Heart disease is the leading cause of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). And testing your total cholesterol, HDL (high-density lipoprotein), and LDL (low-density lipoprotein) has been a tried-and-true way to stay on top of your cardiovascular health. The goal is to have low levels of LDL (the bad kind of cholesterol) and higher levels of HDL (the good kind) to prevent heart disease. But now, health experts are zeroing in on one even more specific heart-related biomarker: ApoB.
It turns out that ApoB (apolipoprotein B) can give you even better insights into the health of your cardiovascular system (aka your heart and blood vessels). “ApoB is a necessary, though not sufficient, factor in the development of ASCVD [atherosclerotic cardiovascular disease], which means the more you lower it, the more you lower risk. Full stop,” says Peter Attia, MD.
Here's everything you need to know about ApoB, as well as how to get it tested and how to improve your levels.
What Is ApoB, and Why Does It Matter?
When talking about ApoB, one may be referring to either the gene or the lipoprotein that results from the gene — but odds are, they're talking about the latter. (FYI, a lipoprotein is a protein that carries fats and cholesterol through the bloodstream.) The ApoB gene helps create two versions of the apolipoprotein B protein:
Apolipoprotein B-48: the short version that's produced only in the gut. It's the building block of another lipoprotein called chylomicron, which moves the cholesterol and fats you get from food from your gut and into your blood, as well as helps your body absorb the fat-soluble vitamins A, D, E, and K.
Apolipoprotein B-100: the longer version that's produced only in the liver. It's the building block of LDL and very low-density lipoproteins (VLDLs), which carry cholesterol around in the blood. More specifically, ApoB-100 is the reason why LDLs can enter your cell and release cholesterol.
So here's the kicker: If you have high levels of ApoB, you probably have high levels of LDL as well, which signifies a higher risk of heart disease, according to the National Library of Medicine. Too much LDL in the bloodstream can lead to cholesterol getting stuck in the artery walls, which is what creates plaques and raises your risk of heart disease.
That's why it's so important to get your levels checked regularly, and it's even more essential for those with a family history of high cholesterol and/or heart disease. Post-menopausal women should also get tested regularly because estradiol is a cardioprotective hormone that depletes after menopause, says Dr. Vinita Tandon, Lifeforce’s Medical Director.
“We often don’t act on things until it's too late, after a heart attack or mini-stroke, but you can be proactive and mitigate these risks,” Dr. Tandon says. “These data points are knowledge that you can act on to move the dial to reduce your risk of premature death, and live a long and healthy life.”
How Is ApoB Measured?
ApoB is measured via a blood test, just like a regular lipid panel (cholesterol test).
Knowing your ApoB helps both you and your doctor figure out how proactive you should be about making lifestyle changes to help improve your heart disease risk. In fact, an ApoB test might even give a more accurate representation of your potential cardiovascular risk than a traditional lipid panel, according to an August 2022 Circulation report.
If you're on a statin (cholesterol-lowering medication), getting an ApoB test can also help you determine how the statin is affecting your lipid levels. And if you have metabolic syndrome or diabetes, the LDL particles in your blood may be denser or smaller leading to low LDL measurements, notes Dr. Tandon. So testing for ApoB might even help better predict your risk of heart disease than a regular cholesterol test (which only tests for LDL), per the Cleveland Clinic.
What Should Your ApoB Levels Be?
After your ApoB test, you'll get your results. Normal levels of ApoB in adults are less than 100 milligrams per deciliter (mg/dL), but optimal levels are less than 90 mg/dL.
Anything over 110 mg/dL means you have a higher risk of cardiovascular disease and should take measures to improve your levels.
You want your levels to be in the optimal range. Here's why: “Most blood tests are checked against ‘normal’ levels based on the average of the people who go to that lab,” says Kerri Masutto, MD, a board-certified functional medicine expert and former Lifeforce VP of Clinical Operations. “These ranges are typically focused on highlighting serious health conditions, not on helping people understand how their levels compare to what’s optimal for performance.”
How Can You Improve Your ApoB Levels?
You can lower your ApoB levels in the same way you'd approach lowering your bad cholesterol overall — and that's via a healthy mix of good nutrition and exercise.
In a nutshell, “Focus on reducing your total caloric intake, as well as cutting down on saturated fats, processed foods, refined grains, and concentrated sugars, whether that’s in pasta, bread, sauces, baked goods, or high fructose corn syrup,” recommends Lifeforce Physician Cono Badalamenti, MD, MHSA.
Here's how you can help lower your ApoB levels if they're borderline high or above 110 mg/dL:
Limit refined carbohydrates, including added sugar, which is found in processed foods such as white bread, white pasta, pastries, soda, among others.
Eliminate trans fats, which are mostly found in fried foods and restaurant dishes.
Reduce your intake of saturated fat, which is mainly found in fatty cuts of meat, full-fat dairy products, and certain plant oils including coconut and palm oil.
Eat foods high in omega-3 fatty acids, such as wild-caught salmon, mackerel, herring, chia seeds, and flaxseed oil. If you find it difficult to incorporate these foods into your meal plan regularly, a quality omega-3 supplement can also help.
Eat more foods rich in soluble fiber, such as whole grains, beans, fruits, and dark, leafy greens. Soluble fiber can help reduce the amount of cholesterol absorbed into your bloodstream.
Make exercise part of your weekly routine. Working out helps remove bad LDL cholesterol in your blood by raising the levels of good HDL cholesterol. The American Heart Association recommends 150 minutes of moderate-intensity aerobic activity per week or 75 minutes of vigorous aerobic activity per week.
The first step to improving your ApoB levels and lowering your risk of heart disease is getting your levels checked.
ApoB testing isn't so common at many doctor offices, but it is prioritized in your Lifeforce Diagnostic, an at-home blood test that measures ApoB in addition to more than 40 other vital biomarkers for a clearer picture of your total health and key risk factors. After taking your Lifeforce blood test, you'll get a detailed lab report and schedule a virtual meeting with your Lifeforce Physician to go over your results and create a personalized plan together to help get your ApoB into the optimal range.
Ready to optimize your heart health? Sign up for the Lifeforce Diagnostic here to get started.
This article was medically reviewed by Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism.