LabCorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
To determine whether or not you have an adequate level of apo A-I, especially if you have a low level of high-density lipoprotein (HDL-C), and to help determine your risk of developing cardiovascular disease (CVD)
When you have a low value of HDL-C, high cholesterol and triglycerides (hyperlipidemia), and/or a family history of CVD; when your healthcare provider is trying to assess your risk of developing heart disease; when monitoring the effectiveness of lipid treatment and/or lifestyle changes
A blood sample drawn from a vein in your arm; blood from the prick of a baby's heel or finger
No test preparation is needed; however, since this test may be performed at the same time as a complete lipid profile, fasting for at least 12 hours may be required.
Apolipoprotein A-I (apo A-I) is a protein that has specific roles in the transportation and metabolism of lipids and is the main protein component in high-density lipoprotein (HDL, the "good cholesterol"). This test measures the amount of apo A-I in the blood.
Lipids alone cannot dissolve in the blood; they are like oil that floats on water. Apolipoproteins are the proteins that combine with lipids to make lipoprotein particles that can transport lipids throughout the bloodstream. Apolipoproteins provide structural integrity to lipoproteins and shield the water-repellent (hydrophobic) lipids at their center.
Most lipoproteins are cholesterol- or triglyceride-rich (two main lipids) and carry them throughout the body for uptake by cells. HDL, however, is like an empty taxi. It goes out to the tissues and picks up excess cholesterol, then transports it back to the liver. In the liver, the cholesterol is either recycled for future use or excreted in bile. HDL's reverse transport is the only way that cells can get rid of excess cholesterol. This reverse transport helps protect the arteries and, if there is enough HDL present, it can even reverse the build-up of fatty plaques, deposits resulting from atherosclerosis that can lead to cardiovascular disease (CVD).
Apolipoprotein A is the taxi driver. It activates the enzymes that load cholesterol from the tissues into HDL and allows HDL to be recognized and bound by receptors in the liver at the end of the transport. There are two forms of apolipoprotein A: apo A-I and apo A-II. Apo A-I is found in greater proportion than apo A-II (about 3 to 1). The concentration of apo A-I can be measured directly and tends to rise and fall with HDL levels. Deficiencies in apo A-I correlate with an increased risk of developing CVD. Apo A-I levels provide more information to help evaluate CVD risk, especially when HDL levels are low.
Apolipoprotein A-I (apo A-I) may be ordered, along with other lipid tests, as part of a profile to help determine a person's risk of developing cardiovascular disease (CVD). It may be used as an alternative to a high-density lipoprotein (HDL) test, but it is not generally considered "better" or more informative than HDL and is not ordered routinely.
Apo A-I is a protein that has a specific role in the metabolism of lipids and is the main protein component in HDL, the "good cholesterol". HDL removes excess cholesterol from cells and takes it to the liver for recycling or disposal. Levels of apo A-I tend to rise and fall with HDL levels, and deficiencies in apo A-I correlate with an increased risk of developing CVD.
An apo A-I test may sometimes be ordered to:
An apo A-I may be ordered along with an apolipoprotein B (apo B) test to determine an apo B/apo A-I ratio. This ratio is sometimes used as an alternative to a total cholesterol/HDL ratio (sometimes reported as part of a lipid profile) to evaluate risk for developing CVD.
Apo A-I may be measured when someone has a personal or family history of abnormal lipid levels and/or premature CVD. It may be ordered when a healthcare practitioner is trying to determine the cause of a person's high cholesterol and/or suspects it may be due to a disorder that is causing a deficiency in apo A-I.
Apo A-I may be ordered along with apo B when a healthcare practitioner wants to check an apo B/apo A-I ratio as a CVD risk indicator, to evaluate the "bad" to "good" cholesterol.
Apo A-I may be ordered, along with other tests, when someone has undergone lipid-lowering treatment or lifestyle changes, such as decreased dietary fat and increased regular exercise, to monitor the effectiveness of the changes.
