How to reduce ApoB

Too much of this protein in your blood is a clear indicator of increased cardiovascular risk. Here's the science on how to lower levels for better health.

WRITTEN BY

Stephanie Eckelkamp

REVIEWED BY

Neil Kathuria, MD

Updated: 06/10/2025|12 min read

Over the last several decades, the most common markers for understanding cardiovascular disease risk---still the leading killer for men and women---have been low-density lipoprotein (LDL) cholesterol and triglycerides. But since 2019, it's become clear that there's a more accurate risk measure: apolipoprotein B (ApoB). This lesser-known protein is a component of all atherogenic (read: arterial plaque-promoting) particles in the bloodstream, so measuring it provides a more complete picture of the number of harmful particles circulating.

High ApoB---considered more than 130 mg/dL, but the threshold may be lower depending on your health status---may indicate a greater risk for hypertension, metabolic syndrome, Type 2 diabetes, and insulin resistance. While ApoB is not a component of a standard blood lipid panel, an increasing number of health experts (like Thomas Dayspring, MD, Peter Attia, MD, and others), along with a number of researchers, think it's worth measuring. Considering your ApoB results alongside other biomarkers can give you a more holistic picture of your cardiovascular and overall health.

If your ApoB levels are high---or you just want to keep them at a healthy level---it's largely in your power, through diet and other lifestyle changes, supplements, and certain medications. Below, learn more about how ApoB functions in the body, optimal levels, and proven strategies to help reduce ApoB.

What is apolipoprotein B?

Apolipoproteins are the main protein components of lipoproteins, which are particles responsible for transporting fatty compounds like cholesterol and triglycerides through the bloodstream. Apolipoprotein molecules attach to the exterior surface of lipoproteins, providing structure and making fats water-soluble in the blood, so they can flow freely in the bloodstream without clumping.

ApoB specifically attaches to the exterior of atherogenic lipoproteins---the ones that promote the buildup of plaque in arteries (known as atherosclerosis), which, in turn, promotes atherosclerotic cardiovascular disease (ASCVD), heart attacks, and strokes. So ApoB-100 is a measure of the total number of atherogenic lipoprotein particles in the blood (ApoB-48 is another type of molecule, but not used for this kind of a count). These lipoproteins are:

• LDL
• Intermediate-density lipoprotein (IDL)
• Very low-density lipoprotein (VLDL)
• Lipoprotein(a)

High concentrations of these ApoB-containing lipoproteins are dangerous, in part because they can become trapped in the arterial wall. There, they become oxidized and promote inflammation, which spurs plaque buildup, restricts blood flow, and increases the risk of clots.

Because each atherogenic lipoprotein particle---LDL, IDL, VLDL, and Lp(a)---contains exactly one ApoB protein molecule, ApoB is considered a superior marker for cardiovascular disease risk compared to the more common biomarker LDL cholesterol (LDL-C), which measures the concentration of cholesterol within the LDL particles in your blood. Time and again, total atherogenic particle number has been shown to be a better indicator of cardiovascular risk than LDL or non-HDL cholesterol concentration.

What is a healthy range for ApoB?

There is no broadly accepted clinical definition of "optimal" ApoB levels, but generally, less than 90mg/dL is recommended. In his book Outlive, longevity expert Peter Attia, MD, writes: "I take a very hard line on lowering ApoB. In short: Get it as low as possible, as early as possible."

According to popular laboratory LabCorp, ApoB less than 90 mg/dL is desirable, 90 to 99 mg/dL is borderline high, 100 to 130 mg/dL is high, and over 130 mg/dL is very high. Your current health status can also inform what number to aim for or when you may need intervention. Per a 2024 expert clinical consensus statement from the National Lipid Association, the following are the recommended thresholds at which ApoB should be treated with lipid-lowering therapy. (This online estimator tool from the American College of Cardiology (ACC) and American Heart Association (AHA) allows people aged 40 to 79 to estimate their 10-year ASCVD risk.)

