Elevated ApoB? Heart surgeon Dr Jeremy London shares 2 lifestyle changes and other ways to lower Apolipoprotein B

High ApoB can be concerning because it raises risk of heart attack and stroke. Dr London shares strategies to lower the number and protect your heart health.

When it comes to heart health, cholesterol is one of the first numbers people look at. But while routine cholesterol tests can flag whether your levels are high, they don't reveal the full picture. Standard lipid panels measure the amount of cholesterol in your blood, not the number of harmful particles that can penetrate artery walls and increase your risk of a heart attack or stroke. That's where Apolipoprotein B (ApoB) comes in – a more precise marker that offers a better assessment of cardiovascular risk.

Dr Jeremy London, a board-certified cardiothoracic surgeon with over 25 years of experience, is explaining why ApoB is one of the most important markers of cardiovascular health. In an Instagram video shared on August 5, the heart surgeon discusses why he recommends checking ApoB levels every six months and shares practical strategies to lower them and reduce the risk of heart disease.

What is ApoB?

Apolipoprotein B (ApoB) is one of the most reliable cholesterol markers for assessing your cardiovascular risk. According to Dr London, it provides a more accurate measure of the harmful atherogenic particles in your blood like LDL, VLDL, IDL and Lp(a).

The heart surgeon explains, “ApoB counts the actual atherogenic particles in your blood, and it’s the best predictor we have for heart attack and stroke risk. It's a more granular way of looking at cholesterol. It measures the atherogenic particles, the ones that can actually penetrate the vessel wall. The problem is this isn't included on most primary care panels.”

Since ApoB is not typically included in standard blood panels, it is important to request this test separately. Dr London says he and his family have their ApoB levels checked every six months to stay informed about their cardiovascular health and monitor any potential risk.

How to lower ApoB?

Once you know your ApoB levels, lowering them comes down to two key lifestyle changes: improving your diet and exercising regularly.

Diet

Dr London recommends cutting back on foods high in saturated fats, refined carbohydrates and added sugars, and replacing them with fibre-rich foods to help lower ApoB levels. He advises, “Swap saturated fat for unsaturated (olive oil, nuts, fatty fish). Add soluble fibre (oats, beans, psyllium). Cut refined carbs and added sugar.”

Exercise

The heart surgeon recommends regular exercise for two main reasons: building muscle and losing weight. Strength training helps increase muscle mass, which improves insulin sensitivity, while weight loss reduces visceral fat – a major contributor to cardiovascular disease.

Other lifestyle changes

Highlighting the role of having a healthier lifestyle, Dr London adds, “Losing visceral fat, regular exercise, cutting back on alcohol, and prioritising sleep all move the needle – sometimes more than people expect.”

Medications

If you've improved your diet, exercised regularly and made other healthy lifestyle changes but your ApoB levels remain elevated, it may be time to discuss medication with your healthcare provider. Dr London recommends, “When diet and lifestyle aren’t enough, statins, ezetimibe, and PCSK9 inhibitors are proven tools – not a failure, just science doing its job. This is the point where you are trying to decrease risk and maximise benefit. This is a discussion that you need to have with your health care professional.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. It is based on user-generated content from social media. HT.com has not independently verified the claims and does not endorse them.

Dr Jeremy London is a board-certified cardiovascular surgeon with more than 25 years of experience. He has an MD from the Medical College of Georgia at Augusta University, and his focus is on the intersection of lifestyle, preventive medicine, and evidence-based longevity.