What is Apolipoprotein B? Here's What Your ApoB Blood Test Means

Discover why ApoB is an essential indicator of heart health

Michelle Darian
By Michelle Darian
Korana Braun | Content Editor | InsideTracker
Edited by Korana Braun

Updated December 20, 2023.

a doctor taking blood from a woman's hand to test apolipoprotein B levels

Apolipoprotein B, commonly known as ApoB, is the main protein found in low-density lipoproteins (LDL).

Lipoproteins are round particles that transport fat and cholesterol throughout the body. Cholesterol must be transported throughout the body because it plays an essential role in producing many hormones that are important for cellular health and function.

Currently, LDL cholesterol is more frequently measured than ApoB levels because it’s included as part of a standard cholesterol test (lipid panel) for yearly physicals. While ApoB is not included in standard cholesterol tests, emerging research indicates that ApoB is an essential indicator of heart health and heart disease risk. [1] Here’s what you need to know about ApoB, the role of DNA on ApoB levels, and how to get your ApoB levels tested.

» Read more about lowering cholesterol naturally

    Key takeaways about ApoB

  • ApoB is the main structural protein found in low-density lipoproteins (LDL) and all potentially atherogenic lipoproteins, and it assists in transporting and clearing cholesterol from the blood.
  • ApoB is a direct measure of atherogenic particles, making it an essential indicator of heart health.
  • High ApoB levels indicate decreased clearance of cholesterol from the blood.
  • ApoB is highly influenced by genetics and is associated with heart disease, stroke, and overall lifespan.
  • ApoB is modifiable, meaning dietary changes and supplement intake can help improve your ApoB levels.


What is Apolipoprotein B?

ApoB is a structural protein, found on all potentially atherogenic (or plaque-forming) particles. [2] So an ApoB blood test is a direct measure of the concentration of all atherogenic particles, including LDL cholesterol as well as other cholesterol markers like:

  • Very low-density lipoproteins (VLDL)
  • Intermediate-density lipoproteins (IDL)
  • Chylomicrons
  • Apolipoprotein A

These particles can either harmlessly pass through arteries (cholesterol clearance) or become trapped in the arterial wall. When ApoB and cholesterol particles are trapped in the arterial wall, the deposits can build up as plaque and restrict blood flow, damaging the arteries and increasing the chances of blood clots. [2, 3]

Knowing your ApoB levels can help you and your healthcare provider further evaluate the status of your heart health and your potential risk for cardiovascular disease. [4]





What’s the reference range for an ApoB blood test?

Blood test results are often displayed against a reference range. Levels that fall outside of the reference range—say they’re too high or too low—should be addressed with your healthcare provider as they may indicate a health concern. Here’s what a normal Apolipoprotein B range is, and what normal and high levels mean for an ApoB blood test.

  • Normal ApoB levels (40-120 mg/dL) can indicate healthy cholesterol transport and clearance. ApoB levels towards the higher end of this range may begin to indicate suboptimal cholesterol clearance.
  • High ApoB levels (greater than 120 mg/dL) can indicate decreased cholesterol clearance from the blood and an increased risk for cardiovascular disease. Consult with your physician if your ApoB levels are above 120 mg/dL.

Can ApoB levels be too low?

Yes, ApoB levels can be too low. Currently, 40-50 mg/dL is cited to be the lower end of the reference range. [5] However, further research is required to establish a standard consensus for the lower end of the reference range.

Low levels of ApoB likely result from medical conditions or diseases in the body including hyperthyroidism, cirrhosis, or malnutrition. While other blood tests are used to detect or diagnose those conditions, always seek proper medical attention and speak with a physician if you have concerns about low ApoB levels. [6, 7, 8]

What does a high ApoB mean?