The consensus group did not state what optimal levels would be for someone at low risk for ASCVD. However, a 2019 paper from the ACC and AHA states that ApoB levels 130 mg/dL or above are considered a "risk-enhancing factor" for the development of atherosclerosis.

ApoB levels are measured with a simple blood test, which doesn't require fasting. However, you may need to fast for 12-14 hours if you plan to get blood drawn for a lipid panel at the same time.

You can lower ApoB through diet and exercise

If your blood test reveals high ApoB, lifestyle changes and medication can help bring your numbers into a healthier range. You'll notice that strategies for lowering ApoB are similar to strategies for lowering LDL cholesterol and triglycerides. The reason: LDL particles (the carriers of cholesterol in the blood) and VLDL particles (one of the primary carriers of triglycerides, produced by our liver) both contain a molecule of ApoB---so anything that lowers these generally lowers ApoB.

Some of the key mechanisms by which the following strategies lower ApoB are through decreasing the amount of cholesterol and triglycerides your body makes, as well as the binding and elimination of cholesterol via the GI tract, and upregulation of LDL receptors in the liver, which increases LDL clearance.

While basic health advice like smoking cessation, limiting alcohol intake, and improving sleep quality can all improve ApoB, the biggest levers for most people will be diet and exercise. Your best bet: Instead of focusing on one or two of the recommended changes below, try to make some healthy shifts in each category to support overall health, and give extra attention to those areas where you know you tend to struggle.

1.Cut back on saturated fat

High saturated fat intake can significantly raise LDL cholesterol, which, in turn, can raise ApoB. If your ApoB levels are high, consider limiting saturated fat to less than 7 to 10 percent of your daily calories (16 to 28 grams or less on a 2,000- to 2,500-calorie diet), as recommended by the NIH's Therapeutic Lifestyle Changes (TLC) Program and the Dietary Guidelines for Americans, 2020-2025, respectively. Decreasing saturated fat intake to less than 7% of daily calories is associated with an LDL-C reduction of 8 to 10 percent, and by extension, lower ApoB.

In a 2012 study, reducing saturated fat intake from an average of 14% of total calories per day (approximating an average Western diet) to less than 7% of total calories per day as part of a high-fish or low-fish therapeutic lifestyle changes (TLC) diet was associated with reductions in ApoB. Per the researchers, both TLC diets increased the LDL fractional catabolic rate---or the rate at which LDL particles were removed from the bloodstream---likely due to an increase in the expression of LDL receptors on the liver, which can bind to and clear LDL particles from the bloodstream.

In a 2017 study on people with atherogenic dyslipidemia (high triglycerides, low HDL, and high small, dense LDL), going from a baseline diet (consuming 8% of total calories from saturated fat) to consuming a high saturated fat diet (18 percent of total energy) was associated with a 9.5 percent increase in ApoB, which may translate to increased cardiovascular disease risk. The reason: Saturated fat increases cholesterol synthesis in the liver and, in turn, decreases the expression of LDL receptors on the liver, which means fewer LDL particles are removed from the blood.

You don't need to limit overall fat intake, though. Instead, opt for high-quality unsaturated fats when possible. When consumed in place of saturated fat, both monounsaturated fats (found in olive oil, avocados, and most nuts) and polyunsaturated fats (found in fatty fish, certain nuts, and seeds) have been shown to decrease ApoB in small trials of people with high cholesterol from insulin resistance.

Common foods high in saturated fat include fatty cuts of beef, lamb, and pork; processed meats; butter; full-fat cheeses; whole milk and full-fat yogurt; ice cream; coconut oil and palm oil; fried fast foods; packaged snacks; cakes; pastries; doughnuts; and muffins.

One important caveat: Not everyone's ApoB levels will be impacted the same by a decrease in saturated fat. "In my clinical experience, about a third to half of people who consume high amounts of saturated fats will experience a dramatic increase in ApoB particles," according to Dr. Attia. Research has shown that increasing saturated fat intake by about 6 percent in people with moderate CVD risk can result in a varied LDL response; increasing LDL cholesterol by up to 45 percent or decreasing it by as much as 20 percent (and these changes in LDL would also likely drive similar changes in ApoB). This variation may be due to an interplay of genetics, gut health, the source of saturated fat, and other factors.

