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HEALTHSPAN
MEDICAL

  • Alexander Olaussen

ApoB: A Key Player in Heart Health and beyond

Background

  • ApoB is a protein found in the outer shell of some lipoproteins, which transport cholesterol and triglycerides in the bloodstream.

  • Apolipoprotein B (ApoB) is a critical component of our cardiovascular health.

  • It plays a key role in lipid metabolism, facilitating the delivery of cholesterol to cells

  • Elevation in ApoB = hyperbetalipoproteinaemia.

  • Hyperbetalipoproteinaemia = elevation in LDL, IDL, VLDL, Lp(a)

  • High levels of ApoB indicate a higher number of atherogenic particles in the bloodstream, which can contribute to the formation of arterial plaques.

  • Essentially, ApoB is the sum total of all the atherogenic lipoproteins.

  • ApoB is measured widely in US and Europe, but not so much in Australia.

  • ApoB is a better marker of ASCVD risk than LDL and Cholesterol levels


Diagnosis

What is a normal ApoB level? And what is optimal?

  • Normal ApoB levels can vary but are generally considered to be under 90 mg/dL.

  • Optimal levels are typically lower, around 70 mg/dL or even lower for individuals at high risk of heart disease.

  • Peter Attia says: "I just don’t see a reason to have an ApoB ever north of 60 milligrams per deciliter.”

ApoB and Heart Disease

  • Elevated ApoB levels are strongly associated with an increased ASCVD risk


ApoB and Dementia / Neurocognitive decline

  • While research on this connection is ongoing, some studies suggest that elevated ApoB levels may be associated with a higher risk of dementia and cognitive decline.

What if my LDL-C and ApoB does not predict the same risk?

  • This is called discordance.

  • It is often seen in metabolic illness / insulin resistance and similar conditions

  • In the presence of discordance, PA relies on the ApoB


Management

How to Lower ApoB:


1. Diet

  • Reduce Carbs

  • Reduce saturated and trans fats

  • Increase consumption of omega-3 fatty acids found in fish

2. Exercise:

  • Regular physical activity can help improve lipid profiles.

  • Aim for at least 150 minutes of moderate-intensity exercise per week.

3. Medications:


Therapies which ultimately clear apolipoprotein B particles by upregulating low-density lipoprotein receptor (LDL-R) expression

  • Statins

  • Ezetimibe

  • Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors

  • Bile acid sequestrants

Therapies which reduce apolipoprotein B independent of LDL-R

  • Cholesteryl ester transfer protein inhibitor

  • Fibrates

  • Niacin

  • Omega-3 fatty acids

4. Weight Management:

  • Maintaining a healthy weight can have a positive impact on ApoB levels.


Conclusion:

  • ApoB is a crucial marker for cardiovascular health, and understanding its levels and implications is vital.

  • ApoB is a better risk predictor than LDL-C

  • Get yours checked

  • Get yours down (at least into normal levels, if not below 60 milligrams per deciliter)

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