From the Guidelines
For high-risk patients, the target apolipoprotein B (apoB) level is generally less than 80 mg/dL, as recommended by the most recent guidelines 1.
Key Points to Consider
- The goal apoB levels for high-risk patients are based on the available evidence from studies such as the European guidelines on cardiovascular disease prevention in clinical practice 1.
- ApoB is considered a more accurate predictor of cardiovascular risk than LDL cholesterol because it represents the total number of atherogenic particles, with each apoB-containing lipoprotein having exactly one apoB molecule, providing a direct measure of the number of potentially harmful particles circulating in the bloodstream.
- To achieve these apoB targets, a combination of lifestyle modifications and lipid-lowering medications is typically necessary, with statins being the first-line therapy, and high-intensity options like atorvastatin 40-80 mg or rosuvastatin 20-40 mg being most effective.
- If statins alone are insufficient, adding ezetimibe 10 mg daily can further reduce apoB levels, and for patients still not at goal, PCSK9 inhibitors (evolocumab or alirocumab) may be added.
Additional Considerations
- The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol also provides recommendations for apoB levels, suggesting that elevated apoB levels ($130 mg/dL) denote high lifetime risk for ASCVD and favor initiation of statin therapy 1.
- The 2020 guidelines on the management of blood cholesterol in diabetes also support the use of apoB levels as a risk enhancer, with elevations $130 mg/dL indicating high risk 1.
Conclusion Not Provided as per Guidelines
Instead, the key points and additional considerations are summarized above, highlighting the importance of apoB levels in managing cardiovascular risk, particularly for high-risk patients. The target apoB level of less than 80 mg/dL is a key consideration in clinical practice, as supported by the most recent and highest quality evidence 1.
From the Research
ApoB Levels for High-Risk Patients
The goal apolipoprotein B (apoB) levels for high-risk patients are:
- < 90 mg/dL for high-risk patients 2, 3, 4
- < 80 mg/dL for highest risk patients, such as those with diabetes mellitus or metabolic syndrome 2, 4
- < 65 mg/dL for very high-risk targets in patients with LDL-C < 40 mg/dL 5
Factors Influencing ApoB Targets
Several factors can influence the attainment of apoB targets, including:
- Triglyceride levels: higher triglyceride levels are associated with higher proportions of individuals not meeting apoB targets 5
- LDL-C levels: apoB targets may be more difficult to achieve in patients with higher LDL-C levels 3, 5
- Statin therapy: intensive statin therapy can lower apoB to meet aggressive targets 2, 3
Clinical Utility of ApoB Measurement
ApoB measurement may be useful in assessing cardiovascular risk and guiding therapy, particularly in high-risk patients 2, 3, 4. However, the utility of apoB measurement in addition to LDL-C and non-HDL-C targets may be limited in patients who have already achieved these targets 6.