Life Extension Magazine®
Man holding chest before taking blood test

Issue: Jun 2019

Why Blood Tests Are Not Saving More Lives

Low blood levels of a cholesterol surface particle called apolipoprotein B have been shown to decrease risk of coronary artery disease by 90%. Another study showed regression of arterial plaque when apolipoprotein B is reduced. Find out easy steps to reduce your apolipoprotein B levels. (The popular Male and Female Blood Test Panels include apolipoprotein B and other reversible vascular risk factors.)

By William Faloon.

William Faloon
William Faloon

Back in the 1950s, a scientist uncovered the link between LDL cholesterol and atherosclerosis.1,2

Critics argued that heart attacks occurred in some people who did not have excess LDL.

What was not known in early years is that there are different types of LDL particles.

Apolipoprotein B is found on all non-HDL cholesterol particles, such as LDL and VLDL.

High apolipoprotein B is a recognized marker for damage to arterial walls and risk of atherosclerosis.

In some populations, those who maintain low lifetime apolipoprotein B levels have an approximately 90% decreased risk of coronary artery disease.3

What impresses us is evidence showing regression of arterial plaque when apolipoprotein B blood levels are reduced.4

Despite intensive educational efforts, apolipoprotein B blood tests are not routinely incorporated into primary care medicine. The tragic result is a failure to prevent heart attacks, strokes, and other occlusive arterial diseases.

What you need to know

Mainstream medicine has not kept up with scientific literature by suggesting the most accurate blood tests to assess disease risk. Total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels do not paint the full picture for heart disease risk. Scientific research has revealed that high levels of a protein on the surface of non-HDL particles, called apolipoprotein B, is a very accurate and overlooked biomarker. A recent study has showed that even when total cholesterol and HDL are in healthy ranges, high levels of apolipoprotein B can increase heart disease risk by about 60%.

For Life Extension® readers, this problem was resolved when apolipoprotein B was added to comprehensive blood tests they undergo each year.

We know today that atherosclerosis is a result of a myriad of risk factors. These include elevated glucose, insulin, homocysteine, triglycerides, and inflammation,5,6 along with hormone imbalances.

This article reveals how coronary artery stenting, bypass surgery, and sudden death can be reduced via inclusion of apolipoprotein B in annual blood test panels.

Heart attack incidence peaked in the year 1968, accounting for 37% of all deaths in the United States.7,8

The epidemic was alarming, as it often targeted otherwise healthy people at the peak of their careers.

Advances in prevention and treatment led to marked reductions in sudden death and improved survival in those stricken.

While heart disease remains the leading killer, it is responsible for 25% of American deaths today compared to 37% in 1968.9,10

As blood testing evolves to better detect artery-damaging factors, further declines in coronary artery disease and ischemic stroke are likely.

Dietary Changes for Lowering Apolipoprotein B

Those who follow a more Mediterranean style diet have a reduced incidence of cardiovascular disease and lower apolipoprotein B blood levels.29,30 Here are some additional dietary suggestions:

  • Eat far fewer saturated fats (such as butter, palm oil, coconut oil, meat fats, and milk fats); trans fats (such as margarine, vegetable shortening, and partially hydrogenated oils); and dietary cholesterol.
  • Eat far more fiber-rich foods (especially soluble fiber from beans, yams, tree nuts, oats, barley, and berries).
  • Eat vegetable proteins (such as tofu and beans) in place of meat and poultry.
  • Eat fewer added sugars and refined grains (such as white flour).
  • Eat more cold-water fish.

Role of Lipoproteins

Apolipoprotein B is linked to the initiation and propagation of atherosclerosis.11

High levels of apolipoprotein B penetrate the inner arterial wall (the endothelium) and set the stage for blockage of blood flow.12-14

Those whose blood test shows elevated cholesterol and apolipoprotein B are especially at risk.15-17

To put this in perspective, higher apolipoprotein B levels have been associated with a 60% increase in coronary heart disease when total cholesterol and HDL are in safer ranges.18

In people with higher levels of cholesterol and apolipoprotein B, along with lower HDL, there is a 160% increased incidence of coronary disease.18

Elevated apolipoprotein B is a more reliable marker for cardiovascular disease than LDL, HDL, and total cholesterol.19-22

The good news is that apolipoprotein B can be easily tested in one's blood and reduced to safe ranges if need be.

