Background
ApoB is a protein found in the outer shell of some lipoproteins, which transport cholesterol and triglycerides in the bloodstream.
Apolipoprotein B (ApoB) is a critical component of our cardiovascular health.
It plays a key role in lipid metabolism, facilitating the delivery of cholesterol to cells
Elevation in ApoB = hyperbetalipoproteinaemia.
Hyperbetalipoproteinaemia = elevation in LDL, IDL, VLDL, Lp(a)
High levels of ApoB indicate a higher number of atherogenic particles in the bloodstream, which can contribute to the formation of arterial plaques.
Essentially, ApoB is the sum total of all the atherogenic lipoproteins.
ApoB is measured widely in US and Europe, but not so much in Australia.
ApoB is a better marker of ASCVD risk than LDL and Cholesterol levels
Diagnosis
What is a normal ApoB level? And what is optimal?
Normal ApoB levels can vary but are generally considered to be under 90 mg/dL.
Optimal levels are typically lower, around 70 mg/dL or even lower for individuals at high risk of heart disease.
Peter Attia says: "I just don’t see a reason to have an ApoB ever north of 60 milligrams per deciliter.”
ApoB and Heart Disease
Elevated ApoB levels are strongly associated with an increased ASCVD risk
ApoB and Dementia / Neurocognitive decline
While research on this connection is ongoing, some studies suggest that elevated ApoB levels may be associated with a higher risk of dementia and cognitive decline.
What if my LDL-C and ApoB does not predict the same risk?
This is called discordance.
It is often seen in metabolic illness / insulin resistance and similar conditions
In the presence of discordance, PA relies on the ApoB
Management
How to Lower ApoB:
1. Diet
Reduce Carbs
Reduce saturated and trans fats
Increase consumption of omega-3 fatty acids found in fish
2. Exercise:
Regular physical activity can help improve lipid profiles.
Aim for at least 150 minutes of moderate-intensity exercise per week.
3. Medications:
Therapies which ultimately clear apolipoprotein B particles by upregulating low-density lipoprotein receptor (LDL-R) expression
Statins
Ezetimibe
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors
Bile acid sequestrants
Therapies which reduce apolipoprotein B independent of LDL-R
Cholesteryl ester transfer protein inhibitor
Fibrates
Niacin
Omega-3 fatty acids
4. Weight Management:
Maintaining a healthy weight can have a positive impact on ApoB levels.
Conclusion:
ApoB is a crucial marker for cardiovascular health, and understanding its levels and implications is vital.
ApoB is a better risk predictor than LDL-C
Get yours checked
Get yours down (at least into normal levels, if not below 60 milligrams per deciliter)
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