Want a Healthier Heart? Here Are 5 Ways to Lower Your ApoB

You’ve likely heard plenty about LDL (bad) and HDL (good) cholesterol, but ApoB is another artery-related acronym on the block you should know about. It can be a more accurate indicator of whether the fats floating in your bloodstream may become artery-clogging plaque.

“ApoB may be a better marker for heart disease risk since it reflects all of the bad particles that can drive heart disease rather than just looking at LDL cholesterol,” says cardiologist Trent Orfanos, M.D. 

To minimize your risk of heart disease, it’s a good idea to learn how to lower ApoB. 

About the Experts

Kimberly Campbell, M.D., F.A.C.C., a noninvasive cardiologist at Cardiology Consultants of Philadelphia.

Trent Orfanos, M.D., F.A.C.C., director of integrative and functional cardiology at Case Integrative Health in Chicago.

Rohit Vuppuluri, D.O., an interventional cardiologist and private practice physician at Chicago Heart and Vascular Specialists.

Jenna Stangland, R.D.N., a registered dietitian nutritionist, sports dietitian, and advisor with Momentous.

Michelle Routhenstein, R.D.N., C.D.N., C.D.C.E.S., a registered dietitian nutritionist specializing in preventive cardiology nutrition and owner of Entirely Nourished.

What Is ApoB?

ApoB (pronounced AY-po-bee) is short for apolipoprotein B (try saying that five times fast.) It’s present in all atherogenic (plaque-forming) lipoproteins (complex particles that ferry cholesterol and fats to cells around the body), Orfanos explains. ApoB is what’s known as a “transport” or “carrier” protein, as it latches onto every single one of those bad lipids (1, 2).

“ApoB carries around all of the ‘bad’ lipid particles that can cause damage to the arteries and circulatory system,” Orfanos says. 

ApoB is measured through a fasting blood test, but it’s not usually part of a standard blood panel, meaning your doctor may consider ordering this test if you have a family history or elevated risk of cardiovascular disease). According to the National Lipid Association, the ApoB test is an adjunctive test to the standard lipid panel (3)

Elevated ApoB levels can show you’re at an increased risk of atherosclerosis, or the hardening of the arteries from plaque caused by a buildup of cholesterol and other cellular waste products (4). Some research has found high ApoB levels can also be a sign of insulin resistance (1), which is a risk factor for many other cardiometabolic conditions, says registered dietitian Michelle Routhenstein, R.D.N.

ApoB tests vs LDL tests 

Compared to LDL tests, ApoB tests give a more complete picture of what’s going on inside your blood. The former tells you the total amount of cholesterol in the blood—not exactly how many LDL particles there are, says cardiologist Kimberly Campbell, M.D. Why this matters? Some LDL particles are bigger than others, and not every LDL particle will automatically turn into plaque, Routhenstein notes. This is why some folks with normal LDL levels still develop cardiovascular disease.

There’s one ApoB protein for every LDL particle, so figuring how many ApoB proteins you have in your blood shows exactly how many bad bits you have, too, Campbell adds. Having more LDL particles bumps up the risk of developing cardiovascular problems. 

Second, as Orfanos mentioned, the ApoB test also picks up other problematic lipids in the blood such as very low-density lipoproteins (VLDL), chylomicrons, and lipoprotein(a)—all of which are linked to cardiovascular disease (1).

How to Lower ApoB

You can, in fact, kick some of those harmful lipids hanging out in your bloodstream to the curb. “Diet and lifestyle changes are the most important factors that can help reduce ApoB,” says cardiologist Rohit Vuppuluri, D.O. 

Cut back on saturated fats

It shouldn’t come as a surprise that saturated fat increases both LDL and HDL cholesterol in the blood (5). One of the biggest offenders is red meat. Registered dietitian Jenna Stangland, R.D.N., encourages cutting back on ribeye and other fatty cuts of meat loaded with saturated fat. 

“You don’t have to eliminate red meat entirely,” she says. “Just opt for a leaner cut like a round steak or sirloin tip.”

Better still, aim to eat more lean proteins, such as fish and plant-based proteins such as nuts, seeds, and beans. Also steer clear of foods containing palm oil (including certain brands of ice cream, chocolate, cereals, and peanut butter), Stangland says, which are high in saturated fat.

