From the Guidelines
The target level for Apolipoprotein B (Apo B) is generally less than 65 mg/dL for very high-risk individuals, less than 80 mg/dL for high-risk individuals, and less than 100 mg/dL for those at moderate risk. These targets are based on the most recent guidelines and evidence, including the 2019 ESC/EAS approach 1 and the 2022 ACC expert consensus decision pathway 1. The importance of Apo B lies in its direct measurement of the number of atherogenic particles in the bloodstream, making it a more accurate predictor of cardiovascular risk than LDL cholesterol alone, especially in patients with metabolic syndrome, diabetes, or hypertriglyceridemia 1. Key factors that influence the target Apo B levels include the presence of established cardiovascular disease, very high risk, high risk, or moderate risk, as well as other risk-enhancing factors such as family history of premature ASCVD, primary hypercholesterolemia, metabolic syndrome, chronic kidney disease, and elevated biomarkers like high-sensitivity C-reactive protein, lipoprotein(a), and apoB itself 1. To achieve these targets, a multifaceted approach is recommended, including:
- Lifestyle modifications: a heart-healthy diet, regular exercise, weight management, and smoking cessation.
- Medications: statins as the first-line therapy, with the potential addition of ezetimibe, PCSK9 inhibitors, or other nonstatin therapies like bempedoic acid, evinacumab, or inclisiran for those who do not achieve adequate LDL-C lowering with statins and ezetimibe alone 1. Regular monitoring of Apo B levels is crucial to assess treatment efficacy and adjust therapy as needed to minimize cardiovascular risk.
From the Research
Apolipoprotein B (Apo B) Target Levels
The target levels for Apolipoprotein B (Apo B) are as follows:
- For high-risk patients, the suggested target goal is < 90 mg/dL 2, 3
- For highest risk patients, the suggested target goal is < 80 mg/dL 2, 3
Importance of Apo B Measurement
Apo B measurement is important because it provides a direct measure of the number of circulating atherogenic lipoproteins, which is a better indicator of cardiovascular risk than LDL cholesterol alone 3, 4
- Apo B is superior to LDL cholesterol in recognizing those at increased risk of vascular disease and in judging the adequacy of lipid-lowering therapy 3
- Excess Apo B is associated with an increased risk of myocardial infarction, atherosclerotic cardiovascular disease, and all-cause mortality 4
Relationship between Apo B and Triglycerides
Triglycerides should not be used to restrict the measurement of Apo B, as cholesterol-depleted Apo B particles may be present at any level of triglyceride 5
- There is an inverse relationship between non-HDL-C/Apo B and triglycerides, such that elevated triglycerides are associated with the highest tertile of non-HDL-C/Apo B 5
- The range of values of Apo B for decisional levels of LDL-C and non-HDL-C is broad, making neither an adequate clinical surrogate for Apo B 5