Apolipoprotein B (ApoB) plays a central role in lipid metabolism and maintaining cardiovascular health, making it an important biomarker to understand and potentially monitor. But what is ApoB, how it is measured, and what does it mean for heart health? Plus, how to support healthy ApoB levels. 

What is Apolipoprotein B? 

As you might suspect from its name, Apolipoprotein B is a protein. It’s also a structural component of low-density LDL “bad” cholesterol, very low-density lipoprotein (VLDL), and intermediate-density lipoprotein (IDL) — all of which are atherogenic, or involved in the production and buildup of artery-clogging plaques. 

ApoB helps these particles move cholesterol and triglycerides through your blood. So, if you have high levels of ApoB, this also indicates high amounts of unhealthy fats in circulation — and an increased risk of heart disease and stroke. 

This makes ApoB a key marker for assessing cardiovascular risk beyond traditional tests. ApoB can help predict your heart disease risk more accurately than standard lipid panels (total cholesterol, HDL, LDL, and triglycerides) among high-risk individuals. 

The National Lipid Association (NLA) Expert Clinical Consensus recommends measuring ApoB with standard lipid panels when assessing risk and managing lipid-lowering therapy.

LDLC vs ApoB

Both LDL cholesterol and ApoB are important markers to evaluate cardiovascular risk, but they measure different aspects of lipid metabolism. Here’s how they differ: 

• LDL-C: This is the amount of cholesterol carried by low-density lipoproteins in your blood, which is traditionally used to approximate the risk of atherosclerosis. LDL-C doesn’t account for the number of LDL particles, which can vary in size and cholesterol content. 
• ApoB: This marker provides a direct count of all atherogenic lipoproteins, including LDL, VLDL, and IDL, because each of these contains exactly one ApoB molecule. This makes ApoB a more accurate marker for evaluating the number of cholesterol-carrying particles that can contribute to arterial plaque, even when LDL-C appears normal. 

Understanding Your ApoB Levels

You likely receive bloodwork at your annual wellness exam that includes a basic cholesterol and blood lipid panel. While knowing these markers can be helpful, it’s important to understand your ApoB levels for a more accurate assessment of your cardiovascular risk. ApoB levels reflect the number of atherogenic lipoproteins in your blood. 

The target ApoB levels vary based on individual risk factors. For most people, an ApoB below 90 mg/dL is considered optimal, while those at higher cardiovascular risk (like if you have diabetes or existing heart disease) may aim for levels below 70 mg/dL. 

Lipoprotein(a), or Lp(a), is another important lipoprotein linked to heart health. Elevated Lp(a) levels are genetically determined and can independently increase cardiovascular risk, often in conjunction with high ApoB levels. Obtaining both your ApoB and Lp(a) provides a more comprehensive understanding of heart disease risk and can help inform the best treatment and prevention plan. 

ApoB Test

The ApoB test is performed like any routine blood draw, providing additional information that’s important for assessing cardiovascular disease risk. It can be added to your regular wellness labs by request but unfortunately isn’t covered by most insurance plans. 

ApoB testing is more often recommended for people living with conditions like insulin resistance, type 2 diabetes, high triglycerides, or metabolic syndrome. This is because these conditions are often associated with a higher number of small, dense LDL particles — which ApoB helps quantify more precisely than standard lipid panels.

What Causes High ApoB Levels?

High ApoB levels aren’t caused by one specific thing, but several potential factors can play a role. Consider how the following may affect you, as they are worth considering when making lifestyle changes to improve cardiovascular risk. 

Obesity

Obesity is associated with increased production of atherogenic lipoproteins, which can increase ApoB. Excess visceral fat (around the belly) contributes to inflammation and insulin resistance, raising the risk of high ApoB levels.

Metabolic syndrome

Metabolic syndrome is a cluster of conditions including high blood pressure, elevated blood sugar, and abnormal cholesterol levels, all of which can contribute to higher ApoB levels. These conditions promote the formation of small, dense LDL particles, which are more likely to cause arterial plaque buildup. Higher ApoB is also associated with a higher risk of metabolic syndrome.

Insulin resistance

Insulin resistance is associated with an increased production of triglyceride-rich lipoproteins, which contain ApoB. Over time, insulin resistance may also promote the formation of more LDL particles in the blood. 

Hypothyroidism

Hypothyroidism, or underactive thyroid, can slow metabolism and clearance of lipoproteins from the blood. This may lead to more ApoB-containing particles left over. Low thyroid hormone levels can also disrupt fat metabolism, resulting in higher cholesterol and ApoB levels.

Sleep deprivation

Chronic sleep deprivation can lead to insulin resistance, inflammation, and changes in lipid metabolism, all of which can increase ApoB. Not getting enough sleep can also disrupt hormones and may impact how well your liver can process and clear atherogenic particles. Experts recommend 7-8 hours of quality sleep per night for adults.

Coffee

Regularly drinking large amounts of coffee may be associated with higher ApoB levels. One study found a positive dose-dependent association, with the highest lipid levels seen among people reportedly drinking over 6 cups per day. Still, the effects were modest and the authors suggest it’s more relevant for people with elevated LDL. 

Interestingly, an old study from 1991 states that this association has nothing to do with caffeine content but something else in coffee. Overall, you probably don’t need to ditch coffee completely, but more research is needed. 

How to Decrease High ApoB Levels

Curious how to lower ApoB with diet and lifestyle? You’re in luck — research shows that the following heart-healthy habits can benefit lipid metabolism and may help decrease elevated ApoB levels. 

Resistance Training and Cardio

A combination of strength training and cardio exercise (like jogging, swimming, or biking) can help lower elevated ApoB by improving overall lipid metabolism and increasing your body’s removal of atherogenic lipoproteins. Regular physical activity improves insulin sensitivity and supports healthy weight management, further decreasing ApoB-containing particles. Aim for 150 minutes per week. 

Reducing Saturated Fat Intake

Replacing saturated fats (from foods like coconut oil, red meat, and full-fat dairy) with unsaturated fats in your diet helps lower ApoB by reducing the production of atherogenic lipoproteins. Unsaturated fats, found in foods like olive oil, nuts, seeds, and avocados, help reduce inflammation and support healthier blood fats.

Increase Fiber

Dietary fiber can lower elevated ApoB levels by improving cholesterol metabolism and reducing the absorption of dietary fats. Soluble fiber (from foods like oats and apples) helps bind to cholesterol in your digestive tract and excrete it from your body, and insoluble fiber (in legumes, berries, and nuts) helps bulk up your stool. 

Apolipoprotein B: The Bottom Line

If you have existing cardiovascular risk factors or are otherwise concerned about your heart health, speak with your healthcare provider about having your ApoB levels checked. 

It’s also important to work with a cardiovascular dietitian to understand your risk factors and create a personalized plan to lower them and improve your cardiovascular wellness. I’d love to help. Schedule a complimentary 15-minute discovery call with me. 

Sources

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