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When it comes to predicting the risk of a fatal heart attack, it may be more accurate to test levels of cholesterol-carrying molecules called apolipoproteins rather than cholesterol levels themselves, findings have revealed.

To evaluate the link between these cholesterol-carrying molecules and the risk of a fatal heart attack, Walldius and his colleagues recruited more than 175,000 Swedish men and women. At the start of the study, the investigators measured levels of apoB, apoA-1, triglycerides, HDL, LDL and total cholesterol. They also calculated the ratio of apoB to apoA-1.

Apolipoprotein B (apoB) and apolipoprotein A-1 (apoA-1) are both proteins that carry cholesterol in the blood. ApoB carries the ``bad'' form of cholesterol, LDL, and ApoA-1 transports the good type, HDL. Testing apolipoprotein levels may be most beneficial in identifying people who are at high risk for a heart attack despite having normal or low cholesterol levels, according to the study's authors.

Measuring levels of apolipoproteins might be particularly useful in people who have normal LDL levels. In this group, apoB levels were more accurate in predicting the risk of heart attack than LDL levels. ApoB is found not only in LDL, but also in another type of cholesterol called VLDL. Abnormalities in this and other blood fats might affect the risk of heart attack, according to the report.

The investigators found that levels of apoB and the ratio of apoB to apoA-1 were strongly related to the risk of fatal heart attack. The balance between apoB and apoA-1 is ``very critical'' for evaluating the risk of a fatal heart attack, according to Walldius. During an average of more than 5 years of follow-up, 864 men and 359 women died from a heart attack, the report indicates, according to The Lancet (2001;358:2012-2013, 2026-2033).