If you have diabetes or obesity, Delhi cardiologist urges to get one test done to know heart attack risks

You might think a normal cholesterol report means your heart’s safe—but a Delhi cardiologist says that assumption could be deadly. He recently took to X to highlight one test that can actually predict your next heart attack. It’s not the standard lipid panel, and yet, 95% of heart patients never get it done. The test is called ApoB, and according to him, it’s the single most powerful indicator of hidden heart risk.
What ApoB really tells you

While your usual lipid panel measures cholesterol mass, that’s not what truly causes atherosclerosis. The real problem lies in the particles that carry cholesterol through your blood. ApoB is a protein found on every plaque-producing particle, including LDL, VLDL, and their remnants. In simple terms, one cholesterol particle equals one ApoB protein—so measuring ApoB gives a direct count of how many harmful particles are circulating in your bloodstream.

95% of post-stent patients never get their ApoB checked.
Yet it's the #1 blood test to predict your next heart attack.

Here's why it matters:

— Dr Shailesh Singh (@drShaileshSingh) October 8, 2025

Why cholesterol numbers can be misleading

A common misconception is that having “normal” LDL or total cholesterol means you’re in the clear, said Dr Shailesh Singh. But your arteries don’t care how much cholesterol floats in your blood—they care about how many particles are trying to squeeze through and get stuck in the arterial walls. The more particles you have, the more likely plaque will form. ApoB shows you that number. LDL cholesterol doesn’t.
The hidden danger of normal LDL but high ApoB

As per the cardiologist, around 25% of people have normal LDL cholesterol but high ApoB levels. For instance, someone may have LDL at 100 mg/dL—considered fine—but ApoB at 120 mg/dL, which signals high risk. This happens because of small, triglyceride-rich particles that carry less cholesterol per particle, he explained in his tweet. The smaller the particle, the more of them your body produces to carry the same cholesterol load. The result: your LDL looks normal on paper, but your arteries are quietly clogging up, Dr Shailesh Singh warns.
Diabetes, belly fat, and insulin resistance—your hidden risk trio

If you’re diabetic, overweight, or carry extra belly fat, your liver tends to churn out these small, cholesterol-poor particles. Even with an LDL of 105 mg/dL—numbers most doctors call “not bad”—your ApoB may still be dangerously high, informs the expert. Insulin resistance drives this process, creating more particles, more plaque buildup, and a higher risk of stroke and heart disease. The standard cholesterol panel completely misses this hidden danger.
When “perfect” numbers don’t protect you

The doctor shared that he’s seen patients who had LDL levels as low as 70 mg/dL after stent placement—seemingly ideal—but still developed new blockages within a few years. The reason? Their ApoB was over 95 mg/dL, high enough to keep atherosclerosis progressing. In these cases, doctors looked at cholesterol mass instead of particle count, missing the real threat. You can have “normal cholesterol” and still be at serious risk—because it’s particles that kill, not just cholesterol mass.
What’s a healthy ApoB level?

As per the cardiologist, if you’ve had a stent or have coronary blockages, your ApoB should be under 65 mg/dL. For context, we’re all born with ApoB levels around 30 mg/dL—at that range, there’s virtually no plaque buildup. That’s your baseline. On the other hand, anyone with ApoB above 100 mg/dL—regardless of stents or diagnoses—is actively building plaque even if they feel fine.
What this means for you

If you have diabetes, obesity, metabolic syndrome, or triglycerides over 150 mg/dL, get your ApoB checked yourself. It might just reveal the danger your regular cholesterol test has been missing all along.