Heart and vessels · Blood

Apolipoprotein B

The protein on every LDL and VLDL particle; counts the number of harmful cholesterol particles and complements LDL and non-HDL.

At a glance

Measured in blood
In 7 test panels
No special preparation

Explanation

Apolipoprotein B: what is measured?

Apolipoprotein B (ApoB) is the protein found on all cholesterol particles that can cause hardening of the arteries: LDL, VLDL, IDL and lipoprotein(a). Each particle carries exactly one ApoB molecule, so the ApoB value reflects the number of these particles, while LDL cholesterol measures the amount of cholesterol inside them. ApoB and LDL usually rise and fall together. They diverge in people with many small, cholesterol-poor LDL particles, such as with overweight, high triglycerides and type 2 diabetes; LDL then underestimates the risk and ApoB (or non-HDL) gives a better picture.

What can it detect?

Raised risk of cardiovascular disease due to a large number of LDL and VLDL particles
Risk underestimated by LDL cholesterol in people with high triglycerides, overweight or diabetes
Effect of cholesterol-lowering treatment, also when LDL cannot be calculated reliably because of high triglycerides

Result

What does the result mean?

Apolipoprotein B too high

A raised ApoB means many harmful cholesterol particles in the blood and fits a higher risk of hardening of the arteries, even if LDL cholesterol still seems acceptable. It causes no symptoms. The causes are the same as for a high LDL and high triglycerides: predisposition (including inherited high cholesterol), diet, overweight, type 2 diabetes, an underactive thyroid, kidney disease with protein loss, blocked bile flow, pregnancy and medicines such as corticosteroids and some beta blockers. How much weight a raised ApoB carries depends, as with LDL, on the other risk factors.

Apolipoprotein B too low

A low ApoB is favorable and means few harmful particles; it fits predisposition, a healthy lifestyle or the use of statins and other cholesterol-lowering medicines. An unexpectedly low or falling ApoB may go with an overactive thyroid, malnutrition, severe liver disease, an acute illness or a rare inherited disorder of fat metabolism. It causes no symptoms.

After an abnormal result

The GP assesses ApoB alongside LDL, non-HDL and the overall risk profile; a raised ApoB does not lead to a different approach than a raised LDL or non-HDL: lifestyle, a repeat measurement and, at high risk, a statin. With strongly raised values or a family history, referral for testing for inherited high cholesterol may follow.

Reliability

How reliable is the test?

ApoB is a risk marker, not a test that proves a disease. In the Netherlands, risk is estimated with SCORE2 based on non-HDL cholesterol, and treatment is guided by LDL or non-HDL. According to the multidisciplinary Dutch cardiovascular risk management guideline (CVRM, Richtlijnendatabase), ApoB is a comparable measure of the harmful particles to non-HDL; non-HDL follows from the standard lipid profile without an extra measurement. ApoB mainly adds value when LDL and non-HDL diverge. You do not need to fast for this test.

What can affect the result?

There are no Dutch cut-off values for ApoB; the limits used come from international guidelines and laboratory references.
During and for a few weeks after an acute illness, surgery or heart attack, the value is temporarily lower.
Pregnancy, thyroid function, kidney and liver disease and medicines (corticosteroids, some beta blockers, estrogens, cholesterol-lowering medicines) affect the value.
Laboratories use different measurement methods; preferably compare results within the same laboratory.

Who it is for

Who is the test useful for?

Useful for

Useful as an addition to the standard lipid profile in people with high triglycerides, overweight, type 2 diabetes or the metabolic syndrome, in whom LDL can underestimate the risk, and for monitoring treatment when LDL cannot be calculated reliably. For most people, ApoB adds little to LDL and non-HDL, because the values usually rise together. Without total cholesterol, HDL and triglycerides alongside it, a single ApoB value is hard to interpret.

How common is it?

There are no separate Dutch figures for a raised ApoB; it largely goes together with a raised LDL. In 2024, more than 1.6 million people in the Netherlands were known to their GP with a disorder of fat metabolism, including high cholesterol; that is about 9 in 100 inhabitants, most often between the ages of 55 and 70.

VZinfo (RIVM) based on Nivel primary care registrations, 2024

Drawbacks and risks

ApoB is often presented online as a 'better' test than LDL; for most people it gives the same information, and an abnormal value without the complete profile can lead to unnecessary worry.

Get tested

Apolipoprotein B: test panels

Apolipoprotein B is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Blood draw
Apolipoprotein B (ApoB)
ApoB; atherogenic lipoprotein particle number.
€ 35,00
Fingerstick
Apolipoprotein B (ApoB)
ApoB; atherogenic lipoprotein number.
€ 35,00
Blood draw
InsideTracker
InsideTracker Blood Analysis: analyze 48 biomarkers for complete health optimization and personalized recommendations.
€ 335,00
Blood draw
Cardio Profile Extensive
Complete lipids, Lipoprotein(a), Apolipoprotein B/A1, kidney function and blood sugar. Advanced cardiovascular risk analysis.
€ 165,00
Blood draw
Supplemental: Testosterone Replacement Therapy (TRT)
Complete hormonal analysis with testosterone, DHEA-S, thyroid, blood count, liver function, kidney function, lipids, glucose, HbA1c, insulin, hs-CRP, vitamin D and ferritin.
€ 335,00
Blood draw
Whoop (Advanced Labs)
Comprehensive blood analysis with biomarkers that integrates directly with your WHOOP wearable for optimal performance and recovery.
€ 385,00
Blood draw
Platos Panel
A fixed metabolic blood panel with 14 markers — blood sugar, insulin sensitivity, heart and liver health, inflammation and stress .
€ 149,00

How reliable is the test?

Apolipoprotein B