Other names: Apo B, Apolipoproteins B, Apolipoprotein B (APOB)
Apolipoprotein B (ApoB) is a key structural protein found in lipoproteins that carry cholesterol and triglycerides through your bloodstream. Each atherogenic (artery-clogging) particle—such as LDL (Low-Density Lipoprotein), VLDL (Very Low-Density Lipoprotein), IDL (Intermediate-Density Lipoprotein), and Lipoprotein(a)—contains one molecule of ApoB. That means ApoB gives a direct count of the number of atherogenic particles in your blood, which is more clinically relevant than just measuring the amount of cholesterol.
While traditional cholesterol tests like LDL-C (LDL cholesterol) estimate the cholesterol content within LDL particles, ApoB actually counts the number of particles, regardless of how much cholesterol each one contains. This matters because it’s the number of ApoB-containing particles that drives plaque buildup in arteries (atherosclerosis)—not just the amount of cholesterol inside them.
Studies consistently show that ApoB is a stronger predictor of cardiovascular risk than LDL-C. Elevated ApoB levels are linked to:
Heart disease
Stroke
Peripheral artery disease
Insulin resistance and metabolic syndrome
An ApoB test measures the concentration of apolipoprotein B in your blood, typically reported in mg/dL. It reflects the total number of atherogenic particles, including LDL, VLDL, IDL, and Lp(a).
Optimal: < 90 mg/dL
Borderline: 90–99 mg/dL
Elevated: ≥ 100 mg/dL
Some cardiology guidelines define high-risk thresholds even lower for individuals with known heart disease, diabetes, or familial hypercholesterolemia.
An elevated ApoB level means there are too many cholesterol-carrying particles circulating in your blood, increasing the likelihood that they will penetrate artery walls, become oxidized, and trigger inflammation. This process leads to plaque buildup, narrowing arteries, and raising the risk of heart attacks or strokes.
High ApoB can be due to:
Diet high in saturated fats and refined carbs
Insulin resistance or type 2 diabetes
Genetic lipid disorders (e.g., familial hypercholesterolemia)
Obesity or metabolic syndrome
Sedentary lifestyle
Poor thyroid function (hypothyroidism)
A low ApoB level is generally considered favorable and associated with lower cardiovascular risk. However, extremely low levels can occur in rare genetic disorders (e.g., abetalipoproteinemia) or in cases of severe liver disease or malnutrition.
LDL-C measures cholesterol content—which can vary from particle to particle.
ApoB counts each atherogenic particle, giving a more accurate picture of risk.
In people with small, dense LDL particles, LDL-C may appear normal while ApoB is high—masking hidden cardiovascular risk.
Guidelines from the American College of Cardiology (ACC) and European Society of Cardiology (ESC) increasingly recommend ApoB for advanced risk assessment, especially in people with:
Diabetes
Obesity
Metabolic syndrome
Borderline cholesterol profiles
ApoB testing is useful for:
People at intermediate or high risk of cardiovascular disease
Those with normal LDL-C but a family history of heart disease
Patients with metabolic syndrome or diabetes
Anyone with persistently high triglycerides
Individuals undergoing cholesterol-lowering treatment to assess response beyond traditional markers
Lifestyle and medications that lower ApoB levels also reduce your cardiovascular risk:
Reduce saturated fat and trans fat intake
Increase soluble fiber (from oats, legumes, fruits)
Incorporate plant sterols and stanols
Exercise regularly (aerobic + resistance training)
Lose excess body weight
Limit refined carbohydrates and sugar
Statins (lower both LDL-C and ApoB)
Ezetimibe
PCSK9 inhibitors
Bempedoic acid
Niacin (less commonly used)
Fibrates (especially in high triglyceride cases)
Always discuss treatment options with your healthcare provider before making changes.
ApoB is a powerful biomarker for assessing cardiovascular risk.
It reflects the number of atherogenic lipoproteins, not just cholesterol levels.
Higher ApoB = more particles = greater atherosclerosis risk.
It’s especially useful for people with normal LDL-C but elevated risk due to metabolic or genetic factors.
ApoB can guide personalized prevention and treatment strategies.
| ApoB Level (mg/dL) | Classification |
|---|---|
| < 90 | Desirable |
| 90 – 99 | Borderline High |
| 100 – 130 | High |
| > 130 | Very High |
| ASCVD Risk Category | Recommended ApoB Target (mg/dL) |
|---|---|
| Extreme Risk | < 70 |
| Very High Risk | < 80 |
| High Risk | < 90 |
| Moderate Risk | < 90 |
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Apolipoprotein B (ApoB) is a key structural protein found in all atherogenic lipoproteins—such as LDL, VLDL, IDL, and Lipoprotein(a)—which transport cholesterol and triglycerides through your bloodstream. Each of these particles contains exactly one ApoB molecule, making ApoB a direct count of the number of harmful lipoprotein particles in circulation.
Unlike traditional cholesterol tests that measure how much cholesterol is being carried, ApoB tells you how many particles are carrying it—which is more predictive of atherosclerosis and cardiovascular events.
An elevated ApoB level means you have too many atherogenic lipoproteins in your blood. These particles are small enough to infiltrate the walls of your arteries, triggering inflammation, forming plaque, and increasing your risk of heart disease, stroke, and other cardiovascular conditions.