Because ApoB-tagged particles carry LDL cholesterol throughout the body, elevated ApoB levels can indicate that the body cannot clear excess LDL cholesterol from the blood. With decreased clearance, more ApoB particles get deposited into the arterial walls. When left unaddressed, elevated ApoB particles (mainly consisting of LDL cholesterol) can eventually increase plaque build-up, which narrows and constricts the arteries and increases the risk of heart disease. [3, 4]

Studies show that high ApoB levels are associated with an increased risk for atherosclerosis (plaque build-up in the arteries), which, when left untreated, increases the risk of heart disease. And because heart disease is the leading cause of death in the United States, addressing ApoB and making cardioprotective lifestyle modifications is critical to living healthier and longer. [2, 3]

What do ApoB levels mean in relation to LDL cholesterol levels?

Knowing your ApoB level provides additional insights when interpreting other cholesterol markers like triglycerides, high-density lipoprotein (commonly called the “good” cholesterol), LDL, and total cholesterol.

Because ApoB is found on all atherogenic particles, higher ApoB levels are often seen with elevated LDL cholesterol levels. That said, discordance between ApoB and LDL cholesterol levels is possible.

In the cases of optimal ApoB levels yet high LDL cholesterol levels, or the reverse (elevated ApoB levels and optimal LDL cholesterol levels), consider referencing your ApoB levels for a more complete look at what’s actually going on with your heart health. [9]

ApoB is considered a more accurate measure of heart disease risk because it is a direct measure. While an LDL cholesterol blood test is a calculation (based on total cholesterol, HDL cholesterol, and triglycerides), ApoB is a direct measure. Every potentially atherogenic particle carries one ApoB, so you’re getting a direct count of all the particles that could contribute to cardiovascular disease in your bloodstream. [10]



Do genetics influence ApoB levels?

Studies show that genetics contribute substantially to ApoB levels, as ApoB is a highly heritable trait. The ApoB trait is strongly associated with heart disease, stroke, and overall lifespan. Studies show that those who had the trait for an increased genetic risk of having elevated ApoB levels were more likely to develop heart disease. [11] InsideTracker’s genetic risk score looks at up to 16,907 genetic markers that can affect ApoB levels and compares your genetic risk level with your current blood ApoB levels.

When looking at InsideTracker’s own customer data on the genetic trait for ApoB, and the expression of the trait, an ApoB blood test, this association holds true. In fact, InsideTracker customers whose trait predicts that their ApoB level to be in the bottom 10% of risk, has an average ApoB level of 67 mg/dL, which is well within the optimal zone for ApoB levels. Conversely, those in the highest risk category had an average ApoB level of over 100 mg/dL, revealing an at-risk ApoB level.

While ApoB is highly influenced by genetics, what you eat and how you move largely influence what your blood levels of ApoB actually are. And it’s never too late to start—if blood levels of ApoB come back elevated, InsideTracker’s Action Plan delivers personalized recommendations aimed at improving levels.

How can you lower ApoB levels?

Like other cholesterol markers, ApoB levels are modifiable by lifestyle habits—meaning, nutrition, lifestyle, and supplement modifications can help improve high levels.

Here are a few of the most common science-backed ways to improve elevated ApoB levels:

  • Reduce foods high in saturated fat: Eating foods high in saturated fat is associated with elevated ApoB levels. Aim to reduce intake of red and processed meats to support ApoB levels. [12]
  • Opt for sources of unsaturated fats: Unsaturated fats, also known as “healthy fats” support optimal cholesterol and ApoB levels. Aim to incorporate unsaturated fats like olive oil, avocados, and flaxseed to support ApoB levels. [13, 14, 15]
  • Eat fiber-rich foods: Fiber is an important nutrient that contributes to optimal cholesterol levels and is critical in supporting ApoB levels. Oats and beans are two excellent food sources of soluble fiber—and research suggests that regular consumption of these foods is effective at lowering ApoB levels. [16, 17]
  • Try out a new supplement: Certain supplements can also benefit your ApoB levels. Studies show that taking a psyllium husk or plant sterol supplement can reduce elevated ApoB levels. Other supplements like artichoke extract and spirulina are also studied for their impact on ApoB. [18, 19] Always consult with a healthcare professional before adding a new supplement to your routine.