Eat Walnuts

Healthy foods

A myriad of studies associates walnut consumption with reduced risk of coronary heart disease.23-26

A study assessed a range of cardiovascular risk markers in response to a diet containing about 1.52 ounces of walnuts daily for eight weeks compared to a typical Western diet.23

Two benefits of walnut consumption in this trial were a modest non-HDL cholesterol reduction and a more pronounced 5.5% reduction in apolipoprotein B.23

These findings led the researchers to conclude that the observation of reduced cardiovascular events in people who eat walnuts may be explained in part by reduced non-HDL cholesterol and apolipoprotein B.23

A follow-up analysis looked at previous studies that evaluated consumption of tree nuts and found reductions in apolipoprotein B in type II diabetics who consumed higher amounts of tree nuts.27

Avoid Sugar

An investigation looked at associations of apolipoprotein B blood levels with education, lifestyle factors, and dietary patterns.28

The intake of sucrose and foods containing added sugar (such as pastries, sweets, jam and sugar-sweetened beverages) correlated with higher apolipoprotein B
levels.28

This study identified other unhealthy factors such as smoking, obesity, and low physical activity with unfavorable lipoprotein profiles.

Exercise Training

Man exercising

A one-year study of overweight, healthy men found a reduction in apolipoprotein B (but not LDL cholesterol) in response to exercise training.31

This led the authors of the study to postulate that exercise might make LDL less atherogenic by reducing apolipoprotein B.

Importance of Sleep

A Chinese study looked at the relationship of sleep duration and apolipoprotein B blood levels using data from 7,381 subjects.32

The participants were divided into three categories according to sleep duration: less than six hours, seven to eight hours, and more than nine hours.32

The study found that short sleep duration (under 6 hours) in women was associated with 1.75-fold greater odds of elevated apolipoprotein B compared to women who got 7-8 hours of sleep per night.32

Longer sleep duration in men was associated with decreased apolipoprotein B. The study authors concluded:

"Sleep hygiene management could serve to treat and prevent cardiovascular diseases by altering unfavorable apolipoprotein profile."32

Thyroid Hormones and Lipoproteins

People with insufficient thyroid hormones can have elevated cholesterol, LDL, triglycerides and apolipoprotein B.33-35

In some cases, people are prescribed statin drugs to lower cholesterol when the appropriate use of a thyroid hormone medication would normalize their lipid profile.

One of several studies on this topic concluded by stating:

"A reduction in lipid and lipoprotein levels after thyroid hormone replacement in our study cohort resulted in a less atherogenic profile."36

Effects of Fish Oil

The effects of fish oil (1,800 mg of EPA and 1,200 mg of DHA a day) were studied on 10 healthy males for four weeks.37

The result was about a 30% reduction in production of apolipoprotein B and reductions in other vascular risk factors like triglycerides and VLDL.37

Note that this EPA/DHA dose of 3,000 mg a day is much higher than many fish oil studies that sometimes use less than 1,000 mg a day.

What is Apolipoprotein B?
Blood test tube

Apolipoprotein B is found on all cholesterol particles except HDL.43

This includes LDL and VLDL (very-low-density-lipoproteins). High levels of VLDL increase the synthesis and secretion of apolipoprotein B.44

Higher apolipoprotein B generally equates to a higher amount of glycated and oxidized LDL particles, which are initiators of arterial plaque.45,46

Acute Risk of Excess Apolipoprotein B

A review of factors that underlie acute heart attack revealed a startling finding.

Amongst those with the greatest risk were current smokers and people with elevated blood ratios of apolipoprotein B to apolipoprotein A1.38 (Apolipoprotein A1 is the major protein component of beneficial HDL.)

