Health markers

What is ApoB? Learn why it’s the future of heart disease prevention

According to new research Apolipoprotein B might be a better way to measure your cholesterol.

There’s a new biomarker on the block, and its name is ApoB. Although traditional cholesterol tests like LDL have long been considered the gold standard for determining heart disease risk, recent research has shown that ApoB is a more accurate marker for cardiovascular health. Read our article to learn all about the new biomarker we'll soon be testing at Aware and reasons you may want to schedule a blood draw. 

Here are the key points we cover:

  • ApoB is the major protein attached to the “bad” cholesterol in your body, and health researchers now consider it the best predictor for heart problems later on. 
  • People at risk for heart disease are recommended to test their ApoB levels, but anyone can check this marker to get a more accurate picture of their heart health and chronic disease risk.
  • Leading a healthy lifestyle with balanced nutrition and regular exercise, and limiting coffee and alcohol, can help bring down high ApoB levels and protect your heart over the long term.

What is ApoB?

ApoB, short for apolipoprotein B-100, is a protein that helps carry cholesterol and other compounds around your body via your blood. Cholesterol is a type of fat your body needs to function and produce cells and hormones. It gets a pretty bad rap, but cholesterol is not all bad – there is both “good” and “bad” cholesterol. 

ApoB is the main protein in LDL cholesterol and other lipid carriers that are known to be harmful to the vessels and heart. LDL, or low-density lipoprotein particles, is known as the “bad kind” of cholesterol because it can clog the arteries and lead to heart attacks and strokes. 

Why ApoB is important – especially for prevention

When you test ApoB, your healthcare provider can learn exactly how much bad cholesterol you have in your body. You may wonder, why not just check LDL cholesterol? Well, the LDL test shows the total concentration of cholesterol contained in these particles rather than the particle number. And it’s the particle number that matters for heart disease risk, which you can find out with an ApoB test. Thus, by getting your ApoB levels checked, you’ll have a more precise assessment of how many  potentially damaging lipid particles are in your body, and your healthcare provider can determine your likelihood of developing heart problems later in life.

What’s more, a meta-analysis from 2011 and review from 2021 concluded that ApoB levels are the strongest predictor of heart disease. And the 2019 European Society of Cardiology and European Atherosclerosis Society Guidelines state that ApoB is a more accurate measure of cardiovascular risk than LDL cholesterol and non-HDL cholesterol. This is important, as heart disease is the leading cause of death worldwide today according to the World Health Organization, responsible for 16% of deaths across the globe. So, knowing your risk early on can help you take vital steps to protect your health. 

But that’s not all this marker can tell you about your well-being. Research shows that ApoB levels may also indicate the risk of developing other chronic conditions such as diabetes, insulin resistance, cancer, and Alzheimer’s. All the more reason to test ApoB to help you keep your health on track for years to come.

Who should test ApoB?

ApoB is a great marker to test for anyone looking to get a complete picture of heart health. It also provides additional insights when interpreting the results of other cholesterol tests. 

Certain groups of people would benefit from an ApoB test, including:

  • People with a family history of heart issues
  • People who have had heart problems in the past (like a heart attack)
  • People who have high cholesterol and triglycerides (another type of fat in the blood)
  • People who are receiving treatment to reduce cholesterol levels
  • People who want to gauge long-term heart health and chronic disease risk for preventive purposes

You may also consider testing ApoB if you have high blood pressure, diabetes, obesity, or if you smoke, as these can increase the chance of developing heart problems later on. 

Understanding your results

Test results that show higher-than-normal levels of ApoB may indicate an above-average risk of getting heart disease. On the other hand, if ApoB is too low, it can signal certain medical conditions, including advanced chronic liver disease, hyperthyroidism, and some genetic disorders. 

Guidelines published by the American College of Cardiology and the American Heart Association in 2019 state that ApoB levels of 130 milligrams per deciliter (mg/dL) or higher can raise the risk for heart disease. If you already have a higher chance of developing heart problems, the American Diabetes Association and the American College of Cardiology Foundation recommend aiming for less than 90 mg/dL. 

It’s important to note that levels of ApoB might differ depending on your sex, health background, age, and where you had your blood test. A healthcare professional should interpret your results in combination with other data about your health.

Furthermore, keep in mind that several factors can affect the results of the ApoB test, such as:

  • Nutrition (particularly high-fat diets) 
  • Some medications
  • Chronic health conditions (diabetes, insulin resistance, hypothyroidism, and kidney disease)
  • Pregnancy 
  • Menopause

What other tests exist to measure cholesterol?

