Atherosclerosis, the leading contributor to heart disease and stroke, accounts for nearly 50% of deaths in Western societies. This life-threatening condition is driven by the buildup of fatty plaques in the arteries, a process closely linked to apolipoprotein B (ApoB).
Unlike standard cholesterol tests, which measure LDL, HDL, and triglycerides, ApoB provides a more comprehensive assessment of cardiovascular risk.
This article provides a comprehensive review of natural ways to lower your ApoB. Understanding your ApoB levels through blood tests may provide insights into your potential risk for atherosclerotic cardiovascular disease (ASCVD) and support discussions about lifestyle changes or medical treatments.
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What Is Apolipoprotein B (ApoB)?
Lipids, such as cholesterol, are fatty substances that are not water-soluble. As they are unable to dissolve in water-rich plasma, lipids are transported in the blood via proteins called lipoproteins which carry cholesterol components in their core and on their outer surface.
A cholesterol panel tests for specific lipoproteins such as:
- Low-density lipoprotein (LDL)
- Very low-density lipoprotein (VLDL)
- High-density lipoprotein (HDL)
Apolipoproteins are proteins that encase lipoproteins, helping to provide structure to lipids as they travel throughout the blood. Apolipoprotein B (ApoB) is a type of apolipoprotein that is attached to the lipoproteins LDL, VLDL, and lipoprotein (a), all of which contribute to the formation of plaques in the arteries.
Lipoproteins typically pass through arterial walls as part of normal transport in the bloodstream. However, apolipoprotein B may become trapped within the arterial wall, contributing to plaque formation, a process associated with atherosclerosis.
As more plaque builds up within the arterial wall, the narrower the artery becomes. If they grow large enough, these plaques can eventually cut off the flow of blood in an artery. They can also break into pieces and be carried downstream into smaller arteries where they lodge, potentially causing a heart attack or stroke. Because of its association with atherosclerosis, ApoB can be a useful marker for an individual’s risk for ASCVD.
Lab Testing for Apolipoprotein B
ApoB is measured using a blood test. It is often added to a larger panel that assesses a person’s overall cholesterol profile. The components of a basic cholesterol panel often include:
- Total cholesterol: the sum of HDL and LDL in the blood.
- Triglycerides: fat stores that are created when caloric intake is in excess, especially sugars and alcohol. Can be a risk factor for cardiovascular disease if elevated.
- HDL-C: often referred to as “good cholesterol”, this lipoprotein is associated with the breakdown and removal of cholesterol in the arteries.
- LDL-C: often referred to as “bad cholesterol”, too much LDL can lead to plaque formation in the arteries.
Although a typical panel looks at LDL-C, it does not measure all the different types of atherosclerotic lipoproteins. Therefore ApoB can be added to more comprehensively assess an individual’s risk for cardiovascular disease. Elevated ApoB levels may indicate a higher amount of lipoproteins associated with plaque formation in the body.
Typical reference ranges for serum ApoB vary, but generally, an ApoB of less than 90 mg/dL is a recommended target to reduce cardiovascular disease risk. Numbers above this threshold may suggest an increased likelihood of arterial plaque presence.
If your ApoB levels are high, your provider may want to order additional testing to determine whether atherosclerosis is present and to initiate treatment if indicated to help lower disease risk. ApoB can be a useful marker in these instances to track the efficacy of treatment plans.
How to Lower ApoB Naturally
Effective ways exist of reducing atherosclerosis risk and ApoB levels. Diet and lifestyle modifications are often sufficient as therapeutic treatments for individuals who have mild elevations in cholesterol and ASCVD risk.
Diet Modification
Diet modification is the cornerstone of cardiovascular disease treatment. For individuals with high cholesterol and who are at increased risk for atherosclerosis, the following is recommended:
- Avoid foods with trans fats
- Reduce saturated fat intake to less than 7% of daily dietary intake, replacing it with monounsaturated fats such as olive oil
- Decrease sugar intake to less than 10% of total calories
- Reduce intake of refined grains and processed meat
- Increase and diversify vegetable intake. An easy way to do this is to “eat the rainbow” by incorporating vegetables of different colors, from leafy greens to red peppers and purple cabbages.
- Increase fiber intake to at least 20-30 grams per day, focusing on whole grains, legumes, and fruits and vegetables
- Diversify protein intake, prioritizing lean meats, seafood, legumes, eggs, seeds, and nuts.
Diets that may support healthy cholesterol levels and cardiovascular health include:
The Mediterranean Diet
Inspired by the dietary patterns of Mediterranean countries, this diet focuses on high intake of fiber from vegetables, legumes and seeds, along with the inclusion of healthy fats and proteins and minimal intake of processed foods.
Studies suggest that the Mediterranean Diet may improve cholesterol profiles and lower ApoB, which could support cardiovascular health and potentially reduce the risk of coronary heart disease.