This comprehensive analysis identified other known causes of heart attack such as hypertension and diabetes. It then listed protective factors including daily consumption of fruits and vegetables, exercise, and modest consumption of alcohol.38

Study participants who were non-diabetic, did not smoke, and had no lipid abnormalities, including high blood ratio of apolipoprotein B to apolipoprotein A1, showed large reductions in acute heart attack risk.38

A separate study found that the cruciferous vegetable extract I3C (indole-3-carbinol) reduced apolipoprotein B secretion from liver cells as much as 56%.39 This may be a mechanism by which plant foods like broccoli reduce cardiovascular risks.

Drugs That Lower Apolipoprotein B

Prescription drugs that lower cholesterol and LDL also reduce blood levels of apolipoprotein B.40

A potentially beneficial mechanism of statin drugs and the new PCSK-9 inhibitors (like Repatha®) is that they can lower LDL down to around 30 mg/dL. Normal target goals for LDL are below 70-100 mg/dL.41

Some people tolerate statin drugs, while others encounter unbearable side effects.42

We are intrigued by the potential of drugs like Repatha® to potentially reverse atherosclerosis by driving lipoproteins down to the levels of those seen in healthy teenagers. The problem is that even at a reduced price of $5,900 a year, Repatha is cost-prohibitive and seldom covered by insurance.

I know most readers of Life Extension Magazine seek non-drug solutions whenever possible.

With the availability of apolipoprotein B blood tests, one can choose to utilize some of the natural interventions described so far and verify efficacy with follow-up blood tests.

Apolipoprotein B and Fasting Insulin—No Added Cost!

Those with high apolipoprotein B blood levels are at greater risk for coronary artery disease.47

Last year we added the apolipoprotein B to the Male and Female Blood Panels at no additional cost.

If an apolipoprotein B blood test result shows high levels, steps can be initiated to correct this.

This year we added fasting insulin to the Male and Female Panels and kept our same low price. High fasting insulin levels may indicate that type II diabetic complications are manifesting.

High insulin levels may also interfere with one's ability to lose weight.

Annual Lab Test Super Sale

Optimal blood levels

The high cost of conventional blood testing precludes many people from availing themselves of this life-saving diagnostic.

We resolved this 23 years ago by enabling our readers to order low-cost blood tests direct, and then to visit a drawing station in their area at their convenience.

Results come back in less than a week and are emailed and mailed to you.

If you have any questions, our Wellness Specialists are available to assist seven days a week at no charge.

Once a year, we discount prices of all lab tests. This serves as a convenient reminder to have one's annual tests performed and save up to 50% in the process.

This year's lab test super sale expires on June 3, 2019.

To view the extensive array of tests included in these comprehensive panels, please see the full description by turning this page.

To order the new Male or Female Blood Panels (that include apolipoprotein B) for $199, call 1-800-208-3444 or log on to: www.lifeextension.com/blood

