At a glance

Why get tested?

Apo B is used to help evaluate your risk of developing atherosclerotic heart disease

When to get tested?

When you have a personal or family history of heart disease and/or hyperlipidaemia and your doctor is trying to determine your risk of developing cardiovascular disease (CVD). It is sometimes measured to help monitor treatment for hyperlipidaemia or to help diagnose a rare Apo B deficiency

Sample required?

A blood sample drawn from a vein in your arm

Note: This test is often ordered at the same time as other tests that require fasting, such as a LDL-C (LDL-Cholesterol), HDL-C (HDL-Cholesterol) and triglycerides; therefore, you may be instructed to fast for 12 hours prior to having this test.

What is being tested?

Apo B-100 is a protein that is an essential part of the very low density lipoprotein (VLDL) and low density lipoprotein (LDL) complexes. Apolipoprotein B helps provide structural integrity to complexes and directs transport of the water-insoluble lipids (like cholesterol and triglycerides) in blood. Apo B is recognised by LDL receptors found on the surface of many of the body's cells. These receptors promote the uptake of cholesterol into the cells.

There are actually two forms of apolipoprotein B: Apo B-100 and Apo B-48. Apo B-48 is created in the intestines. It is an integral part of the structure of chylomicrons, large lipoproteins that are responsible for the initial transport of dietary lipids to the liver. In the liver, the body repackages the lipids and combines them with Apo B-100 (made in the liver) to form triglyceride-rich VLDL. Lipoprotein lipase (LPL) is an enzyme mainly produced by adipose (fat) tissue and muscle but other tissues as well. LPL removes triglycerides from VLDL to create first, intermediate density lipoproteins (IDL) and then, low density lipoproteins (LDL - the "bad" cholesterol). Each VLDL particle contains one molecule of Apo B-100, which is retained as VLDL shrinks by losing triglyceride to become the more cholesterol-rich LDL. Laboratory tests typically measure only Apo B-100, which is often reported simply as Apo B or apolipoprotein B.

The cholesterol that LDL and Apo B-100 transport is vital for cell membrane integrity, sex hormone production, and steroid production. In excess, however, LDL can lead to fatty deposits (plaques) in artery walls and lead to hardening and scarring of the blood vessels. This atherosclerosis narrows the coronary vessels that supply the heart (coronary artery disease or CAD) and increases the risk of heart attack. The LDL cholesterol (LDL-C) test is routinely ordered as part of a lipid profile. It is usually calculated from the total cholesterol level and tends to be less reliable as triglyceride levels rise. Some labs will directly measure LDL-C levels.

Apo B-100 levels tend to mirror LDL-C levels. Some scientists think that Apo B-100 levels may eventually prove to be a better indicator of risk of atherosclerotic heart disease than LDL-C however this has not been shown to be true at present. Other cardiac risk markers are available such as Apo A-I, ApoB/Apo A1 ratio, Non-HDL-C, LDL particle size, Lp(a), and hs-CRP but have not been shown to offer a clear benefit in all cases.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.


Is any test preparation needed to ensure the quality of the sample?

There is no special preparation needed for an apolipoprotein B-100 test. However, this test is often ordered at the same time as other tests that do require fasting, such as a LDL-C, HDL-C and triglycerides. Therefore, the patient is often instructed to fast for 12 hours prior to having this test.

The Test

How is it used?

Apo B-100 levels are used, along with other lipid tests, to help determine an individual's risk of developing atherosclerotic heart disease. It is not used as a general population screen but may be ordered when a patient has a family history of heart disease and/or hyperlipidaemia. It may be performed, along with other tests, to help diagnose the cause of hyperlipidaemia, especially when someone has elevated triglyceride levels (preventing accurate LDL cholesterol calculations).

Sometimes doctors will order both Apo A-I (associated with high-density lipoprotein (HDL) - the 'good' cholesterol) and Apo B-100 levels to get a ratio of apo B/apo A to obtain additional risk information.

Occasionally Apo B-100 levels may be ordered to monitor the effectiveness of lipid treatment. In rare cases, they may be measured to help diagnose a genetic problem that causes over- or under-production of Apo B-100.

When is it requested?

Apo B-100 may be measured, along with other lipid tests, when your doctor is trying to evaluate your risk of developing atherosclerotic heart disease and when you have a personal or family history of heart disease and/or hyperlipidaemia, especially when you have significantly elevated triglyceride levels. Sometimes Apo B-100 is monitored when you are undergoing treatment for hyperlipidaemia.

What does the test result mean?

Elevated levels of Apo B-100 correspond to elevated levels of LDL-C and are associated with an increased risk of CAD. Elevations may be due to a high fat diet and/or decreased clearing of LDL from the blood. Increased levels of Apo B-100 are seen with hyperlipidaemia and in those patients with:

  • Diabetes
  • Familial hypercholesterolaemia
  • Familial combined hyperlipidaemia (an inherited disorder causing high blood levels of cholesterol and triglycerides)
  • Hypothyroidism
  • Nephrotic syndrome (a kidney disease)
  • Pregnancy (levels increase temporarily and decrease again after delivery)

Apo B-100 levels may be decreased with any condition that affects lipoprotein production or affects its synthesis and packaging in the liver. Lower levels are seen with:

  • Drugs such as: oestrogen ( in post-menopausal women), lovastatin, simvastatin, niacin, and thyroxine
  • Diet: Vegans have lower levels of Apo B-100 than meat eaters
  • Hyperthyroidism
  • Malnutrition
  • Weight reduction
  • Severe illness
  • Surgery
  • Familial hypobetalipoproteinaemia and abetalipoproteinaemia
  • Cirrohsis

A high ratio of Apo B-100/ApoA-1 (B/A) may indicate a higher risk of developing coronary artery disease.

About Reference Intervals

Is there anything else I should know?

Some elevations of Apo B-100 (and LDL-C) are due to mutations in the Apo B gene that cause it to produce Apo B-100 that is not recognised as easily by LDL receptors. Or the fault might be a mutation of the LDL receptor gene. This slows the clearing of LDL from the blood and increases the risk of heart disease. These are genetic errors that are found in familial hypercholesterolaemia.

Common Questions

Should my doctor be measuring Apo B-48?

While researchers are looking into the role of chylomicrons (the lipoprotein that contains Apo B-48), there is currently no reason to measure Apo B-48.

What can I do to lower my Apo B-100?

Improving your diet and taking more exercise can lower LDL levels (and increase HDL - the good cholesterol). This will lower your Apo B-100 levels and decrease your risk of heart disease.

Last Review Date: September 27, 2015