What does high Apolipoprotein B (Apo B) level mean?

From the Guidelines

A high Apolipoprotein B (Apo B) level, specifically above 130 mg/dL, indicates an increased risk of cardiovascular disease, as it reflects an elevated number of potentially harmful lipid particles in your bloodstream. Apo B is a protein found on the surface of atherogenic lipoproteins including LDL (bad cholesterol), VLDL, and lipoprotein(a), with each particle containing exactly one Apo B molecule. Therefore, your Apo B level provides a direct count of these potentially harmful particles, making it a more accurate predictor of cardiovascular risk than standard LDL cholesterol measurements alone 1.

Key Points to Consider

• Apo B levels are a strong predictor of cardiovascular risk, with levels above 130 mg/dL considered a risk-enhancing factor for atherosclerotic cardiovascular disease (ASCVD) 1.
• The measurement of Apo B is particularly useful when triglyceride levels are high, as it can provide a more accurate assessment of cardiovascular risk 1.
• Treatment for high Apo B typically includes lifestyle modifications such as adopting a heart-healthy diet low in saturated fats and refined carbohydrates, regular exercise, weight management, and smoking cessation.
• Medications may be necessary if lifestyle changes aren't sufficient, with statins being the first-line treatment, as they have been shown to effectively reduce Apo B levels and cardiovascular risk 1.

Management and Treatment

• The target Apo B level is generally below 80 mg/dL for high-risk individuals, though optimal goals may vary based on your overall cardiovascular risk profile.
• Statins, such as atorvastatin or rosuvastatin, are effective in reducing Apo B levels and should be considered as first-line therapy for individuals with high Apo B levels and elevated cardiovascular risk 1.
• Other options, such as ezetimibe, PCSK9 inhibitors, or bempedoic acid, may be considered for those who cannot tolerate statins or require additional lipid-lowering therapy.

From the Research

High Apolipoprotein B (Apo B) Level

A high Apolipoprotein B (Apo B) level is associated with an increased risk of cardiovascular disease. Here are some key points to consider:

• Apo B is a constituent of atherogenic lipoproteins and is considered a better predictor of cardiovascular events than LDL cholesterol 2
• Elevated levels of Apo B are associated with increased cardiac events, and the Apo B/apo A-I ratio is superior to conventional cholesterol ratios in evaluating lipoprotein-related risk of vascular disease 2, 3
• Apo B directly estimates the number of atherogenic particles in plasma, making it a preferred measurement for refining the estimate of ASCVD risk 4
• However, in patients with elevated lipoprotein(a) (Lp(a)), Apo B may considerably underestimate risk, as the atherogenicity of Lp(a) is approximately 7-fold greater than that of LDL on a per Apo B particle basis 4

Implications of High Apo B Levels

High Apo B levels have been linked to:

• Increased risk of coronary heart disease, aortic valve stenosis, and heart failure 5, 6
• Atherosclerotic cardiovascular disease (ASCVD) 4
• Peripheral arterial disease and carotid atherosclerosis, although the evidence is not as conclusive 5
• The Apo B/apo A-I ratio is a superior predictor of cardiovascular risk than LDL cholesterol or other cholesterol indices 3

Measurement and Guidance

• Apo B should be included in guidelines as an indicator of cardiovascular risk, and a target of <80 mg dL(-1) may be considered for high-risk patients 3
• The Apo B/apo A-I ratio is a useful tool for evaluating lipoprotein-related risk of vascular disease, especially in patients without symptomatic vascular disease or diabetes 3
• Risk-weighted Apo B, a novel metric that takes into account the atherogenicity of Lp(a), may provide a more accurate estimate of ASCVD risk 4