For longer life,

For Longer Life

William Faloon, Co-Founder
Life Extension Foundation Buyers Club

References

  1. Gofman JW. Serum lipoproteins and the evaluation of atherosclerosis. Ann N Y Acad Sci. 1956 Nov 16;64(4):590-5.
  2. Gofman JW, Lindgren F. The role of lipids and lipoproteins in atherosclerosis. Science. 1950 Feb 17;111(2877):166-71.
  3. Tabas I, Williams KJ, Boren J. Subendothelial lipoprotein retention as the initiating process in atherosclerosis: update and therapeutic implications. Circulation. 2007 Oct 16;116(16):1832-44.
  4. Masson W, Siniawski D, Lobo M, et al. Association between LDL-C, Non HDL-C, and Apolipoprotein B Levels with Coronary Plaque Regression. Arq Bras Cardiol. 2015 Jul;105(1):11-9.
  5. Available at: https://www.nhlbi.nih.gov/health-topics/atherosclerosis. Accessed March 25, 2019.
  6. Rafieian-Kopaei M, Setorki M, Doudi M, et al. Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prev Med. 2014 Aug;5(8):927-46.
  7. Available at: https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-846.pdf. Accessed March 25, 2019.
  8. Available at: https://www.cdc.gov/nchs/data/vsus/mort68_2a.pdf. Accessed March 25, 2019.
  9. Available at: https://www.cardiosmart.org/heart-basics/cvd-stats. Accessed March 27, 2019.
  10. Available at: https://www.cdc.gov/heartdisease/facts.htm. Accessed March 27, 2019.
  11. Shapiro MD, Fazio S. Apolipoprotein B-containing lipoproteins and atherosclerotic cardiovascular disease. F1000Res. 2017;6:134.
  12. Available at: https://www.ncbi.nlm.nih.gov/books/nbk343489. Accessed,
  13. Ohwada T, Sakamoto T, Kanno Y, et al. Apolipoprotein B correlates with intra-plaque necrotic core volume in stable coronary artery disease. PLoS One. 2019;14(2):e0212539.
  14. Boren J, Williams KJ. The central role of arterial retention of cholesterol-rich apolipoprotein-B-containing lipoproteins in the pathogenesis of atherosclerosis: a triumph of simplicity. Curr Opin Lipidol. 2016 Oct;27(5):473-83.
  15. Mora S, Buring JE, Ridker PM. Discordance of low-density lipoprotein (LDL) cholesterol with alternative LDL-related measures and future coronary events. Circulation. 2014 Feb 4;129(5):553-61.
  16. Williams K, Sniderman AD, Sattar N, et al. Comparison of the associations of apolipoprotein B and low-density lipoprotein cholesterol with other cardiovascular risk factors in the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2003 Nov 11;108(19):2312-6.
  17. St-Pierre AC, Cantin B, Dagenais GR, et al. Low-density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13-year follow-up data from the Quebec Cardiovascular Study. Arterioscler Thromb Vasc Biol. 2005 Mar;25(3):553-9.
  18. Lamarche B, Moorjani S, Lupien PJ, et al. Apolipoprotein A-I and B levels and the risk of ischemic heart disease during a five-year follow-up of men in the Quebec cardiovascular study. Circulation. 1996 Aug 1;94(3):273-8.
  19. Levinson SS. Comparison of apolipoprotein B and non-high-density lipoprotein cholesterol for identifying coronary artery disease risk based on receiver operating curve analysis. Am J Clin Pathol. 2007 Mar;127(3):449-55.
  20. Contois JH, McConnell JP, Sethi AA, et al. Apolipoprotein B and cardiovascular disease risk: position statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices. Clin Chem. 2009 Mar;55(3):407-19.
  21. Ference BA, Kastelein JJP, Ginsberg HN, et al. Association of Genetic Variants Related to CETP Inhibitors and Statins With Lipoprotein Levels and Cardiovascular Risk. Jama. 2017 Sep 12;318(10):947-56.
  22. Trompet S, Packard CJ, Jukema JW. Plasma apolipoprotein-B is an important risk factor for cardiovascular disease, and its assessment should be routine clinical practice. Current Opinion in Lipidology. 2018;29(1):51-2.
  23. Wu L, Piotrowski K, Rau T, et al. Walnut-enriched diet reduces fasting non-HDL-cholesterol and apolipoprotein B in healthy Caucasian subjects: a randomized controlled cross-over clinical trial. Metabolism. 2014 Mar;63(3):382-91.
