Andrew Huberman· PhD
So we treat ApoB, and basically what it comes down to is you want ApoB to be as close to the level as it was when you were born.
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So we treat ApoB, and basically what it comes down to is you want ApoB to be as close to the level as it was when you were born.
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So it's this really young ApoB level of kind of 20 to 30 milligrams per deciliter, that makes it impossible to get atherosclerosis.
if we have any other factors meaning we're starting later in life you know or a person already has gross evidence of disease calcification soft plaque family history is significant any other risk factors are present I mean we'll we'll treat apob to 30 to 40 milligrams per deciliter
if your objective is to not die from heart disease and only to die with it then you want apob as low as possible
I know if I lower April B I reduce inflammation so that's one perhaps that's your first therapeutic initiative lowering April B by nutrition or if the risk category is high enough a drug fine
so if you have somebody whose apo b is 160 milligrams per deciliter there's a risk reduction that comes to lowering it from 160 to 100 and lowering it from 100 to 80 and lowering it from 80 to 60.
the first thing they suggest at least in the higher risk people is try and get a 50 reduction and that's where most of the bang for the buck is going to be
if i want to talk about april b that's probably under 50 milligrams per deciliter if we can get there that's what the newborns have that's when you go in clinical trials if you take it down that low you see your most risk reduction
most people don't have the type of levels where with modern therapeutics with modern lifestyle we can more often than not attain physiologic concentrations and if i want to talk about april b that's probably under 50 milligrams per deciliter if we can get there that's what the newborns have that's when you go in clinical trials if you take it down that low you see your most risk reduction
lowering apob pharmacologically nutritionally etc is arguably the most important strategy you have to reduce it along with probably improving metabolic health so those two things right so regulating glucose insulin lowering apob all of these things can be done through lifestyle through drugs etc can dramatically reduce a person's risk of atherosclerosis
in some ways i would view an apob ceiling of 60 as the limit and that's probably at about the fifth percentile
i just don't see a reason to have an apo b ever north of 60 milligrams per deciliter
the earlier you start in the lower you go the more you can make that number approximate zero
if you have an ldl cholesterol below 30 or an apob below 40 milligrams per deciliter for a very long period of time i think the odds that you're going to suffer asvd are incredibly low
so in some ways i would view an apo b ceiling of 60 as the limit and that's probably at about the fifth percentile you sort of want everybody to be below the fifth percentile
the evidence is overwhelming that infantile levels of apob are not deleterious in any way meaning an apob of 30 to 40 milligrams per deciliter which is the level that children would have poses not only no risk to children as evidenced by the fact that i mean that doesn't require an explanation but as evidenced by what we see in the literature on adults with levels that have been pharmacologically reduced tells me that we need to be lower
basically by the time you're in your late 30s or early 40s if you have any measure of apo b that's even north of the 20th percentile that should be completely lowered
pharmacologically lower apob to somewhere in the 20 to 30 milligram per deciliter range for everybody in the population while someone is in their 20s can you eliminate ascvd and i think the answer is probably yes in other words i think what you're basically going to do is eliminate death from atherosclerotic causes and that would need to be started in 20s i think
so apob gives you the total atherogenic burden of those lipoproteins and therefore I think it's the preferred metric by which we want to assess risk
the first thing they suggest at least in the higher risk people is try and get a 50 reduction and that's where most of the bank for the buck is going to be
your goal of therapy be it lifestyle or drug is did I normalize apob yeah
Peter Libby has done an analysis that has demonstrated that you will continue to see a meaningful reduction in cardiovascular disease as APOB heads towards 30 milligs per deciliter.
So if I have a patient who's already had two stances placed and has a significant burden of disease, you bet your bottom line they're at 30 milligrams per deciliter of apo even if we have to put three drugs on them to make sure that's the case because their burden of disease and their lifetime exposure to apo has been so high.
if you had an apob level below about 30 Mig per deciliter 20 to 30 milligrams per deciliter it wouldn't be possible to develop atherosclerosis
so to have a lifetime ceiling of 60 would also be a very very low-risk individual