How long does it take ApoB levels to change?

The time it typically takes to see movement in your ApoB level will depend on multiple factors such as where your level currently is, your lifestyle habits, your willingness to adopt new habits, and your ability to stick to the habits you’ve formed. That said, the studies show that ApoB levels can be notably modified after approximately three months. [14, 19, 20]

How can you get your ApoB levels measured?

ApoB is currently not measured as part of standard cholesterol blood tests and many insurance companies don’t cover the test—especially for preventative screening. Depending on your healthcare provider, where you live, current cardiovascular risk factors, and your insurance, you may be able to get an ApoB test through your primary care provider.

Your personal health analytics dashboard

Since ApoB is a critical marker of health, a cardiovascular indicator, and can be impacted through lifestyle choices, InsideTracker has added this biomarker to the Ultimate Plan. [2, 4]

InsideTracker, your personal health analytics dashboard

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Brief overview

InsideTracker is a personalized health and wellness platform that aims to help people optimize their biomarkers to live healthier and longer lives. It analyzes genetics, behaviors, and goals to give you personalized nutrition, fitness, sleep, stress, and supplementation recommendations.

Why choose InsideTracker

InsideTracker offers DNA testing for dozens of genetic fitness, nutrition, and longevity genetic markers. Since genetics influence many aspects of your health, the app can provide helpful context and an action plan. It also integrates with wearable devices to collect real-time health data, tracking factors like sleep, activity, and heart rate.

Pros and cons

Science-backed recommendations

Comprehensive blood biomarker testing

DNA testing

Integration with wearables

Encourages retesting every 3 to 6 months

User-friendly interface

Personalized optimal zones

Customizable Action Plan

Not a replacement for medical care

DNA testing not available outside of the U.S.



InsideTracker’s science team has collected research on ApoB for over a year, and can now confidently say that the addition of this marker provides more context to other lipid markers and allows for a more comprehensive analysis of your heart health. The team established an optimal zone for ApoB levels within the reference range. Biomarkers that fall within a reference range don’t necessarily indicate optimal health, and according to the research, optimal heart health status is linked to ApoB levels less than 90 mg/dL.

If your levels are above optimal, you’ll also get science-backed recommendations to improve ApoB levels, which in turn support LDL cholesterol levels.




References:

[1] https://pubmed.ncbi.nlm.nih.gov/34773457/

[2] https://pubmed.ncbi.nlm.nih.gov/31642874/

[3] https://pubmed.ncbi.nlm.nih.gov/34677405/

[4] https://pubmed.ncbi.nlm.nih.gov/22760866/

[5] https://www.mountsinai.org/health-library/tests/apolipoprotein-b100

[6] https://pubmed.ncbi.nlm.nih.gov/9532235/

[7] https://pubmed.ncbi.nlm.nih.gov/12459887/

[8] https://pubmed.ncbi.nlm.nih.gov/8421075/

[9] https://pubmed.ncbi.nlm.nih.gov/20421882/

[10] https://pubmed.ncbi.nlm.nih.gov/36216435/

[11] https://pubmed.ncbi.nlm.nih.gov/34729547/

[12] https://pubmed.ncbi.nlm.nih.gov/31434580/

[13] https://pubmed.ncbi.nlm.nih.gov/26136585/

[14] https://pubmed.ncbi.nlm.nih.gov/1414966/

[15] https://pubmed.ncbi.nlm.nih.gov/17981439/

[16] https://pubmed.ncbi.nlm.nih.gov/1654739/

[17] https://pubmed.ncbi.nlm.nih.gov/34836152/

[18] https://pubmed.ncbi.nlm.nih.gov/14764424/

[19] https://pubmed.ncbi.nlm.nih.gov/20413122/

[20] https://pubmed.ncbi.nlm.nih.gov/14764424/