If you are concerned about heart health, you’ve probably heard a lot of buzz about an important marker that is recently getting press from the functional medicine and biohacker community – ApoB – and it’s for a very good reason. Understanding ApoB is key for promoting optimal heart health and is a pivotal step in enhancing longevity.

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In fact, cardiovascular disease (CVD) is the leading cause of death in the United States and according to the American Heart Association (AHA), one in three people will be affected by some form of cardiovascular disease during their lifetime. So let’s dive into how to properly screen for CVD and the importance of measuring apo b so you can better understand your overall CVD risk.

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The 3 key risk factors for heart disease include:

• High blood pressure
• High blood cholesterol
• Smoking

Other health conditions and lifestyle choices increasing heart disease risk include:

• Diabetes
• Overweight and obesity
• Unhealthy diet
• Physical inactivity
• Excessive alcohol use

The overall approach to address CVD morbidity and mortality thus far has been focused on primary and secondary prevention and reducing modifiable risk factors. During an annual physical exam, most patients will get the standard lipid panel – this includes total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides (TGs). Despite these efforts, millions of Americans continue to have substantial risk for CVD and recent literature suggests that new approaches to combat CVD are needed. Welcome apolipoprotein B! The essential measurement to assess lipoprotein-related atherosclerotic cardiovascular disease (ASCVD) risk that should be part of routine clinical practice.

What is Apolipoprotein B (apoB):  

Apolipoprotein B (ApoB) is a crucial protein involved in the metabolism of lipids (fats) and lipoproteins in the body. Measuring ApoB levels provides valuable insights into your heart health and can be a more accurate predictor of cardiovascular disease risk than traditional cholesterol measurements.

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ApoB carries all the substances in the blood that help to make plaque, the waxy fat that can block your arteries. Measuring ApoB can therefore allow for a better understanding of one’s risk of experiencing a cardiac event, such as heart attack or stroke.  

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Why should we measure apo B:

• A Better Indicator of Cardiovascular Risk: While total cholesterol and low-density lipoprotein cholesterol (LDL-C) are commonly used markers for assessing cardiovascular risk, they do not provide a complete picture. ApoB is a more accurate reflection of the total number of atherogenic (artery-clogging) particles in the blood. High levels of ApoB are associated with an increased risk of atherosclerosis, the underlying cause of most heart diseases.

• Reflects the Total Burden of Atherogenic Particles: LDL-C, often referred to as “bad cholesterol,” measures the amount of cholesterol carried by LDL particles. However, there are other lipoproteins like very-low-density lipoprotein (VLDL), intermediate-density lipoproteins (IDL), chylomicrons, and Apolipoprotein (A) that also contribute to atherogenic particle burden. ApoB measures all of these particles, providing a more comprehensive assessment.

• Useful for Individuals with High Triglycerides: In cases of high triglyceride levels, ApoB can be a more reliable marker than LDL-C. Since, LDL may be denser or smaller in patients with diabetes or metabolic syndrome, Apo B can be a better predictor of CVD risk as it takes into account the increased number of atherogenic particles (often seen in these individuals with elevated triglycerides).

• Identifying Familial Hypercholesterolemia (FH): FH is a genetic condition characterized by extremely high LDL-C levels and a high risk of premature heart disease. Measuring ApoB can be helpful in diagnosing FH, as it provides a more accurate assessment of LDL particle number in these individuals.

• Monitoring Response to Treatment: ApoB levels can be used to track the effectiveness of lipid-lowering therapies, including statins and lifestyle modifications. Since it directly reflects atherogenic particle concentration, a decrease in ApoB levels indicates a reduction in cardiovascular risk.

• Personalized Treatment Decisions: ApoB measurements can help guide personalized treatment decisions. Some individuals may have elevated ApoB levels despite normal LDL-C levels, indicating a higher risk of heart disease. These individuals may benefit from more aggressive lipid-lowering therapies but we will not know who may benefit until the apo b test becomes standard of practice!

• Early Detection and Prevention: Measuring ApoB can help identify individuals at high risk for heart disease early on, allowing for proactive interventions through lifestyle changes and medication if necessary. Prevention is often more effective than treating advanced cardiovascular disease. Measuring apo B earlier in life and aggressive lowering of apo b, has the exciting potential to change the course of ASCVD development and improve patient outcomes!

At Eleven Eleven Wellness Center, we order advanced lipid testing to provide a detailed analysis of cholesterol and inflammatory markers to understand the patients’ overall cardiovascular risk. Based on the patients’ lab results, family medical history, and lifestyle choices, we may discuss further imaging with a Cleerly test, which uses AI-driven Coronary Computed Tomography Angiogram (CCTA) to analyze atherosclerosis (plaque) and stenosis; and detection of early signs of heart disease. Looking at all results together in relation to the patient’s clinical picture, we create a personalized treatment plan with you – providing nutrition based guidance, lifestyle changes (stress management techniques, exercise, sleep tips), and targeted supplements/medications.

Summary Highlights:

• Measuring ApoB is a valuable tool for assessing cardiovascular risk, providing a more comprehensive understanding of a person’s lipid profile and their susceptibility to heart disease.
• While traditional cholesterol measurements are still important, ApoB offers additional insights that can help healthcare professionals make more informed decisions about prevention and treatment strategies.
• If you are concerned about your heart health, discussing ApoB testing with your healthcare provider may be a wise step.

If you have any of the risk factors for heart disease listed at the beginning of this article please come and work with us at Eleven Eleven Wellness Center. If you are not ready to delve in deeper to do a comprehensive lipid panel, ask your general practitioner to measure your Apo B to get a better understanding of your cardiovascular disease risk.