Low levels of apo A-I are usually associated with low levels of HDL and impaired clearance of excess cholesterol from the body. Low levels of apo A-I, along with high concentrations of apo B, are associated with an increased risk of cardiovascular disease. High levels of apo A-I is considered protective and can be independent of HDL levels.
There are some genetic disorders that lead to deficiencies in apo A-I (and therefore to low levels of HDL). People with these disorders tend to have abnormal lipid levels, including high levels of low-density lipoprotein (LDL – the "bad" cholesterol). Frequently, they have accelerated rates of atherosclerosis. These genetic disorders are primary causes of low apo A-I.
Changes in levels of apo A-I may also be associated with other factors. Some of the conditions that contribute to decreases or increases in apo A-I are listed below.
Apo A-I may decrease with:
Apo A-I may increase with:
The concentration of apo A-I reflects the amount of HDL in the serum. Since women tend to have higher HDL, they also have higher levels of apo A-I.
The apo A-I test is not routinely ordered. Healthcare practitioners still have to determine the best uses for the apo A-I and other tests for emerging cardiac risk markers (such as apo B, hs-CRP, and Lp(a)). They offer additional information in specific situations but are not meant to replace the lipid tests already routinely available.
Behaviors that tend to raise HDL also raise apo A-I. Regular exercise is one of the best ways to raise HDL and apo A-I. By decreasing the saturated fat in your diet, maintaining a healthy weight, and exercising, you can help decrease your risk of developing heart disease.
No, the apo A-I test requires specialized equipment and is not offered by every laboratory. Your blood may need to be sent to a reference laboratory for testing.
Sources Used in Current Review
2018 Review performed by Alan F. Weir, PhD, DABCC, FACB, Instructor, Fox Valley Technical College.
McPherson, Richard A and Pincus, Matthew R. (2017). Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd Edition: Elsevier, St Louis, MO. Pp 221-235.
Rifai, Nader, Horvath, Andrea Rita, and Wittwer Carl T. (2018). Teitz Textbook of Clinical Chemistry and Molecular Diagnostics, 6th Edition: Elsevier, St Louis, MO. Pp 539-554.
(8 Jul 2018) APOA1 apolipoprotein A1 [ Homo sapiens (human) ], Gene ID: 335 Available online at https://www.ncbi.nlm.nih.gov/gene/335. Accessed on 13 Jul 2018.
(2017 Sep 22) Milasan A, Jean G, Dallaire F, Tardif JC, Merhi Y, Sorci-Thomas M, Martel C. Apolipoprotein A-I Modulates Atherosclerosis Through Lymphatic Vessel-Dependent Mechanisms in Mice. J Am Heart Assoc. 6(9). Available online at https://www.ncbi.nlm.nih.gov/pubmed/28939717/. Accessed on 26 June 2018.
Test ID: APLA1 Apolipoprotein A1, Plasma. Available online at https://www.mayomedicallaboratories.com/test-catalog/Overview/80309. Accessed 26 June 2018.
(9 Mar 2011) Davidson, Michael H. Apolipoprotein A-I Therapy, Promises, Challenges and Disappointment. Journal of the American College of Cardiology, 57(9). Available online at http://www.onlinejacc.org/content/57/9/1120?_ga=2.246128391.243757801.1531140093-1338087802.1531140093. Accessed 26 June 2018.
(June 20, 2012) Corresponding Author: John Danesh, FRCP, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, England. Lipid-Related Markers and Cardiovascular Disease Prediction, The Emerging Risk Factors Collaboration. JAMA 307(23):2499-2506. Available online at https://jamanetwork.com/journals/jama/fullarticle/1187927. Accessed 3 Jul 2018.
(June 2000) Frank, Phillipe G., Marcel, Yves L. Apolipoprotein A-I: Structure-Function Relationships. Journal of Lipid Research 41: 853-872. Available online at http://www.jlr.org/content/41/6/853.full. Accessed 3 Jul 2018.
(May 2015) Wiggins, Susan. Natural Methods to Control Cholesterol. Life Extension Magazine Available online at http://www.lifeextension.com/Magazine/2015/5/Natural-Methods-To-Control-Cholesterol/Page-01. Accessed 3 Jul 2018.