Besides ApoB, you can check your cholesterol levels with a lipid profile test, which measures the following markers:

  • LDL: High LDL cholesterol levels can cause plaque to accumulate in your arteries and increase the chance of heart disease or stroke. 
  • HDL: High HDL cholesterol levels decrease heart disease and stroke risk. 
  • Triglycerides: High triglycerides, low HDL and/or high LDL contribute to heart problems. 
  • Total cholesterol: All cholesterol in your blood, including the numbers mentioned above . 

The combination of these tests and ApoB will give you a full picture of your heart health.

Soon you will be able to test ApoB and in addition to your regular lipid profile with Aware at our new lab in Berlin. Inside the Aware app, you’ll get helpful tips on improving any biomarkers out of range and boosting your overall health.

The U.S. Centers for Disease Control and Prevention recommends that most healthy adults check their cholesterol every 4-6 years. People with high cholesterol or risk factors for heart problems should be tested more often. 

6 tips to lower bad cholesterol and boost your heart health

If tests reveal that you have high cholesterol, you should first meet with your doctor to figure out why. Beyond that, the good news is that there are many ways to lower bad cholesterol and increase good cholesterol to protect your heart health. 

1. Eat foods that lower cholesterol

Cutting down on sugary, fried foods and saturated fats can work wonders for your cholesterol levels – and your heart will thank you for it. 

Evidence shows that following the Mediterranean diet, which is high in olive oil (a great source of healthy fat), leafy green vegetables, legumes, nuts, and fruits, with moderate amounts of oily fish, meat, and dairy, is a great way to reduce high ApoB levels and heart disease risk. 

A 4-week study from 2012 published in the British Journal of Nutrition involving 70 male and female participants found that eating a Mediterranean diet lowered LDL cholesterol by 10% in men and 7% in women, and ApoB decreased by 10% in men and 9% in women. It also had a positive effect on total cholesterol and blood pressure. A further study involving 551 people at high risk for heart problems found that eating the Mediterranean diet over 3 months had a better effect on ApoB levels and cardiovascular health than a low-fat diet. 

2. Exercise regularly

Exercising a few times per week is one of the best things you can do to lower your cholesterol. Working out improves cholesterol levels by eliminating LDL cholesterol and boosting HDL cholesterol. According to the Cleveland Clinic, aerobic exercises that work multiple muscle groups are the best form of activity to decrease cholesterol. Aerobic exercises include brisk walking, cycling, swimming, and yoga.

Research from 2013 in the Endocrinology Nutrition journal involving over 100 generally healthy people shows that people who exercised between 30 minutes to one hour 5 days each week had significantly better triglyceride, HDL, and ApoB levels than the group who didn’t work out at all. People who are overweight can bring down cholesterol levels through nutrition and exercise to get to a healthy weight. 

3. Sleep well

Don’t skimp out on your sleep. Not getting enough Zzz’s on the regular can cost you big time, as sleep deficiency is associated with a wide range of chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, and depression. The Centers for Disease Control and Prevention recommend all adults get at least 7 hours of sleep per night. 

Research published in the Nutrition and Metabolism journal in 2018 using data from 7381 people between the ages of 18 and 75 discovered that sleeping 6 hours or less significantly increases the chance of elevated ApoB levels in women. 

4. Keep coffee consumption to 2-3 cups per day

If you’re a coffee addict, you may want to limit your daily cups of Joe to 2, or 3 max. Evidence shows that drinking more than that increases ApoB, LDL cholesterol, and total cholesterol levels. 

In case 3 cups max per day just won’t cut it for you, you can turn to green tea for your caffeine fill: a 2020 systematic review and meta-analysis of 31 randomized controlled trials, including over 3,300 participants, found that green tea intake significantly reduces total cholesterol and LDL cholesterol. 

5. Quit smoking

Smoking elevates triglycerides while decreasing HDL cholesterol. It is one of the top causes of heart disease and is responsible for 1 in 4 deaths from heart disease, according to the Centers for Disease Control and Prevention. Quitting can make a big difference in decreasing your risk of heart problems.

6. Drink responsibly

Interestingly, drinking some alcohol may actually help protect your heart. A handful of studies have shown that low-to-moderate alcohol consumption may improve heart health by increasing HDL and reducing triglycerides, total cholesterol, LDL, and ApoB. Moderate drinking means 2 drinks or less per day for men and 1 drink or less per day for women. Too much alcohol, however, can raise cholesterol and triglycerides, so just don’t overdo it.

The bottom line

Although the ApoB test isn’t that widely used across healthcare practices globally yet, researchers agree that it is the #1 way to find out someone’s risk for cardiovascular disease. If you’re interested in gauging your heart health over the long term, ask your doctor for an ApoB test, or join the Aware Early Access waitlist and drop into our lab in Berlin. In case your results show high ApoB levels, you can lower cholesterol and protect your heart health by living a healthy lifestyle. 

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