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Biomarker library / Lipids

Apolipoprotein B (ApoB)

Also called apo B, apoB-100

Each atherogenic lipoprotein particle (LDL, VLDL, IDL, lipoprotein(a)) carries exactly one apolipoprotein B molecule, so ApoB is a count of those particles rather than the cholesterol they carry. Two people can have the same LDL-C and different particle counts.

Written by the VitalDecades editorial team Reviewed by the editorial review process Updated

01  /  Reference ranges

What counts as normal

Scale in mg/dL. Cut points from the sources listed below.
Population Adults, primary prevention (2018 AHA/ACC)
Category Risk-enhancing factor
Range 130 or higher mg/dL Corresponds to an LDL-C of about 160 mg/dL per the guideline.
Source 2018 AHA/ACC Multisociety Guideline on the Management of Blood Cholesterol

Effective

Population Very high ASCVD risk (NLA 2024 US consensus)
Category Treatment threshold for intensification
Range 60 or higher mg/dL
Source National Lipid Association Expert Clinical Consensus on apolipoprotein B (2024)

Effective

Population High ASCVD risk (NLA 2024)
Category Treatment threshold
Range 70 or higher mg/dL
Source National Lipid Association Expert Clinical Consensus on apolipoprotein B (2024)

Effective

Population Borderline to intermediate ASCVD risk (NLA 2024)
Category Treatment threshold
Range 90 or higher mg/dL
Source National Lipid Association Expert Clinical Consensus on apolipoprotein B (2024)

Effective

Population Very high CV risk (2019 ESC/EAS)
Category ApoB secondary goal
Range under 65 mg/dL
Source 2019 ESC/EAS Guidelines for the management of dyslipidaemias

Effective

Population High CV risk (2019 ESC/EAS)
Category ApoB secondary goal
Range under 80 mg/dL
Source 2019 ESC/EAS Guidelines for the management of dyslipidaemias

Effective

Population Moderate CV risk (2019 ESC/EAS)
Category ApoB secondary goal
Range under 100 mg/dL
Source 2019 ESC/EAS Guidelines for the management of dyslipidaemias

Effective

Population Untreated US adults, NHANES 2005 to 2016 (NLA 2024)
Category Population median (50th percentile)
Range 90 to 90 mg/dL 90th percentile 125 mg/dL; 95th percentile 137 mg/dL.
Source National Lipid Association Expert Clinical Consensus on apolipoprotein B (2024)

Effective

Normal vs optimal

Lab reference intervals for ApoB vary and are typically population-based, not outcome-based. The numbers above are thresholds and goals from guideline bodies, and they differ by risk category and by continent. If your report prints a single "normal" cutoff, ask which body it comes from.

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02  /  Why it matters

What the number tells you

US guidelines have been cautious. The 2018 AHA/ACC guideline lists ApoB of 130 mg/dL or higher as a risk-enhancing factor for the statin discussion, noting a relative indication to measure it when triglycerides are 200 mg/dL or above, and that 130 mg/dL corresponds to an LDL-C of about 160. The National Lipid Association's 2024 expert consensus goes further, suggesting ApoB treatment thresholds of 60, 70 and 90 mg/dL for very high, high, and borderline-to-intermediate risk, chosen to line up with existing LDL-C and non-HDL-C thresholds. It also states plainly that US guidelines have not set specific ApoB thresholds. In Europe the 2019 ESC/EAS guideline sets ApoB secondary goals of under 65, 80 and 100 mg/dL for very high, high and moderate risk.

  • Population context (NLA 2024, NHANES 2005 to 2016, untreated US adults): the median ApoB is 90 mg/dL, the 90th percentile 125, the 95th percentile 137.

03  /  In practice

Testing and what moves it

When it is tested

  • Not part of a standard lipid panel; ordered separately or as part of an advanced lipid test.
  • The 2018 AHA/ACC guideline names elevated triglycerides (200 mg/dL or higher) as a relative indication to measure it.
  • Fasting is not required for ApoB.

What raises it

  • The same drivers as LDL-C plus insulin resistance and high triglycerides, which raise the number of small dense particles without a matching rise in LDL-C.

What lowers it

  • Statins, ezetimibe and PCSK9 inhibitors lower ApoB alongside LDL-C; weight loss and better glycemic control lower the triglyceride-rich fraction.

04  /  Related

Read next

HDL cholesterol HDL-CLDL cholesterol LDL-CTriglycerides TG

Frequently asked questions

Is ApoB better than LDL cholesterol? ▼

ApoB counts atherogenic particles; LDL-C measures the cholesterol they carry. The NLA 2024 consensus supports using ApoB to refine risk and guide intensity, especially when triglycerides are high or LDL-C looks discordant with overall risk. US guidelines have not replaced LDL-C with ApoB.

What ApoB should I aim for? ▼

It depends on your risk category and which body's numbers your clinician uses. NLA 2024 suggests under 60, 70 or 90 mg/dL by risk tier; ESC/EAS 2019 uses under 65, 80 or 100. For an average-risk adult, the US population median is 90 mg/dL.

Do I need to fast for ApoB? ▼

No.