(4 Feb 1998) Borhani, D.W., Rodgers, D.P., Englers, J.A., Brouillette, C.G. 1AV1 Crystal Structure of Human Apolipoprotein A-I. Research Collaboratory for Structural Bioinformatics, Protein DataBase. Available online at http://www.rcsb.org/structure/1AV1. Accessed on 5 Jul 2018.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
ARUP's Guide to Clinical Laboratory Testing (CLT). Apolipoprotein A-1 [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_al67.htm#1142700.
Theoretical Biophysics Group (2001 February 19, Modified). HDL and Apo A-1 Structure Prediction. NIH Resource for Macromolecular Modeling and Bioinformatics [On-line information]. Available online at http://www.ks.uiuc.edu/Research/apoa1/.
Hargrove, G.M., Junco, A., and Wong, N.C.W. (1999). Hormonal regulation of apolipoprotein AI. Journal of Molecular Endocrinology 22, 103-111 [On-line Journal]. PDF available for download at http://journals.endocrinology.org/jme/022/0103/0220103.pdf.
(2000 March). What Are Cholesterol, Other Lipids, And Lipoproteins? Northern Berkshire Health Systems, Health A to Z [Well-Connected Online report]. Available online at http://www.nbhealth.org/myhealthadviser/atoz/doc23.html.
Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO., Pp 110-114.
Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC. Winter, W. and Harris, N. Chapter 21: Lipoprotein Disorders, Pp 251-259.
O'Riordan, M. (2007 March 22). High Levels of Apolipoprotein A1 and HDL Associated With Reduced Risk of Recurrent VTE. Heartwire - a professional news service of WebMD [On-line information]. Available online at http://www.medscape.com/viewarticle/554016.
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL eds, (2005). Harrison's Principles of Internal Medicine, 16th Edition, McGraw Hill.
Benderly, M. et. al. (2009 February 16). Apolipoproteins and Long-Term Prognosis in Coronary Heart Disease Patients. Medscape from American Heart Journal. 2009;157(1):103-110 [On-line information]. Available online at http://www.medscape.com/viewarticle/585982. Accessed July 2010.
(© 1995–2010). Unit Code 80309: Apolipoprotein A1, Plasma. Mayo Clinic, Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/80309. Accessed July 2010.
Delgado, J. et. al. (Updated 2010 April). Cardiovascular Disease (Non-traditional Risk Markers) - Risk Markers - CVD (Non-traditional). ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/CVDRiskMarkerNontrad.html?client_ID=LTD#. Accessed July 2010.
O'Riordan, M. (2007 March 22). High Levels of Apolipoprotein A1 and HDL Associated With Reduced Risk of Recurrent VTE. Medscape Today [On-line information]. Available online at http://www.medscape.com/viewarticle/554016. Accessed July 2010.
Myers, G. Editor (2009). Emerging Biomarkers for Primary Prevention of Cardiovascular Disease and Stroke. The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines [On-line information]. PDF available for download at http://www.aacc.org/members/nacb/LMPG/OnlineGuide/PublishedGuidelines/risk/Documents/EmergingCV_RiskFactors09.pdf. Accessed July 2010.
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 110-114.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 142-145.
Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. Louis: Elsevier Saunders; 2006 Pp 916-917, 928-934.
Elhomsy, G and Griffing, G. (Updated 2012 August 31). Apolipoprotein A-I. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2087313-overview. Accessed March 2014.
Delgado, J. et. al. (Updated 2014 February). Cardiovascular Disease (Non-traditional Risk Markers) - Risk Markers - CVD (Non-traditional) ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/CVDRiskMarkerNontrad.html?client_ID=LTD. Accessed March 2014.
(© 1995–2014). Apolipoprotein A1, Plasma. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/80309. Accessed March 2014.
Lam, J. (Revised 2012 September) Atherosclerosis. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed March 2014.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 112-115.
Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 288-289.
McPherson, R. and Pincus, M. (© 2011). Henry's Clinical Diagnosis and Management by Laboratory Methods 22nd Edition: Elsevier Saunders, Philadelphia, PA. Pp 240.