From the Guidelines
ApoA and apoB are crucial proteins that significantly impact cardiovascular health, and improving their ratio and levels naturally can be achieved through a Mediterranean-style diet, regular exercise, weight management, and avoiding smoking, as supported by the European Society of Cardiology guidelines 1. To improve cardiovascular health, it is essential to understand the role of apolipoprotein A (apoA) and apolipoprotein B (apoB) in the body. ApoA is found in HDL ("good") cholesterol and helps remove excess cholesterol from the body, while apoB is found in LDL ("bad") cholesterol and contributes to plaque buildup in arteries.
Key Lifestyle Changes
The following lifestyle changes can help improve the apoB/apoA ratio naturally:
- Focus on a Mediterranean-style diet rich in olive oil, fatty fish, nuts, fruits, vegetables, and whole grains
- Regular exercise, aiming for 150 minutes of moderate activity weekly
- Weight management
- Avoiding smoking Specific foods that can help include:
- Fatty fish (salmon, mackerel) 2-3 times weekly
- Daily servings of nuts and seeds
- Olive oil as the primary fat source
- Oats and barley for soluble fiber
- Plant sterols found in vegetables and fruits Limiting processed foods, refined carbohydrates, and trans fats is also essential, as supported by the American Heart Association 1.
Mechanism of Action
These lifestyle changes work by reducing inflammation, improving liver function (where these proteins are produced), and enhancing cholesterol transport and metabolism. The European guidelines on cardiovascular disease prevention in clinical practice also suggest that apoB can be substituted for LDL cholesterol in risk assessment, and that apoB levels should be <80 and <100 mg/dL for subjects with very high or high CVD risk, respectively 1.
Expected Outcomes
Most people see improvements in their apoB/apoA ratio within 3-6 months of consistent lifestyle changes, though individual results vary based on genetics and baseline health status. The esc/eas guidelines for the management of dyslipidaemias also recommend that clinicians exercise judgment when implementing lipid-lowering therapy, considering the potential side effects and the importance of lifestyle interventions in the long term 1.
From the Research
Clinical Significance of Apolipoprotein A and Apolipoprotein B
- Apolipoprotein B (apoB) and apolipoprotein A (apoA) play a crucial role in cardiovascular health, with elevated apoB and apoB/apoA-1 ratio increasing the risk of myocardial infarction (MI) and stroke, while high apoA-1 is protective 2.
- The apoB/apoA-1 ratio is a powerful and more accurate predictor of future cardiovascular disease risk than total cholesterol and HDL cholesterol 3, 4, 5.
- An imbalance between apoB and apoA-1 resulting in an increased apoB/apoA-1 ratio is strongly associated with major adverse cardiovascular events (MACEs) and its sub-components, in both men and women of all ages 2.
Factors Influencing Apolipoprotein Levels and Ratio
- Obesity, age, cigarette smoking, and alcohol intake are important determinants of apoB/apoA-1 and total cholesterol/HDL ratios 3.
- Alcohol intake is the only dietary factor that appreciably attenuates the association between obesity and each of the ratios, with a stronger attenuation in women 3.
- Other dietary intake and lifestyle-related factors such as smoking status and physical activity have a lower effect on this association 3.
Improving Apolipoprotein Levels and Ratio Naturally
- Reducing obesity and alcohol intake, and increasing physical activity may help improve apoB/apoA-1 ratio and reduce the risk of cardiovascular disease 3.
- A healthy diet and lifestyle can directly influence dyslipidemia and modify the association between obesity and apoB/apoA-1 ratio 3.
- Simple evidence-based cut values for apoB/apoA-1 ratio should be considered in future cardiovascular guidelines to promote early recognition and primary prevention of cardiovascular disease 2.
Comparison with Other Lipid Markers
- ApoB is a direct measure of circulating numbers of atherogenic lipoproteins, and its measurement can be standardized across laboratories worldwide 6.
- Non-HDL cholesterol includes the assessment of remnant lipoprotein cholesterol, an additional risk factor independent of LDL cholesterol, but apoB is the more accurate marker of cardiovascular risk 6.
- The apoB/apoA-1 ratio is superior to any of the cholesterol ratios in predicting coronary risk, especially in subjects with LDL-C levels <3.6 mmol/l 5.