respiratory Health · Accuracy: Calculated · Importance: Supporting

Also called: discordance, particle count versus cholesterol, ApoB LDL mismatch, discordant lipids

## In one sentence

Whether your particle count (ApoB) and your cholesterol mass (LDL cholesterol) tell the same story; for most people they do, and when they do not, the particle count is the number the cohorts followed.

## Why it matters

Two people with the same LDL cholesterol can carry very different numbers of particles, because particles vary in how much cholesterol each one holds; in insulin resistance and with high triglycerides the particles are small and cholesterol-poor, so there are more of them than the cholesterol suggests. That is the discordant case, and it is where the two markers part company in the cohorts: among 389,529 UK Biobank adults, ApoB, non-HDL cholesterol and triglycerides each tracked incident myocardial infarction on their own, but assessed together only ApoB remained (Marston 2022), and across twelve studies with 233,455 people ApoB was the strongest of the three markers and LDL cholesterol the weakest (Sniderman 2011). The European consensus on LDL made the same point from the other side: the benefit of lowering LDL cholesterol holds where the fall in cholesterol is matched by a fall in particle number (Ference 2017).

## What moves it

Triglycerides and insulin resistance push the two apart (ApoB up, LDL cholesterol unchanged); weight loss and better glucose handling bring them back together; a very-low-carbohydrate diet can raise LDL cholesterol more than ApoB in some people, the discordance in the other direction.

## How to measure it well

Both from one draw, under the lipid profile's rules; ApoB does not need fasting but the triglyceride that shapes the picture does. Compare draws taken the same way.

## How Vitality Tracker uses it

Computed only when ApoB and LDL cholesterol come from one collection. VT places each in a band (the laboratory's range and VT's working optimal, 0.8 g/L for ApoB and 2.0 mmol/L for LDL cholesterol) and reports one of three readings: concordant; discordant with ApoB the higher; discordant with LDL cholesterol the higher, with the sentence that in the discordant case the cohorts followed ApoB. The rule is marked *working* until the clinical advisor has reviewed it; the result is shown in the lipids panel and in the derived-indices section of the pre-visit report, and it prompts nothing on its own.

## How far to trust the number

Calculated from two laboratory results, one of which (LDL cholesterol) is usually itself calculated; the reading is a category, so a value near a band edge can flip between draws for no biological reason.

## Method

Band each result against its reference lines; discordant when the two fall in different bands. Percentile-based discordance, the research form, needs population tables VT does not yet hold.

## Sources

1. Marston NA, et al. JAMA Cardiol 2022;7:250–6. [doi:10.1001/jamacardio.2021.5083](https://doi.org/10.1001/jamacardio.2021.5083)
2. Sniderman AD, et al. Circ Cardiovasc Qual Outcomes 2011;4:337–45. [doi:10.1161/CIRCOUTCOMES.110.959247](https://doi.org/10.1161/CIRCOUTCOMES.110.959247)
3. Ference BA, et al. Eur Heart J 2017. [doi:10.1093/eurheartj/ehx144](https://doi.org/10.1093/eurheartj/ehx144)
4. Vitality Tracker, Clinician report content specification (derived indices); optimal set v0.1 (working).

## Related

- [Apolipoprotein B](https://vitalitytracker.app/knowledge/apolipoprotein-b)
- [Lipid profile](https://vitalitytracker.app/knowledge/lipid-profile)
- [Non-HDL, the ratios and remnant cholesterol](https://vitalitytracker.app/knowledge/non-hdl-and-lipid-ratios)
- [HOMA-IR](https://vitalitytracker.app/knowledge/homa-ir)
- [Getting your blood tests done in New Zealand](https://vitalitytracker.app/knowledge/blood-tests-in-new-zealand)

Reviewed October 2026 · v1

Source: https://vitalitytracker.app/knowledge/apob-ldl-discordance