So, if you consistently reduce saturated fat and ApoB doesn't budge within about three months, focus more of your efforts on the other strategies discussed in this article.

2. Cut back on refined carbs

Research shows that high-carbohydrate diets---those with more than 55 percent of calories from carbs---can increase the liver's synthesis of triglycerides, and as a result, VLDL particles. Each VLDL particle has one molecule of ApoB, so the more triglycerides and VLDL produced by the liver, the higher ApoB levels may rise.

In people with healthy triglyceride levels, VLDL only accounts for about 5 to 10 percent of total ApoB particles, but as triglyceride levels increase, VLDL can account for 15 to 20 percent of ApoB. This means that reducing carbohydrate intake becomes an even more important dietary strategy for lowering ApoB when your triglycerides are also elevated. Note also that not all carbs are created equal: non-sugar, high-fiber carbs (e.g., lentils, steel-cut oats) usually don't raise VLDL and can aid ApoB control.

In a 2022 podcast, neuroendocrinologist Rob Lustig, MD, said an important step for lowering LDL is to lower triglycerides, and that a very effective dietary tool we have for this is to cut sugar and refined carbs (e.g., breads, pastas, french fries, desserts, and sugar-sweetened beverages). Several studies support this recommendation.

• In a 2017 study investigating the association between apolipoprotein concentrations and dietary habits, intake of sucrose (table sugar) and foods containing added sugars, such as sugar-sweetened beverages, pastries, jams, and chocolate, were associated with higher ApoB concentrations and a higher ApoB:ApoA1 ratio. ApoA1 is the apolipoprotein attached to more beneficial HDL cholesterol, so this ratio measures atherogenic versus anti-atherogenic lipoproteins in the blood.
• Similarly, a 2022 study found that greater intake of sugar-sweetened beverages was associated with higher levels of ApoB, triglycerides, and LDL cholesterol (including small, dense LDL particles), and a higher ApoB:ApoA1 ratio.

As you reduce carbs, be mindful not to replace those carbs with saturated fats, which could cancel out reductions in ApoB. A 2024 trial found that a low-carb, high-fat diet (23 percent carbohydrate, 52 percent total fat, 17 percent saturated fat on average) increased concentrations of ApoB compared to a standard diet (51 percent carbohydrate, 31 percent total fat, 11 percent saturated fat). If the diets were matched for saturated fat, these elevations in ApoB would be less likely. (As mentioned above, lean on quality sources of monounsaturated and polyunsaturated fats instead.)

3. Increase Omega-3s through food (and possibly supplements)

Intake of omega-3-rich fatty fish has been shown to decrease the risk of cardiovascular mortality, partly due to a reduction in ApoB-containing lipoproteins, specifically triglyceride-rich VLDL particles. Eating about 4 ounces of fatty fish three times per week or taking a high daily dose of fish oil (3,000 to 4,000 mg of combined EPA/DHA) may help, according to research (though you should always consult a doctor before starting a supplement, especially at very high doses):

• In a 2012 trial, a high-fish diet containing 1.23 grams of the omega-3s EPA and DHA per day (equivalent to about six 4--ounce servings of salmon per week) for six months decreased ApoB concentration by 23 percent and decreased LDL concentration by 9 percent.
• A 2012 study found that women with high triglycerides who ate 2.8 ounces of fatty fish (salmon, herring, or pompano) five days a week experienced up to a 6.5 percent reduction in ApoB levels and a 25 percent reduction in triglycerides.
• Taking 4,000 mg of EPA or DHA daily for four weeks led to a 24 percent drop in postprandial (post-meal) ApoB levels in a small 2002 trial. (Up to 5,000 mg per day of EPA/DHA combined is considered safe for most, per the European Food Safety Authority.)

