Biomarkers · Lipids & Apolipoproteins
Apolipoprotein B (ApoB)
Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 5% lower risk of death. Low LDL in older adults often reflects existing illness, so the raw pattern looks reversed. Trials support lowering LDL. No clear pattern in NHANES
ApoB and risk of death
Published curve higher than the NHANES fitNHANES fit higher
Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.
ApoB by age and sex
Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.
The percentiles as a table
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 52.0 | 69.0 | 84.0 | 99.0 | 136 | 695 | NHANES 2015-2016 |
| All | 40-59 | 63.0 | 83.0 | 99.0 | 117 | 145 | 759 | NHANES 2015-2016 |
| All | 60+ | 60.0 | 76.0 | 90.0 | 105 | 133 | 775 | NHANES 2015-2016 |
| All | all | 56.0 | 76.0 | 91.0 | 108 | 140 | 2,229 | NHANES 2015-2016 |
| Men | 20-39 | 53.0 | 74.0 | 90.0 | 108 | 138 | 345 | NHANES 2015-2016 |
| Men | 40-59 | 64.0 | 83.7 | 101 | 120 | 150 | 355 | NHANES 2015-2016 |
| Men | 60+ | 57.0 | 72.0 | 87.0 | 102 | 133 | 387 | NHANES 2015-2016 |
| Men | all | 57.0 | 76.0 | 92.0 | 112 | 143 | 1,087 | NHANES 2015-2016 |
| Women | 20-39 | 51.0 | 65.0 | 78.0 | 92.4 | 119 | 350 | NHANES 2015-2016 |
| Women | 40-59 | 62.6 | 82.0 | 95.0 | 115 | 141 | 404 | NHANES 2015-2016 |
| Women | 60+ | 62.3 | 78.0 | 93.0 | 108 | 133 | 388 | NHANES 2015-2016 |
| Women | all | 56.0 | 74.0 | 89.0 | 105 | 136 | 1,142 | NHANES 2015-2016 |
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in ApoB, study by study
7 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| diet | Portfolio diet (viscous fibre, plant protein, nuts, sterols) on a low-saturated-fat NCEP Step II diet | Significantly reduced apolipoprotein B vs NCEP Step II diet alone (pooled ApoB magnitude not reported; LDL-C ~17% lower) | meta-analysis | Chiavaroli L, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A… |
| diet | Diets enriched with oat beta-glucan at a median 3.5 g/day for >=3 weeks | Lowers apoB by 0.03 g/L (95% CI -0.05 to -0.02) with a median 3.5 g/day oat beta-glucan vs control diets | meta-analysis | Ho HV, et al. Br J Nutr. 2016. The effect of oat beta-glucan on… |
| pharmacologic | PCSK9 monoclonal antibody (alirocumab) added to maximally tolerated statin, vs usual care (incl. ezetimibe or fenofibrate), in type 2 diabetes | ApoB -32.3% (LDL-C -43.0%) at week 24 vs usual care | RCT | Ray KK, et al. Alirocumab vs usual lipid-lowering care as add-on to statin… |
| pharmacologic | PCSK9 monoclonal antibodies (Evolocumab / Alirocumab) | ApoB reduced 43-52% vs placebo in statin-treated patients; 54.95% with evolocumab 140 mg Q2W | meta-analysis | Huang YT, et al. Efficacy and Safety of Proprotein Convertase Subtilisin/Kexin… |
| pharmacologic | High-intensity statins (Atorvastatin 40-80mg / Rosuvastatin 20-40mg) | High-intensity statin monotherapy reduced ApoB by 32.8% (49 RCTs, 19,603 patients) | meta-analysis | Kyan K, et al. The lipid lowering efficacy of PCSK9 inhibitors alone vs… |
| pharmacologic | Obicetrapib 10 mg orally once daily for 365 days in patients with ASCVD or heterozygous familial hypercholesterolaemia on background therapy | ApoB -19.0 mg/dL (-21.7%) with obicetrapib vs -3.0 mg/dL (-3.6%) with placebo over 365 days | meta-analysis | Nicholls SJ, Nelson AJ, Ray KK, et al. Impact of Obicetrapib on Major Adverse… |
| pharmacologic | Resmetirom 100 mg orally once daily for 24 weeks in adults with NAFLD/presumed NASH (MAESTRO-NAFLD-1) | ApoB -18.0% vs placebo at 24 weeks with 100 mg (-15.6% with 80 mg); P<0.0001 | RCT | Harrison SA, et al. Nat Med. 2023. Resmetirom for nonalcoholic fatty liver… |
| supplement | Psyllium (Plantago ovata) fibre at a median ~10.2 g/day for >=3 weeks in adults with or without hypercholesterolaemia | Lowers apoB by 0.05 g/L (95% CI -0.08 to -0.03) with a median dose of 10.2 g psyllium (trials of >=3 weeks) | meta-analysis | Jovanovski E, et al. Am J Clin Nutr. 2018. Effect of psyllium (Plantago ovata)… |
| supplement | Soluble dietary fibre supplements (any type) taken daily in adults; pooled across 181 RCTs | Lowers apoB by 44.99 mg/L (95% CI -62.87 to -27.12) after soluble fibre supplementation in the overall analysis | meta-analysis | Ghavami A, et al. Adv Nutr. 2023. Soluble Fiber Supplementation and Serum Lipid… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | Familial combined hyperlipidemia and hepatic ApoB overproduction | FCH defined by hyperapoB (> 1200 mg/l) with TG > 1.5 mmol/l; driven by hepatic VLDL overproduction; affects 1 to 3% of adults | review | de Graaf J, et al. Diagnostic criteria in relation to the pathogenesis of… |
| diet | Saturated-fat (palm oil) diets vs MUFA/PUFA diets; trans-fat diets vs palm oil | ApoB significantly higher with palm oil (saturated) diets than MUFA/PUFA diets, and higher with trans-fat diets than palm oil diets (effect size not reported) | meta-analysis | Fattore E, et al. Palm oil and blood lipid-related markers of cardiovascular… |
Sources
- Risk curve: Yang 2024 (PMID 38241044): all-cause HR 1.11 (1.06-1.16) per SD increase in genetically predicted apoB (mendelian randomization). Scaled to US values (NHANES).
- Yang et al. Dose-Response Associations of Lipid Traits With Coronary Artery Disease and Mortality. JAMA network open. 2024;7:e2352572.
- NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.
Map Apolipoprotein B (ApoB) against another biomarker.
Related markers: Apolipoprotein A1 (ApoA1) · HDL Cholesterol · LDL Cholesterol · Lipoprotein(a) [Lp(a)] · Remnant Cholesterol · Serum Triglycerides · Total Cholesterol