ApoB and Lp(a) — Essential Tests for Cardiovascular Risk

ApoB and Lp(a)

ApoB and Lp(a) are must-have blood tests if you want to clearly understand your risk for cardiovascular disease, the #1 killer in many industrialized countries. HDL and LDL tests are comparatively worthless. Learn why.

ApoB and Lp(a)

ApoB and Lp(a) are two tests that reveal your risk for cardiovascular disease far better than your annual Cholesterol Panel that shows the near-worthless LDL Cholesterol and HDL Cholesterol markers.

If your doctor is not testing for ApoB and Lp(a), you need to request them, as I did. My Cholesterol Panel was exceptional, it turns out that my ApoB gave me the inside scoop that was really going on with my LDL particles; it wasn’t a happy story.

I’ve written about this before: Why High ApoB Is A Ticket to Heart Disease, which begin thus:

High ApoB is the most consequential warning sign that you could suffer a heart attack. But what is it, and how can you test for it? I review the science and get Dr. Peter Attia’s take on why you must drive down ApoB.

But now I’m at it again, spurred on by a question that a Subscriber, Donna, emailed me:

Hi Joe, I have been following your last post about this topic. Just found out I have Lp(a) and my ApoB is 100. Do you think a PCSK9 inhibitor would be something for me to try. Fighting high cholesterol forever and now this. I was told statins don’t do anything. Any advice? Thank you Donna 

I answered here right away, but got thinking that this topic is sufficiently important to go deeper into why any middle-aged person needs to know his or her ApoB and Lp(a) numbers.

So, here’s what I cover in this post:

Let’s dig in…


Why ApoB and Lp(a) are important markers for cardiovascular risk

High ApoB is the best predictor of heart disease

Credit: Revolutionhealth.org

ApoB (Apolipoprotein B) is a protein that carries lipids in the blood, specifically associated with atherogenic particles like LDL, VLDL, and intermediate density lipoprotein. It provides a measure of the total number of atherogenic particles in the bloodstream.

Lp(a) (Lipoprotein(a)) is a genetically determined, causal, and prevalent risk factor for atherosclerotic cardiovascular disease. It’s a unique lipoprotein particle that combines LDL-like particles with apolipoprotein(a), a key component of Lp(a).


ApoB and Lp(a)’s relationship to LDL and HDL cholesterol

ApoB is present on all atherogenic lipoproteins (types of lipoproteins that promote the development of atherosclerosis, which is the buildup of plaque in artery walls), including LDL, but not on HDL.

Each atherogenic particle contains one ApoB molecule, providing a more accurate count of these particles than LDL Cholesterol alone.

Lp(a) is distinct from both LDL and HDL but shares some similarities with LDL. It’s considered more atherogenic than LDL, with studies suggesting its atherogenicity (plaque-forming capacity) is about six-fold greater than that of LDLC.


ApoB and Lp(a)’s importance compared to standard cholesterol panel

ApoB and Lp(a) are considered superior predictors of cardiovascular risk compared to the standard lipid panel for these reasons:

  • ApoB represents the total number of atherogenic lipoprotein particles, including LDL, VLDL, and intermediate-density lipoprotein. Each atherogenic particle contains one ApoB molecule, making it a more precise indicator of cardiovascular risk than LDL-C alone. This is particularly important in cases where LDL-C might underestimate risk, such as in people with diabetes, obesity, or metabolic syndrome.
  • Lp(a) is a genetically determined, causal, and prevalent risk factor for atherosclerotic cardiovascular disease that is not measured in standard lipid panels. Studies have shown that the atherogenicity of Lp(a) is substantially greater than that of LDL-C, with estimates suggesting it is about 6-fold more atherogenic based on particle-to-particle comparisons.


ApoB and Lp(a) tests resolves discordance issues

apoB levels related to LDL levels

Credit: https://www.japi.org/x264d454/apolipoprotein-b-as-a-predictor-of-cvd

ApoB measurement resolves the issue of discordance when LDL-C is normal, but the number of atherogenic particles is elevated. This discordance can occur in conditions like metabolic syndrome, where LDL-C levels may appear normal despite an increased number of small, dense LDL particles.

My Lp(a) and LDL cholesterol were very low (respectively: 12 nmol/L and 59 mg/dL) at the same time my ApoB was high (100 mg/dL). If I had not tested for ApoB, I would have thought that my risk for cardiovascular disease was very low when it was not!


Impact on lifespan

Research has shown that higher ApoB levels are associated with a shorter lifespan, independent of LDL cholesterol and triglycerides. This further underscores the importance of ApoB in assessing overall cardiovascular health and longevity.


Optimal, borderline and high ApoB and Lp(a) measurements

While specific targets can vary based on individual risk factors, generally:


  • Optimal: < 80 mg/dL
  • Borderline high: 80-99 mg/dL
  • High: ≥ 100 mg/dL


  • Optimal: < 30 mg/dL or < 75 nmol/L
  • Elevated risk: ≥ 30 mg/dL or ≥ 75 nmol/

Your health insurance should pay for both tests, but if not, they’re inexpensive:

  • LifeExtension offers an ApoB blood test for $28.
  • Labcorp offers a Lipoprotein(a) test for as low as $49.


Factors that can reduce ApoB and Lp(a)


  •  Statins can be effective in lowering ApoB levels.
  • If statins are ineffective, a more powerful pharmaceutical are PCSK-inhibitors.
  •  Lifestyle factors such as a healthy diet, regular exercise, and weight management can help reduce ApoB.


  •  Lp(a) levels are largely genetically determined and less responsive to lifestyle changes.
  •  Currently, there’s no FDA approved therapy specifically for Lp(a) reduction.
  •  Some drugs in development, such as antisense oligonucleotides targeting Lp(a), show promise in reducing Lp(a) levels.
  •  Niacin and PCSK9 inhibitors may have modest effects on Lp(a) levels, but their use for this specific purpose is not well established.

It’s important to note that management strategies should be personalized based on individual risk factors and in consultation with a healthcare provider.

As mentioned, my Lp(a) at 12 nmol/L was very low, even though my ApoB was high at 100 mg/dL. This is discordant. My doctor put me on a low-dose statin (5 mg) and two months later, my ApoB was 57 md/dL, an excellent score.

I also supplemented with:

  • Garlic extract,
  • Plant sterols,
  • Fish oil, and
  • Citrus bergamia (bergamot).


  1. Because of all the supplements, I can not be sure if what lowered my ApoB so precipitously was the statin or the supplements.
  2. The supplements above became the ones I stuck with, but I began with a larger list that you can check out here.


Your Takeaway

While the standard lipid panel (total cholesterol, LDL-C, HDL-C) provides valuable information, ApoB and Lp(a) offer a more comprehensive and accurate assessment of cardiovascular risk.

Their measurement can lead to better risk stratification and more targeted interventions, potentially improving your cardiovascular disease prevention and management. Remember: cardiovascular disease is the #1 killer in America and much of the developed world.

Your health insurance should pay for the ApoB and Lp(a) tests, but if not, check out what Life Extension and Labcorp have to offer.



Last Updated on July 7, 2024 by Joe Garma

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Joe Garma

I help people live with more vitality and strength. I'm a big believer in sustainability, and am a bit nutty about optimizing my diet, supplements, hormones and exercise. To get exclusive Updates, tips and be on your way to a stronger, more youthful body, join my weekly Newsletter. You can also find me on LinkedIn, Twitter and Instagram.

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