How do you lower an elevated ApoB?

ApoB is a protein found on virtually all 'bad' fat particles in your blood, including LDL. The more ApoB you have, the more of those particles are circulating. An observational study across 32 countries found that a high ApoB level relative to the protective protein ApoA1 is associated with nearly twice the risk of ischaemic stroke¹. That is an association, not a proven cause, but it illustrates why this number is taken seriously.

The most powerful approach is PCSK9 inhibitors. These are drugs that block a liver enzyme, allowing the liver to clear more fat particles from the blood. Inclisiran is an injection needed only twice a year and substantially lowers ApoB, in line with an LDL reduction of approximately 44%, in people for whom statins alone are not sufficient². Alirocumab not only lowers ApoB but also reduces the harmful properties of those particles, and decreases the risk of serious cardiovascular events in heart patients³. Both drugs are approved and well tolerated.

In terms of diet, oats are the most thoroughly studied option. A meta-analysis of 58 studies involving nearly 4,000 participants shows that approximately 3.5 grams of beta-glucan (a type of fibre from oats) per day, equivalent to a large bowl of porridge, lowers ApoB by an average of 0.03 g/l⁴. Statistically reliable, but modest in absolute terms. If your level is mildly elevated, this is a worthwhile step. If it is substantially elevated, diet alone will not be enough.

Muvalaplin is an experimental pill developed primarily to lower lipoprotein(a), another risk factor. In a 12-week study it also reduced ApoB, from approximately 9% at the lowest dose to 16% at the highest dose⁵. It was well tolerated, but whether it actually prevents cardiovascular events has not yet been studied. It is therefore not yet an available treatment.