Foundation 547

Apolipoprotein B: The Key player in Heart health

4 min read

Simon Körösi

Reviewed by: Joanna Elmes

In recent years, a new biomarker named Apolipoprotein B-100, often referred to as ApoB, has garnered significant attention. While traditional cholesterol tests such as LDL have long been regarded as the benchmark for determining heart disease risk, recent research has revealed that ApoB is a more precise marker for cardiovascular health.

ApoB is a protein that aids in the transportation of cholesterol and other compounds throughout your body via your blood. What makes ApoB particularly intriguing is that each circulating particle, which may cause plaques and atherosclerosis in your body, contains one molecule of ApoB. This means that measuring ApoB can provide a direct indication of the number of atherogenic particles circulating in your body.

Therefore, measuring ApoB can help furnish information regarding your cardiovascular health and estimated risk of developing cardiovascular diseases. ApoB can aid in identifying a potential need for lifestyle modifications as well as tracking the effectiveness of such changes.

When you test for ApoB, you can determine the precise amount of 'bad' cholesterol in your body. You may be wondering why you wouldn't just check LDL cholesterol. Well, an LDL test reveals the total concentration of cholesterol within these particles, rather than the number of particles, which is the important factor when considering heart disease risk - something an ApoB test can provide. Therefore, by getting your ApoB levels checked, you'll gain a more accurate evaluation of how many potentially harmful lipid particles are present in your body, and this can help determine your chances of developing heart complications later in life.

Furthermore, a meta-analysis from 2011 and a review from 2021 concluded that ApoB levels are the strongest predictor of heart disease. The 2019 European Society of Cardiology also suggests that ApoB is a more precise measure of cardiovascular risk than LDL cholesterol and non-HDL cholesterol. This is significant, given that heart disease, according to the World Health Organisation, is the leading cause of death globally today, accounting for 16% of deaths worldwide. Therefore, being aware of your risk early on can enable you to take crucial steps towards safeguarding your health.

Apolipoprotein B may increase the risk of cardiovascular disease through various mechanisms within our bodies:

Oxidation - LDL particles, which contain Apolipoprotein B, are prone to oxidation. Oxidised LDL can contribute to the onset of atherosclerosis.


Retention of LDL in our blood vessels - Apolipoprotein B facilitates the attachment of LDL to our arterial walls, leading to LDL being retained within these walls. This retention contributes to the accumulation of molecules, eventually forming atherosclerotic plaques.


Inflammation - LDL particles containing Apolipoprotein B can trigger inflammation within our arterial walls, resulting in the formation of atherosclerotic plaques.


Dysfunction of the inner layer of the blood vessel - The inner layer of our blood vessels, also known as the endothelium, can be damaged by LDL particles. This harm can hinder vasodilation and is a key contributor to cardiovascular disease.

Several factors could potentially cause an increase in Apolipoprotein B, including:



Lack of physical activity


High intake of trans fats and saturated fats










Why does a lack of physical activity increase Apolipoprotein B?


A sedentary lifestyle results in an accumulation of energy in your body, which in turn alters lipid metabolism.


This triggers the body to produce VLDL, the precursor of LDL containing Apolipoprotein B, in your liver.



Indirectly, higher circulating levels of glucose can lead to insulin resistance, resulting in an increase in LDL production.



Elevated chronic low-grade inflammation can be associated with increased LDL levels.

What can cause a decrease in Apolipoprotein B?

Weight loss, especially when achieved through a balanced diet and regular physical activity, can be particularly effective.


A healthy diet – one that's rich in fruits, vegetables, and whole grains, but low in trans and saturated fats.


Regular physical activity can help reduce Apolipoprotein B levels.


Genetics also play a role in the levels of Apolipoprotein B.