ApoB & Lp(a): The Silent Risk Factors You Need to Know

When it comes to your health, knowledge isn’t just power—it’s prevention. One of the most impactful yet overlooked ways to stay ahead of potential health issues is by getting comprehensive bloodwork done annually. This isn’t just about cholesterol or blood sugar. It’s about digging deeper into your personal risk factors—especially when it comes to your heart.

Let’s break it down: why does annual bloodwork matter, and what markers should everyone be asking for with regards to cardiovascular health?

The Basics Are No Longer Enough

For years, conventional blood panels have focused on “total cholesterol,” HDL, LDL, and triglycerides. While these numbers are helpful, they don’t always tell the full story—especially if you have a family history of cardiovascular disease.

Two critical markers that often go untested are ApoB and Lp(a). If you're serious about preventing heart disease or stroke, it's time to get familiar with these two game-changers.

What is ApoB?

Apolipoprotein B (ApoB) is the protein that carries LDL (“bad”) cholesterol in your blood. It’s a more accurate indicator of cardiovascular risk than LDL alone. Why? Because ApoB counts the number of cholesterol-carrying particles, not just the total amount of cholesterol inside them.

Ideal Target: Less than 70 mg/dL, especially if you have risk factors or a family history of heart disease.

What is Lp(a)?

Lipoprotein(a)—also called Lp(a)—is a type of LDL particle that’s inherited (and sticky). High levels can dramatically increase your risk of heart attacks, strokes, and valve disease, regardless of how “normal” your LDL may be. Although there are officially no medications to treat this hereditary marker, PCSK9 inhibitors are sometimes used off label to reduce Lp(a) levels, with reductions typically ranging from 20% to 30%. With high Lp(a), you may also want to be more aggressive with treating other high lipid markers, LDL/ApoB. And since it is inherited, if your levels are high, your childrens levels may also be and therefore should be checked.

Ideal Target: As low as possible, generally under 30 mg/dL. Many people don’t know they have elevated Lp(a) until it's too late.

Why Test for These?

Because you can’t manage what you don’t measure. If your ApoB or Lp(a) levels are high, you may be at increased risk even if your regular cholesterol panel looks “fine.” And more importantly—there are now effective ways to treat it.

The Power of Prevention:

There have been several human clinical trials conducted on whether or not diet can help lower Lp(a) and ApoB. The evidence has shown diet has no effect on Lp(a). It can, however, help with ApoB levels by reducing saturated fats, trans fats and added sugars and eating more plant-based foods, unsaturated fats and fiber but how much? That depends on several factors for each individual, how high their numbers are, how much they room they have to improve in their diet, etc. We know now evidence is clear how important animal protein is for longevity, supporting muscle growth and repair, providing essential nutrients and potentially reducing the risk of certain diseases. Therefore when looking at the big picture, medication options may allow for optimal health. Let’s talk treatment. If you or your doctor discover elevated ApoB or Lp(a), there are smart, safe, and proven interventions that can help.

Medication Options:

5 mg Rosuvastatin: The Super Statin

• Just 5 mg (a microdose!) of Rosuvastatin can reduce ApoB levels by approximately 30%.

• It’s powerful, well-tolerated, and unlike higher doses, it’s not associated with cognitive decline, in fact, can have anti-inflammatory benefits.

Zetia (Ezetimibe): A Helper for Hyperabsorbers

• Some people absorb more cholesterol from their diet—a trait called “hyperabsorber.”

• Zetia works in the gut to block absorption and is often added to low-dose statins when ApoB is still above 70.

PCSK9 Inhibitors: The Next Level

• These are injectable monoclonal antibodies that reduce both ApoB and Lp(a).

• Ideal for those with very high inherited risk or who don't tolerate statins and/or Zetia well.

• Brands include Repatha and Praluent, and they’re making life-saving strides in cardiovascular medicine.

The Bottom Line

Getting the right bloodwork—including ApoB and Lp(a)—is a vital step in protecting your heart and your future. If you're not checking these markers yearly, you could be missing silent risks. The good news? Once you know, you can take action.

Don't settle for the basics. Advocate for your health, ask for the deeper tests, and work with a provider who takes prevention seriously.

Because when it comes to your heart, every number matters.