  24. Guasch-Ferre M, Li J, Hu FB, et al. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: an updated meta-analysis and systematic review of controlled trials. Am J Clin Nutr. 2018 Jul 1;108(1):174-87.
  25. Munoz S, Merlos M, Zambon D, et al. Walnut-enriched diet increases the association of LDL from hypercholesterolemic men with human HepG2 cells. J Lipid Res. 2001 Dec;42(12):2069-76.
  26. Chisholm A, Mann J, Skeaff M, et al. A diet rich in walnuts favourably influences plasma fatty acid profile in moderately hyperlipidaemic subjects. Eur J Clin Nutr. 1998 Jan;52(1):12-6.
  27. Del Gobbo LC, Falk MC, Feldman R, et al. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. Am J Clin Nutr. 2015 Dec;102(6):1347-56.
  28. Frondelius K, Borg M, Ericson U, et al. Lifestyle and Dietary Determinants of Serum Apolipoprotein A1 and Apolipoprotein B Concentrations: Cross-Sectional Analyses within a Swedish Cohort of 24,984 Individuals. Nutrients. 2017 Feb 28;9(3).
  29. Sola R, Fito M, Estruch R, et al. Effect of a traditional Mediterranean diet on apolipoproteins B, A-I, and their ratio: a randomized, controlled trial. Atherosclerosis. 2011 Sep;218(1):174-80.
  30. Aros F, Estruch R. Mediterranean diet and cardiovascular prevention. Rev Esp Cardiol (Engl Ed). 2013 Oct;66(10):771-4.
  31. Holme I, Hostmark AT, Anderssen SA. ApoB but not LDL-cholesterol is reduced by exercise training in overweight healthy men. Results from the 1-year randomized Oslo Diet and Exercise Study. J Intern Med. 2007 Aug;262(2):235-43.
  32. Ren H, Liu Z, Zhou X, et al. Association of sleep duration with apolipoproteins and the apolipoprotein B/A1 ratio: the China health and nutrition survey. Nutr Metab (Lond). 2018;15:1.
  33. Gutch M, Rungta S, Kumar S, et al. Thyroid functions and serum lipid profile in metabolic syndrome. Biomed J. 2017 Jun;40(3):147-53.
  34. Chin KY, Ima-Nirwana S, Mohamed IN, et al. The relationships between thyroid hormones and thyroid-stimulating hormone with lipid profile in euthyroid men. Int J Med Sci. 2014;11(4):349-55.
  35. Jain RB. Associations between the levels of thyroid hormones and lipid/lipoprotein levels: Data from National Health and Nutrition Examination Survey 2007-2012. Environ Toxicol Pharmacol. 2017 Jul;53:133-44.
  36. Martinez-Triguero ML, Hernandez-Mijares A, Nguyen TT, et al. Effect of thyroid hormone replacement on lipoprotein(a), lipids, and apolipoproteins in subjects with hypothyroidism. Mayo Clin Proc. 1998 Sep;73(9):837-41.
  37. Bordin P, Bodamer OA, Venkatesan S, et al. Effects of fish oil supplementation on apolipoprotein B100 production and lipoprotein metabolism in normolipidaemic males. Eur J Clin Nutr. 1998 Feb;52(2):104-9.
  38. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):937-52.
  39. Maiyoh GK, Kuh JE, Casaschi A, et al. Cruciferous indole-3-carbinol inhibits apolipoprotein B secretion in HepG2 cells. J Nutr. 2007 Oct;137(10):2185-9.
  40. Available at: https://www.ncbi.nlm.nih.gov/books/nbk395573. Accessed March 27, 2019.
  41. Bandyopadhyay D, Qureshi A, Ghosh S, et al. Safety and Efficacy of Extremely Low LDL-Cholesterol Levels and Its Prospects in Hyperlipidemia Management. J Lipids. 2018;2018:8598054.
  42. Available at: https://www.nhs.uk/conditions/statins/side-effects. Accessed March 27, 2019.
  43. Morita SY. Metabolism and Modification of Apolipoprotein B-Containing Lipoproteins Involved in Dyslipidemia and Atherosclerosis. Biol Pharm Bull. 2016;39(1):1-24.
  44. Wu X, Sakata N, Dixon J, et al. Exogenous VLDL stimulates apolipoprotein B secretion from HepG2 cells by both pre- and post-translational mechanisms. Journal of Lipid Research. 1994 July 1, 1994;35(7):1200-10.
  45. Gillotte KL, Horkko S, Witztum JL, et al. Oxidized phospholipids, linked to apolipoprotein B of oxidized LDL, are ligands for macrophage scavenger receptors. J Lipid Res. 2000 May;41(5):824-33.
  46. Alique M, Luna C, Carracedo J, et al. LDL biochemical modifications: a link between atherosclerosis and aging. Food & nutrition research. 2015;59:29240-.
  47. Sniderman AD, Williams K, Contois JH, et al. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011 May;4(3):337-45.