So Why Is Everyone Talking About Apo-B? 

Cardiovascular disease (CVD) is incredibly common—in fact, it's the leading cause of death in America. But as longevity-focused doctor Peter Attia, M.D., shares on the mindbodygreen podcast, we've been thinking about CVD all wrong, from diagnosis to treatment. His one must-have tip to take CVD off the table? Get to know your Apo-B. 

Attia arguably put Apo-B at the forefront of the CVD conversation. So let's talk about it!

Apo-B is a complex particle, but basically, it's a protein found in many lipids within the arterial walls, and too much of it can be dangerous1. 

"It is a protein that is wrapped around a class of lipoproteins that are atherogenic, meaning that they promote atherosclerosis," says Attia. (Refresher: Atherosclerosis refers to plaque buildup in the arteries.) "The most prevalent of these is LDL, or low-density lipoproteins, but they're also found on very low-density lipoproteins, intermediate-density lipoproteins, and Lp(a) particles," Attia adds. 

But here's the thing: Most people only get their LDL cholesterol measured by the doctor. "While that's a decent predictor of cardiovascular risk, it's nowhere near as good as counting the number of all of those particles—and that's what Apo-B is measuring," says Attia. 

Essentially, your Apo-B number gives your doctor a much better understanding of the level of buildup of cholesterol on your artery walls.

Now, Attia mentions that Apo-B is a necessary criterion for atherosclerosis. Meaning, "You can't get atherosclerosis without Apo-B," he declares. "If you want to eradicate atherosclerosis, all you would have to do is eradicate Apo-B."

So how low should you go? Well, Attia notes that when children are born, their Apo-B is very low—we're talking 20 to 30 milligrams per deciliter. 

The question becomes: How do you get your Apo-B down to that 20- to 30-milligrams-per-deciliter range? 

"Nutrition absolutely makes a difference," says Attia. Think reducing saturated fat intake, eating more fiber, plus plenty of other heart-healthy dietary interventions. "But even once those things are fully optimized, very few people would be able to get their Apo-B below, say, 70 milligrams per deciliter," he argues. 

To cross the finish line, he recommends a few pharmaceuticals. "We have classes of drugs called PCSK9 inhibitors3 or another drug called Ezetimibe that blocks the reabsorption of cholesterol in the gut that is being recirculated by the liver," he explains. "And [there's] even another drug that impairs cholesterol synthesis called Bempedoic Acid. These are drugs that have no side effects." 

Full disclosure: These drugs can be expensive, but hopefully that will change with more research and exposure. "It certainly makes it now feasible to get everybody's Apo-B to a desirable level," Attia adds, and identifying the solution is the first step. 

Look, lifestyle interventions are key when it comes to reducing your risk of serious health outcomes. There's no doubt about that. But according to Attia, lifestyle can only get you partially there in reducing the risk for cardiovascular disease.

Let's review: Apo-B provides a much better understanding of the level of buildup of cholesterol on your artery walls. According to Attia, Apo-B is necessary for developing heart disease, so by eradicating Apo-B, you may be able to eliminate CVD. To do so, he recommends a combination of lifestyle and pharmaceutical interventions.