# ApoB and Lp(a): the two cardiovascular numbers your standard German check-up does not measure

ApoB and Lp(a) are two cardiovascular markers your standard German Check-up 35 does not measure: it covers only total cholesterol, LDL-C, HDL-C, and triglycerides. ApoB counts the actual atherogenic particles (one ApoB per particle) instead of just their cholesterol mass, and the 2019 ESC/EAS guidelines prefer it in high-triglyceride, diabetes, and metabolic-syndrome settings (the 2025 focused update did not revise the ApoB recommendation). Lp(a) is more than 90 percent genetically fixed, and the EAS 2022 consensus says it should be measured at least once in every adult's life. Both are usually self-pay (IGeL/Selbstzahler) in DACH without a clinical indication.

Here is the honest version. What the 2025 European cardiology guidelines actually recommend, what your Hausarzt orders by default, and what the science really says about acting on these results.

## On this page

- Why ApoB beats LDL-C: particles vs cholesterol mass
- What is Lp(a) and why is it the silent genetic risk factor?
- How do you read your ApoB and Lp(a) results without panic?
- Why doesn't your Hausärztin order ApoB or Lp(a)?
- What do ApoB and Lp(a) cost across Germany, Austria, and Switzerland?
- Your ApoB or Lp(a) is high. What now?

## FAQ

- Should I get ApoB tested?
- What is a "good" Lp(a)?
- Is Lp(a) dangerous?
- Why doesn't my doctor order this?
- Will my Krankenkasse pay for it?
- Can I do anything about a high Lp(a)?
- ApoB or LDL-C: which actually matters?

## Sources

- Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O; ESC Scientific Document Group. (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal. https://doi.org/10.1093/eurheartj/ehz455
- Mach F, Koskinas KC, Roeters van Lennep JE, Tokgozoglu L, Badimon L, Baigent C, Benn M, Binder CJ, Catapano AL, De Backer G, Delgado V, Fabin N, Ference BA, Graham IM, Landmesser U, Laufs U, Mihaylova B, Nordestgaard BG, Richter DJ, Sabatine MS, et al.. (2025). 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf190
- Sniderman AD, Thanassoulis G, Glavinovic T, Navar AM, Pencina M, Catapano A, Ference BA. (2019). Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2019.3780
- Marston NA, Giugliano RP, Melloni GEM, Park JG, Morrill V, Blazing MA, Ference B, Stein E, Stroes ES, Braunwald E, Ellinor PT, Lubitz SA, Ruff CT, Sabatine MS. (2022). Association of Apolipoprotein B-Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis: Distinguishing Between Particle Concentration, Type, and Content. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2021.5083
- Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky M, Lambert G, Mach F, McNeal CJ, Moriarty PM, Natarajan P, Nordestgaard BG, Parhofer KG, Virani SS, von Eckardstein A, Watts GF, Stock JK, Ray KK, Tokgozoglu LS, Catapano AL. (2022). Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. European Heart Journal. https://doi.org/10.1093/eurheartj/ehac361
- Tsimikas S. (2017). A Test in Context: Lipoprotein(a) — Diagnosis, Prognosis, Controversies, and Emerging Therapies. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2016.11.042
- Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, White IR, Marcovina SM, Collins R, Thompson SG, Danesh J; Emerging Risk Factors Collaboration. (2009). Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. https://doi.org/10.1001/jama.2009.1063
- Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. https://doi.org/10.1161/CIR.0000000000000625
- Rivera FB, Cha SW, et al.. (2025). Impact of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on Lipoprotein(a): A Meta-Analysis and Meta-Regression of Randomized Controlled Trials. JACC: Advances. https://doi.org/10.1016/j.jacadv.2024.101549

_Full guide: https://longevity-china.com/en/guide/apob-lpa_

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_Canonical: https://longevity-china.com/en/guide/apob-lpa · Part of Longevity Cities · Updated 2026-06-22_