DASH (Dietary Approaches to Stop Hypertension) Diet
Similar to the Mediterranean Diet, the DASH Diet focuses on a high intake of vegetables, lean proteins, whole grains, and legumes while limiting saturated fats, alcohol, and processed meats. Additionally, it is meant to lower blood pressure levels which also decreases cardiovascular risk.
Vegetarian and Plant-Based Diets
These diets involve higher intakes of fiber, vegetables, whole grains, and legumes, which leads to decreased LDL and lower incidence of cardiovascular disease mortality.
Physical Activity
Exercise can also play a critical role in reducing cardiovascular disease risk. Multiple medical associations, including the American Heart Association (AHA) and the American Stroke Association, recommend regular physical exercise as part of a comprehensive treatment program for ASCVD. Regular exercise has been associated with:
- Potential reductions in LDL levels and some reduction in ApoB.
- Reduced triglyceride and total cholesterol levels.
- Increased HDL levels.
- Increased metabolism of body fat which results in less plaque-inducing lipids circulating through the arteries.
- Decreased risk for diabetes, high blood pressure, and obesity, all of which can negatively impact cardiovascular health and function.
To improve cardiovascular disease risk, the AHA recommends engaging in moderate aerobic exercise for 30 minutes 5 times per week or high intensity exercises for at least 25 minutes 3 times per week. To further reduce heart attack and stroke risk, 40 minutes of moderate to high intensity exercise is recommended at least 3 days per week.
Supplements
In addition to diet and exercise, certain supplements may offer potential benefits as part of a comprehensive treatment plan for cardiovascular disease.
Most commonly, niacin and omega 3 fatty acids are used to help improve cholesterol profiles in conjunction with statin therapy. Niacin may help increase HDL levels, while omega-3 fatty acids have been studied for their potential to improve triglyceride levels.
When to Consider a Pharmaceutical Approach
Although natural interventions can reduce ASCVD risk, pharmaceutical therapy may be required if dietary and lifestyle changes are not enough to modify cholesterol profiles and disease outcomes. To assess risk, the ASCVD risk calculator estimates the 10-year likelihood of an ASCVD event based on factors such as cholesterol numbers, blood pressure, and the presence of other risk factors.
Pharmaceutical interventions may be considered when the 10-year ASCVD risk is estimated to exceed 7.5% or if other high-risk factors are present, such as LDL levels greater than 160 mg/dL, chronic kidney disease, family history of early-onset ASCVD, or metabolic disease.
Commone Drug Therapies
Common drug therapies for lowering ASCVD include:
Statins
Statins are often the first-line treatment for elevated atherosclerotic lipid levels. They are highly effective in lowering LDL levels, with reductions ranging from 20% to 50% depending on statin dose and intensity.
Additionally, statins play a role in stabilizing plaques to help prevent their breakage, thereby reducing stroke risk. Downsides of statin use include increased risk for muscle pain and liver damage.
Bile Acid Sequestrants
These bind to bile acids causing them to be eliminated from the body. To compensate, the liver converts cholesterol into bile acids, effectively lowering cholesterol levels. Side effects of bile acid sequestrants include constipation, loss of appetite, and indigestion.
Cholesterol Absorption Inhibitors
These reduce the absorption of dietary cholesterol by inhibiting uptake at the intestinal border leading to reductions in LDL, ApoB, and total cholesterol levels. Common side effects include headache, runny nose, and sore throat.
When to See Your Doctor
High cholesterol is often discovered incidentally as part of a routine screening panel on annual exam lab work. As the early stages of ASCVD can be asymptomatic, it is important to undergo regular health check-ups with your healthcare provider so that interventions can be started early if needed.
If you are experiencing any of the following symptoms, consider consulting your doctor, as these may be associated with ASCVD:
- Chest pain
- Frequent heart palpitations
- Shortness of breath
- Extreme fatigue
- Aching pain in your legs during movement that stops when you rest
- Significant memory loss and changes in mental cognition
- Erectile dysfunction
Risk factors that should be discussed with your doctor include:
- Diabetes
- High blood pressure
- Smoking or exposure to secondhand smoke
- Inflammatory diseases such as rheumatoid arthritis and psoriasis
- History of preeclampsia in pregnancy
- Family history of premature ASCVD (earlier than 55 years old in men and 65 years old in women)
Working with your healthcare provider is critical in identifying the need for treatment and managing interventions to meet your ASCVD risk goals and be safely monitored.
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Key Takeaways
- Lowering ApoB naturally may involve a heart-healthy diet, regular exercise, and, when necessary, pharmaceutical interventions. These lifestyle changes may help support cardiovascular health and reduce plaque buildup.
- Regular monitoring of cholesterol and ApoB levels is essential to track progress.
- Managing heart health is not one-size-fits-all—consult your doctor for personalized guidance and tailored interventions to effectively reduce your risk of atherosclerotic cardiovascular disease.
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