Research consistently shows that ApoB is a stronger predictor of cardiovascular risk than LDL-C (low-density lipoprotein cholesterol), especially in people with:
Insulin resistance or type 2 diabetes
Obesity or metabolic syndrome
Normal LDL-C but high particle number
A family history of premature heart disease
| ApoB Level (mg/dL) | Classification |
|---|---|
| < 90 | Desirable |
| 90 – 99 | Borderline High |
| 100 – 130 | High |
| > 130 | Very High |
| ASCVD Risk Category | Recommended ApoB Target (mg/dL) |
|---|---|
| Extreme Risk | < 70 |
| Very High Risk | < 80 |
| High or Moderate Risk | < 90 |
ApoB can be elevated due to a combination of lifestyle, metabolic, genetic, and medical factors, including:
| Cause | How It Contributes |
|---|---|
| High intake of saturated fat and refined carbs | Increases VLDL and LDL production |
| Insulin resistance / Type 2 diabetes | Promotes small, dense LDL particles |
| Obesity or metabolic syndrome | Disrupts lipid metabolism |
| Familial hypercholesterolemia | Genetic defect in LDL clearance |
| Hypothyroidism | Slows LDL receptor activity |
| Chronic kidney disease | Alters lipid profiles |
| Sedentary lifestyle | Increases triglyceride-rich lipoproteins |
Some medical conditions and medications can temporarily or persistently increase ApoB levels:
| Secondary Cause | Mechanism |
|---|---|
| Diabetes | Increases production of atherogenic lipoproteins |
| Pregnancy | Temporarily elevates ApoB due to hormonal shifts |
| Nephrotic syndrome | Causes lipid abnormalities and high ApoB |
| Medications | Includes androgens, beta blockers, thiazide diuretics, and progestins |
| Hypothyroidism | Reduces clearance of ApoB-containing lipoproteins |
If you're pregnant or taking any of these medications, elevated ApoB may be temporary. Discuss with your healthcare provider for personalized assessment.
Elevated ApoB levels are directly linked to a greater risk of cardiovascular disease, including:
Coronary artery disease (CAD)
Heart attack (myocardial infarction)
Ischemic stroke
Peripheral artery disease
Atherosclerosis progression
Because ApoB reflects the actual number of atherogenic particles, it provides a clearer picture of risk even when cholesterol levels appear normal.
Making targeted lifestyle adjustments can significantly reduce ApoB:
Reduce saturated fat and dietary cholesterol
Limit red meat, full-fat dairy, processed snacks, and fried foods.
Increase fiber and whole plant foods
Focus on legumes, fruits, vegetables, oats, and nuts to improve lipid profiles.
Limit refined carbohydrates and sugars
These promote small, dense LDL particles and increase ApoB.
Engage in regular physical activity
Exercise improves lipid metabolism, lowers triglycerides, and reduces ApoB.
Lose excess body weight
Especially abdominal fat, which drives insulin resistance and lipoprotein overproduction.
Your healthcare provider may recommend medications based on your ApoB level and overall cardiovascular risk:
Statins – First-line treatment to reduce LDL particle number and ApoB
PCSK9 inhibitors – Powerful injectable therapies for high-risk patients
Ezetimibe – Reduces cholesterol absorption in the gut
Fibrates or niacin – May be used in specific cases, especially when triglycerides are elevated
Always consult your healthcare provider before starting or changing any treatment.
High ApoB = high number of artery-clogging particles.
It’s a powerful and reliable predictor of cardiovascular risk—more so than LDL-C alone.
Elevated ApoB is often modifiable through lifestyle changes and medical therapy.
If your ApoB is high, it’s a signal to take proactive steps toward improving your heart health.
Anthony
Unlimited Plan Member since 2021
I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
Low ApoB levels are generally considered favorable and are associated with a lower risk of atherosclerosis and cardiovascular disease. However, very low or abnormally decreased ApoB levels may sometimes indicate underlying health conditions or genetic disorders.
| Cause | Explanation |
|---|---|
| Effective lipid-lowering therapy | Medications like statins, PCSK9 inhibitors, or lifestyle interventions can significantly reduce ApoB levels—this is typically intentional and beneficial. |
| Malnutrition or severe weight loss | Inadequate intake of fats and calories can reduce lipoprotein synthesis. |
| Liver dysfunction | The liver produces ApoB-containing lipoproteins. Advanced liver disease (e.g., cirrhosis, hepatitis) may impair this process. |
| Hypobetalipoproteinemia | A rare genetic disorder in which the body produces abnormally low levels of ApoB, leading to extremely low LDL and total cholesterol. |
| Abetalipoproteinemia | A very rare inherited condition where ApoB production is almost completely absent, causing fat malabsorption and neurological problems. |
| Hyperthyroidism | Overactive thyroid function can reduce ApoB levels due to increased clearance of lipoproteins. |
Mildly low ApoB in the context of heart-healthy efforts (diet, exercise, medications) is not a concern and usually indicates good cardiovascular health.
Extremely low ApoB (< 40 mg/dL), especially when not due to treatment, may warrant further investigation for malabsorption, liver disease, or rare genetic disorders.
Low ApoB is usually good, especially if achieved through lifestyle or treatment.
Exceptionally low levels, particularly with symptoms like fatigue, neurological changes, or digestive issues, may require clinical follow-up.
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I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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