Similar to carbohydrate restriction, the omega-3s in fatty fish appear to decrease the synthesis and secretion of triglyceride-rich VLDL from the liver and may increase its clearance from the blood. Specifically, the omega-3s EPA and DHA may:

• Decrease the synthesis of ApoB in the liver, which is required for VLDL production
• Stimulate a pathway that increases the degradation of newly synthesized ApoB
• Increase oxidation of ApoB in the liver, which reduces the starting materials (substrates) needed for triglyceride synthesis
• Block enzymes required for the final steps in triglyceride synthesis
• Increase activity of the enzyme lipoprotein lipase (LPL), which accelerates the metabolism of VLDL and its clearance from the bloodstream

4. Boost your soluble fiber intake

Soluble fiber---found in beans, seeds, nuts, certain fruits and vegetables, whole grains (like barley, bran, and oats), and supplements---dissolves in water to form a thick, viscous gel that slows digestion as it travels through the GI tract. Once fiber reaches the gut, it acts as a fuel for "good" bacteria. Soluble fiber has also been shown to lower levels of ApoB and LDL cholesterol.

Soluble fiber lowers LDL by trapping and eliminating bile acids---substances composed of cholesterol that help digest fat---as it moves through the intestines. Normally, most bile acids are reabsorbed in the lower intestines and recycled back to the liver. Increasing the excretion of bile acids means the liver must synthesize more to meet the body's needs. This increases the liver's demand for cholesterol (a building block of bile acids), which increases expression of LDL receptors on the liver and the clearance of cholesterol from the bloodstream. The end result: fewer circulating LDL particles (and, thus, ApoB).

While fiber-rich foods are certainly beneficial, it's easier to see soluble fiber's impact when looking at well-formulated studies on supplements like psyllium husk and beta-glucan. In a review of 28 studies, taking an average of 10.2 grams of psyllium husk fiber daily for eight weeks lowered ApoB by 5 mg/dL and LDL cholesterol by nearly 6 mg/dL. And a review of 58 trials found that taking an average of 3.5 grams of oat beta-glucans daily lowered ApoB by nearly 3 mg/dL after five weeks and LDL cholesterol by 3.4 mg/dL after six weeks.

Dietary sources of soluble fiber will help lower LDL and ApoB, but it can be challenging to hit your daily total fiber quota (around 25 to 38 grams of combined soluble and insoluble fiber, but some sources recommend closer to 50 grams) from food alone. So you may want to consider a psyllium husk supplement (about 10 grams per day, divided into two 5-gram doses) or a supplement containing oat beta-glucans (at least 3 grams per day). Start slowly and drink plenty of water when introducing a fiber supplement to help reduce gastrointestinal side effects.

5. Combine aerobic and resistance training

Both aerobic and resistance exercise have been shown to lower ApoB levels, with some studies showing significant benefits with three one-hour aerobic workouts or three one-hour resistance training sessions per week.

In a 2023 research review of 57 clinical trials, at least 12 weeks of aerobic exercise training at greater than 40 percent VO2max (i.e., moderate-intensity) among previously sedentary adults decreased ApoB and VLDL, increased anti-atherogenic ApoA1, and improved the ApoB:ApoA1 ratio. Specifically, ApoB decreased by nearly 2.1 mg/dL, which could result in a 4.3 percent reduced risk of coronary heart disease (CHD), per the study authors.

And a review from 2020 found that moderate- to high-intensity aerobic exercise (65 to 80 percent VO2max) produced beneficial blood lipid changes as well---a decrease in ApoB and triglycerides, and an increase in beneficial ApoA1 and HDL cholesterol.

Aerobic exercise.) promotes the breakdown of the triglycerides within VLDL particles into fatty acids that can then be used to fuel working muscles. This accelerates the metabolism of VLDL and may enhance its clearance (and potentially the clearance of IDL and LDL) from the blood. Over time, regular aerobic exercise may also decrease the synthesis and subsequent secretion of triglyceride-rich VLDL particles into the bloodstream. Additionally, reductions in waist circumference and improvements in physical fitness (as measured by VO2max) following aerobic exercise regimens have both been associated with reductions in ApoB.

While fewer studies investigate the relationship between resistance training and ApoB levels, current research suggests it's also a helpful strategy.

