What is apolipoprotein B? The cholesterol test many people don’t know about

A person donating blood and a nurse holding blood collection tubes in a mobile blood donation center.

GoodRx reports that apolipoprotein B (ApoB) levels indicate heart disease risk, with high levels linked to heart attacks, emphasizing the importance of testing.

A person donating blood and a nurse holding blood collection tubes in a mobile blood donation center.

You probably know that high levels of low-density lipoprotein (LDL), or the “bad” cholesterol, can raise your risk for heart attack and stroke. But you may not have heard about apolipoprotein B (ApoB).

The usual numbers in your cholesterol test (lipid profile) may leave out this important measure of your risk for heart disease. Scientists and lipid specialists have known about the harms of high ApoB for years, but it’s getting more attention now. For people who are at risk for heart disease, it may be an important number to know.

In this article, GoodRx, a platform for medication savings, looks into ApoB, what causes its high levels, what you need to lower ApoB levels, and how to test for it.

Apolipoprotein B (ApoB) is a protein found on the surface of certain particles in your blood. You can think of these particles as tiny packages that carry cholesterol and fat. This is an important process that helps deliver energy to your muscles and other organs. But problems can happen when there are too many ApoB-containing particles in the blood.

ApoB is found on particles that can cause plaque to build up in your arteries. LDL cholesterol — the “bad” type of cholesterol — is one of these particles. Over time, plaque (atherosclerosis) can narrow your arteries and create blockages. These blockages are what cause heart attacks and strokes.

A high ApoB level means there are a lot of harmful cholesterol-carrying particles in your blood. In general, having more particles means you are at greater risk for heart attack and stroke.

A target (or “good”) ApoB level depends on your risk for heart disease. In general, many experts aim for:

A high ApoB level means something a little different from the usual measurement of LDL cholesterol. Your LDL cholesterol number tells you how much cholesterol is being carried inside the LDL particles. But it doesn’t tell you exactly how many particles are carrying that cholesterol. ApoB helps answer that question. It gives a better estimate of the total number of plaque-forming particles circulating in your blood.

Here are the main reasons that people have high ApoB levels:

There are a few medications — including certain older beta blockers, some thiazide diuretics, and some older HIV medicines — that may affect ApoB levels in some individuals. If you’re taking one of these and your ApoB is high, check with your healthcare professional to see if there might be an alternative.

Many of the same steps that lower LDL cholesterol can also lower ApoB. These include:

The medications that lower LDL cholesterol also improve ApoB. These include:

A few stronger specialty medications can also lower ApoB, including lomitapide (Juxtapid) and evinacumab (Evkeeza). These are usually used only for rare genetic cholesterol disorders, such as homozygous familial hypercholesterolemia. They aren’t used for most people with mildly or moderately high ApoB.

It’s likely that more medications that target ApoB will become available in the future.

Not everyone needs an ApoB test. For many people, the usual cholesterol panel gives enough information to guide care. But ApoB levels can be especially useful for people who have:

A healthcare professional can help you decide if an ApoB test might be useful for you.

Apolipoprotein B (ApoB) is measured with a blood test. It’s not part of the standard lipid profile, but it can often be ordered at the same time. You usually don’t need to fast before your ApoB is checked.

Is apolipoprotein B or LDL cholesterol a better measure of heart health?

There’s good evidence that high ApoB is more predictive of heart problems than LDL cholesterol. That may be especially true for people with Type 2 diabetes, high triglycerides, or metabolic syndrome. But an ApoB level reading doesn’t replace an LDL measure. Instead, it can add useful information beyond the standard cholesterol numbers.

ApoB levels can be affected by your genetics. For most people, it’s a combination of genes and lifestyle. That means that even if you have genetically high ApoB, there may be important lifestyle changes that you can make to lower your risk. These include eating a heart-healthy diet, doing regular exercise, and avoiding smoking.

A blood test for apolipoprotein B (ApoB) can show how many harmful cholesterol-carrying particles are in your blood. In some people, ApoB can reveal heart risk that a standard cholesterol panel may miss. This is especially true for people with high triglycerides, Type 2 diabetes, metabolic syndrome, or a family history of heart disease.

The good news is that medications that lower LDL or “bad” cholesterol can also help lower ApoB. Lifestyle habits like following a Mediterranean-style diet, doing regular exercise, maintaining a healthy weight, and not smoking can also help. A healthcare professional can help you decide whether ApoB testing is right for you.

This story was produced by GoodRx and reviewed and distributed by Stacker.

Originally published on goodrx.com, part of the BLOX Digital Content Exchange.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language. PLEASE TURN OFF YOUR CAPS LOCK. Don't Threaten. Threats of harming another person will not be tolerated. Be Truthful. Don't knowingly lie about anyone or anything. Be Nice. No racism, sexism or any sort of -ism that is degrading to another person. Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts. Share with Us. We'd love to hear eyewitness accounts, the history behind an article.

Click Below To Read The Latest e-Edition!

Success! An email has been sent to with a link to confirm list signup.

Error! There was an error processing your request.

Would you like to receive a link to the Laconia Daily Sun online eEdition and preview the top stories? Now includes Court & Cops on Mondays!

Sorry, there are no recent results for popular commented articles.

Get up-to-the-minute news sent straight to your device.