ApoB Target for a 65-Year-Old
The ApoB target for a 65-year-old depends on their cardiovascular risk category: <80 mg/dL for very high-risk patients and <100 mg/dL for high-risk patients. 1, 2
Risk Stratification is Essential
The first step is determining the patient's cardiovascular risk category, as this directly dictates the ApoB target 1:
Very High-Risk Category (ApoB target <80 mg/dL)
Patients fall into this category if they have any of the following 1:
- Established cardiovascular disease (prior MI, stroke, ACS, coronary/peripheral artery disease) 1
- Type 2 diabetes with CVD or chronic kidney disease 1
- Type 2 diabetes in patients >40 years with additional CVD risk factors or target organ damage 1
- Stage 3-5 chronic kidney disease (eGFR 15-59 mL/min/1.73 m²) 1
High-Risk Category (ApoB target <100 mg/dL)
Patients fall into this category if they have 1:
- Type 2 diabetes without additional risk factors or target organ damage 1
- Calculated 10-year ASCVD risk ≥7.5-10% (depending on guideline used) 1
- Multiple cardiovascular risk factors without established disease 1
Corresponding LDL-C Targets for Context
The European Society of Cardiology guidelines establish these ApoB targets as secondary goals alongside primary LDL-C targets 1:
- Very high-risk patients: LDL-C <70 mg/dL (1.8 mmol/L) corresponds to ApoB <80 mg/dL 1
- High-risk patients: LDL-C <100 mg/dL (2.6 mmol/L) corresponds to ApoB <100 mg/dL 1
Why ApoB Matters More at Age 65
ApoB measurement becomes particularly valuable in older adults because it captures total atherogenic particle burden more accurately than LDL-C alone 2, 3:
- ApoB ≥130 mg/dL constitutes a risk-enhancing factor corresponding to LDL-C ≥160 mg/dL 1, 2
- ApoB is superior when triglycerides are elevated (≥200 mg/dL), a common scenario in older adults 1, 2, 3
- During statin therapy, achieving ApoB <90 mg/dL requires more aggressive LDL-C lowering (to <70-80 mg/dL) than previously recognized 4
Common Pitfalls to Avoid
Do not assume all 65-year-olds have the same target 1. A healthy 65-year-old with no risk factors has a different target than one with diabetes or prior MI. The 30 mg/dL difference between high-risk and very high-risk targets is clinically significant and affects treatment intensity 1.
Do not rely solely on LDL-C in patients with metabolic syndrome, diabetes, or triglycerides >175 mg/dL 2, 3. These patients often have discordantly high ApoB relative to LDL-C, meaning their particle number (and true risk) exceeds what LDL-C suggests 3.
Recognize that most 65-year-olds will qualify as at least high-risk given age alone plus typical accumulation of risk factors 1. Age ≥65 years in men is itself a major risk factor, and the presence of hypertension, family history, or metabolic syndrome would elevate them to very high-risk status 1.