In a 2012 study, people with overweight or obesity and Type 2 diabetes who participated in a three-month resistance training program, performing hour-long workouts three times per week, experienced an average decrease in ApoB from 136 mg/dL to 86 mg/dL and improvements in the ApoB:ApoA1 ratio. According to the researchers, resistance training-induced improvements in insulin sensitivity were independently associated with an improved ApoB:ApoA1 ratio, though other mechanisms may also influence ApoB.

And in a 2019 study, healthy men who participated in a four-month resistance training program experienced decreased fat mass, increased lean body mass, and subsequent changes in blood lipids and lipoproteins, including: decreased ApoB, improved ApoB:ApoA1 ratio, and decreased IDL and LDL cholesterol. According to the researchers, resistance training results in positive body composition changes that likely contributed to improved lipid and lipoprotein markers (having a higher body fat percentage is known to be causally linked to elevations in ApoB).

Overall, including both aerobic and resistance workouts in your regimen may help lower ApoB via various mechanisms that you may not get from engaging in just one type of training.

When should you consider medications and supplements to lower ApoB?

If you have elevated ApoB that is resistant to lifestyle changes, medication or supplementation (beyond soluble fiber and fish oil supplements) may help.

With medications, in nearly every case, your doctor will prescribe a statin as a first-line therapy. These drugs are relatively effective and well tolerated by most people. If statins don't work, or if you experience side effects, your doctor will likely prescribe bempedoic acid, ezetimibe, or a combination of these two medications, which have a different mechanism of action. And if you fail to respond well to any of these, insurance may cover the highly effective but more expensive class of injectable lipid-lowering medications called PCSK9 inhibitors.

With supplements, the improvements in ApoB are either more subtle (in the case of plant sterols and stanols) or unreliable (as with red yeast rice), but some people may benefit.

Ultimately, the decision to take one or several of the options below requires a discussion with your doctor, who can explain the pros and cons based on your individual health.

Statins

Commonly prescribed for lowering cholesterol, statin medications including atorvastatin, rosuvastatin, simvastatin, and lovastatin have been shown to lower ApoB levels 19 to 42 percent in randomized controlled trials. Statins inhibit the action of HMG-CoA reductase, an enzyme that synthesizes cholesterol in the body. Diminished cholesterol synthesis in the liver, in turn, increases the number of LDL receptors expressed on the liver, allowing it to take up more LDL cholesterol from the bloodstream, thus lowering circulating LDL (and ApoB) levels. Statins have also been shown to reduce the rate at which the liver produces ApoB-containing lipoproteins, including triglyceride-rich VLDL.

It's true that statins have some potential downsides, but most research suggests the benefits of these drugs outweigh the risks. Some research has shown that statin therapy may interfere with normal glucose metabolism and modestly raise hemoglobin A1C levels up to 1.05 percent, depending on the intensity of the statin therapy. Other people may experience muscle pain and weakness, but this risk is only up to 5 percent greater in statin users than non-users. Statins may also elevate liver enzyme levels, but this is usually mild to moderate, and the risk of statin-induced liver injury is relatively low, occurring in 1.9 to 5.5 percent of statin users. To reduce risk, some clinical recommendations suggest having liver enzymes and other labs tested at baseline, after three months on statin therapy, and then annually.

As with all of these drugs, deciding whether to take a statin should be done by weighing the pros and cons with your doctor.

Bempedoic acid

Similar to statins, bempedoic acid is a medication that inhibits cholesterol synthesis and increases the number of LDL receptors expressed on the liver, thereby reducing LDL cholesterol (and ApoB) levels in the blood. It does this by inhibiting an enzyme in the liver called ATP citrate lyase. One key difference: Bempedoic acid is inactive until it reaches the liver, while statins are active throughout the body, including in the muscles. For this reason, if someone doesn't tolerate statins due to muscle pain, they may be prescribed bempedoic acid. In studies, bempedoic acid has been shown to lower ApoB levels by 12 to 19 percent.