Up your intake of healthy fats and fiber 

Stangland recommends focusing on eating unprocessed, unsaturated fats. Monounsaturated and polyunsaturated fats lower bad cholesterol and raise good cholesterol (5). Heart-healthy examples are extra virgin olive oil, avocados, flaxseeds, and chia seeds.

You’ll also want to prioritize eating foods with both soluble and insoluble fiber, Routhenstein says. “Soluble fiber helps to grab the things in the body that don’t belong and make them into a ball,” she explains, “and then insoluble fiber is a broom to help push it through as a bowel movement.”

Insoluble fiber sources include any type of bean, lentils, blueberries, and nuts, Stangland says. Soluble fiber is found in veggies such as cauliflower, potatoes, and the skins of apples, pears, and other fruit, as well as in oats (6).

“Oats are an excellent source of soluble fiber and beta glucans, which research has specifically shown to reduce ApoB levels,” Stangland says (7). 

Fiber-rich complex carbs, including oats, quinoa, barley, and broccoli, provide other important nutrients, such as magnesium, B vitamins, and folate, which help reduce oxidative stress, Routhenstein explains. “Once ApoB goes into the arterial wall, the LDL becomes oxidized.” 

“That’s one of the early stages of that plaque-forming process,” she adds. “So if you have high ApoB and high levels of oxidative stress, it’s going to cause plaque to form more aggressively,” 

Get moving

Incorporating a mix of aerobic and resistance training-based exercise into a workout routine helps reduce cardiovascular disease risk, Vuppuluri says. 

Recent research published in the European Heart Journal found that strength training alone didn’t lower the risk of cardiovascular disease for participants who were overweight or obese and had high blood pressure. Cardio alone or a combination of cardio and strength training, however, did (8).

The American Heart Association recommends 150 minutes of moderate exercise a week (9). What does “moderate” mean? You’re breathing a little heavier but still able to carry on a conversation, Campbell says.

Get good sleep and manage stress

While genetics, diet, and exercise have a direct influence on cardiovascular health, stress and sleep are indirect markers, Routhenstein says. But they’re still important. 

“When you don’t get adequate sleep or your sleep quality is low, that can increase oxidative stress, which can therefore also increase LDL oxidation and lead to more issues with heart health,” she says. 

Also, when you’re tired and stressed, your food choices might not be the best. (Comfort carbs, anyone?). That’s because too much stress and too little sleep work together to throw satiety and hunger hormones out of whack, Routhenstein explains.

Supplement with medication if needed 

While diet and lifestyle changes can go a long way toward improving ApoB levels, some people may still need medication. 

Statins, PCSK9 inhibitors, ezetimibe, and bempedoic acid are medications that can effectively lower ApoB, Orfanos says.

Taking medication doesn’t mean you can skip the gym or eat whatever you want, though. The treatment works better if you incorporate lifestyle changes in tandem with medication. “I always like to say that sometimes both can be a solution,” Routhenstein says.  

What Is a Normal ApoB level?

As of right now, there aren’t any specific guidelines on what a normal ApoB level should be in the general population. What we do know? Having a lower ApoB level is recommended for those who are at increased risk of cardiovascular disease.

“Someone who has other risk factors for heart disease—someone who has a strong family history, or someone who’s had a cardiac or vascular event, like a stroke—we will shoot to get these numbers lower in those folks,” Campbell says. 

ApoB levels of 130 mg/dL or higher can increase the risk of cardiovascular disease, Campbell notes. 

Early detection of ApoB

ApoB can play a pivotal role in cardiovascular risk assessment. Your results can inform you of certain lifestyle changes to make now to prevent the progression of disease later on.

In both men and women, heart disease risk increases as you age (10). Men, in particular, often wait until middle age to start thinking about heart health, Routhenstein says. For women, declining estrogen levels before and during menopause raise the risk of heart disease (11). 

But plaque formation and other potential problems can start developing without symptoms well before that, Routhenstein says, so getting a sense of your risk early on can arm you and your doctor with the intel needed to ward off future problems.

“Ninety percent of cases of heart disease are preventable,” Routhenstein says. “The more proactive and the earlier you know these numbers, the better you can reduce your risk.”

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