Ezetimibe

Similar to bempedoic acid, ezetimibe may be prescribed in cases where statins are not well tolerated. This medication blocks cholesterol-transporter protein NPC1L1, located in liver and intestinal cells, which reduces the absorption of dietary cholesterol and the reabsorption of biliary cholesterol (the cholesterol present in bile) via the intestines. One small trial found that ezetimibe reduced ApoB levels by about 23 percent among men with high cholesterol. While ezetimibe and bempedoic acid are each less potent than statins, currently one drug (e.g., the name-brand Nexlizet) combines both.

PCSK9 inhibitors

Injectable PCSK9 inhibitor medications like Praluent (alirocumab) and Repatha (evolocumab) are monoclonal antibody drugs that effectively lower ApoB---but they can be hard to access. These medications are expensive to produce, are currently only available as brand-name products, and are typically covered by insurance only after other cholesterol-lowering medications have failed or are not well tolerated. Two separate studies have shown that when combined with statins, alirocumab can reduce ApoB by 54 and 56 percent, while evolocumab may lower ApoB by 40--52 percent when used alone or with statins. These medications interfere with the protein (PCSK9), which breaks down LDL receptors and prevents LDL from effectively being cleared from the blood. PCSK9 inhibitors are among the few interventions that lower the atherogenic lipoprotein Lp(a).

Plant sterols/stanol supplements

Plant sterols and stanols, such as beta-sitosterol, are compounds naturally found in vegetables, fruits, whole grains, and nuts that have a structure similar to cholesterol and help block cholesterol absorption in the intestines. While it may be challenging to get enough naturally from foods to lower cholesterol or ApoB, supplemental doses of 2 to 3 grams per day may help. A 2014 research review found that taking up to 3 grams of plant sterols and stanols per day reduced LDL cholesterol by about 12 percent. Other studies show that plant sterols and stanols can lower the ApoB:ApoA1 ratio, suggesting an improvement in the ratio of atherogenic to anti-atherogenic lipoproteins.

Red yeast rice supplements

Red yeast rice is a popular statin alternative, but it's important to weigh the risks versus benefits, as the lipid-lowering compound found in this supplement is not well-regulated.

Red yeast rice is produced via the fermentation of a specific type of fungus found on rice. Under the correct conditions, fermentation of this fungus enriches the rice with substances called monacolins, including monacolin K, which is structurally identical to the statin lovastatin and targets and inhibits the same enzymes of cholesterol synthesis in the body. (Because of the structural similarities, side effects tend to be similar, too.)

Studies have found that red yeast rice supplements with a meaningful amount of monacolin K (about 3 to 10 mg per day, per some studies) may effectively lower LDL cholesterol and ApoB. However, in 1998, the FDA determined that one red yeast rice supplement should be classified as a "drug" and it was removed from the market. The agency has also sent warning letters to several other companies it found had boosted their product by adding additional lovastatin, which cannot be sold legally as a supplement. Most natural red yeast rice supplements contain a trace amount of monacolins.. "Trace amounts" have not been defined, but they are likely less than 1 mg per capsule.

Supplements with naturally occurring monacolin K may be sold, but their benefits are unclear. Most widely available supplement brands suggest 1,200 to 2,400 mg of red rice yeast daily, divided into two or three doses---but monacolin K content is not typically listed. One 2017 study found that 26 of 28 supplements tested did contain some monacolin K, some with barely any, and some that exceeded the FDA limit (a dose equivalent to 4mg/day or higher)---ranging from 0.09 to 5.48 mg per 1,200 mg of red yeast rice.

So it's hard to know what you're getting, and, consequently, the types of results or side effects to expect. Red yeast rice also contains compounds like isoflavonoids, sterols, and monounsaturated fatty acids, which may support healthy cholesterol and ApoB levels, but it's unclear how much. Red yeast rice may also contain a mycotoxin called citrinin, which can damage kidneys.

If you choose to supplement, let your doctor know and seek out a reputable brand (such as Thorne) that regularly tests for citrinin and consistent levels of monacolins in its product.

Test and improve your ApoB levels

Levels members can test their ApoB levels through Levels Labs, and then use the Levels app to help improve levels by logging meals and setting exercise goals. Click here to learn more about Levels.