How to Naturally Lower Cardiovascular Risk: The Role of ApoB
- Dott. Giulio Rossi
- Sep 18, 2025
- 5 min read
Learn how to lower your cardiovascular risk by monitoring your apolipoprotein B level.
What is cholesterol?
Cholesterol is a lipid molecule belonging to the sterol category, self-produced by our body and/or ingested through food.
Cholesterol functions are essential for the proper functioning of our body.
In fact, cholesterol participates in the synthesis of:
Steroid hormones ( cortisol, aldosterone, DHEA, testosterone, estrogen, progesterone ): regulating sexual, metabolic and circadian functions
Vitamin D : essential for bone and immune health
Bile: a fundamental substance for the digestive process
Cell membranes: determines the structure and fluidity of the membrane, allowing for its integrity and proper functioning
Cholesterol is produced by the liver from a molecule called “acetyl-CoA”, but can also be introduced through food (e.g. egg yolk, cheese, liver, red meat , etc.).
Since the human body is a “machine” capable of self-producing all the cholesterol it needs, dietary cholesterol is included within non-essential molecules.
The factors that regulate cholesterol biosynthesis are mainly:
Activators : sugars, refined carbohydrates, trans-saturated and saturated fatty acids
Inhibitors : calorie deficit, ketone metabolism, fasting
This happens because the key enzyme in cholesterol biosynthesis ( HMG-CoA reductase ) is activated by insulin and inhibited by glucagon.
A low-calorie diet , or better yet a low-calorie low-carb or ketogenic diet, will stimulate insulin less and glucagon more, thus reducing cholesterol biosynthesis.
A hypercaloric diet or a normocaloric Mediterranean-style diet ( i.e. with carbohydrates >50% ), by stimulating insulin more, will tend to increase hepatic cholesterol biosynthesis.
Excess cholesterol has been associated with an increased cardiovascular risk as it promotes the phenomenon of arteriosclerosis , or the occlusion of blood vessels due to the formation of atheromatous plaque.
Once the role of cholesterol in the arteriosclerotic process was discovered, the concept of “ good ” cholesterol and “ bad ” cholesterol was created.
In reality the molecule is the same: what changes is the transporter .
2. "Bad" vs. "Good" Cholesterol
Since the liver is the only organ capable of producing cholesterol, once produced it must be distributed to all cells in the body to perform its functions.
To reach the peripheral districts, cholesterol is bound to transporters (lipoproteins).
Lipoproteins are not all the same.
There are lipoproteins that transport cholesterol from the site of production to the periphery ( LDL : low density lipoprotein ) and lipoproteins that transport cholesterol from the periphery to the site of production ( HDL : high density lipoprotein ).
Since LDL is the lipoprotein that increases cholesterol levels, while HDL is the lipoprotein that reduces them, the concept of “ good ” cholesterol has been associated with HDL and “ bad ” cholesterol with LDL.
In reality, without LDL, we wouldn't be here talking: we wouldn't be able to perform our vital functions.
However, excess LDL, combined with oxidative stress capable of causing cholesterol to sediment in the arteries and activate the atherosclerotic process, promotes cardiovascular risk.
It is therefore advisable to maintain a good ratio between LDL and HDL.
3. ApoB and ApoA: the evolution of bad cholesterol
Over the years, science has realized that the association between cardiovascular risk and LDL was in some cases discordant.
By delving deeper into the topic, it was discovered that a better description of the “cholesterol-cardiovascular risk” phenomenon was offered not by the quantity of LDL cholesterol but by its apolipoprotein.
The apolipoprotein represents the envelope within which the lipid micelles to be transported are enclosed.
The protein structure (apolipoprotein) of LDL is different from that of HDL, but in agreement with that of VLDL (very low density lipoprotein), i.e. the triglyceride transporters.
So we have two types of apolipoproteins in the blood:
ApoB100 : present in LDL and VLDL, responsible for the transport of cholesterol and triglycerides from the liver to the rest of the body
ApoA1 : present in HDL, which collects cholesterol in the periphery to bring it back to the liver
Assessing the ratio between ApoB and ApoA is equivalent to measuring the balance between atherogenic lipoproteins and antiatherogenic lipoproteins, ensuring greater precision in predicting associated cardiovascular risks.
Normal values in men are below 0.7, while in women they are 0.6; a moderate risk in men is between 0.7 and 0.89, while in women 0.6-0.79; high risk >0.9 in men or >0.8 in women.
4. Cholesterol reference values
Cholesterol reference values can often be imprecise and convey inaccuracies to patients who read the tests without having an overall view.
As described in previous chapters, cholesterol is an essential molecule for human health, therefore excessively low values can compromise vital functions such as cell structure, digestion or reproduction.
However, for cardiovascular prevention purposes, a good ratio between LDL and HDL transporters is important.
In particular, this ratio (LDL/HDL) should remain <2.5.
Higher values indicate an imbalance between the cholesterol that leaves the liver and that which returns/is used, increasing the risk of atherosclerosis.
In these cases, it is advisable to change your eating habits to reduce cardiovascular risk.
Below we will describe the dietary strategies and supplements useful for restoring a good ratio between HDL and LDL.
5. Strategies to Lower Cholesterol and ApoB
Maintain a good ratio between LDL and HDL cholesterol, but even more so a good ratio
between ApoB and ApoA, helps reduce cardiovascular risk and promote longevity.
Dietary strategies to improve cholesterol levels can be divided into 3 points:
Reduction of endogenous biosynthesis: In this case, we use a low-calorie diet and/or dietary techniques such as low-carb, the ketogenic diet, and/or intermittent fasting to deactivate the enzyme responsible for biosynthesis (HMG-CoA reductase), just like statins do but without the adverse effects. In fact, statins also block the biosynthesis of Coenzyme Q10, damaging mitochondrial health. With these dietary techniques, however, in addition to reducing cholesterol biosynthesis, we improve mitochondrial function, improving metabolism.
Reduced intestinal absorption and increased fecal excretion: Including soluble fiber (typically found in legumes and whole grains) and insoluble fiber (typically found in vegetables) reduces intestinal cholesterol absorption and increases its excretion. Remember that cholesterol present in bile is partially reabsorbed. Consuming 30-45g of fiber per day reduces dietary absorption and enterohepatic reabsorption.
Improved gut microbiota : A healthy microbiota produces numerous beneficial molecules for our body, including SCFAs. SCFAs are three short-chain fatty acids with multiple functions. One of these (propionate) has been shown to inhibit cholesterol biosynthesis.
6. Useful supplements for reducing cholesterol
Nutrition plays a primary role in cholesterol metabolism. We have seen
Indeed, just like insulin or glucagon stimulation, it's the primary factor in cholesterol balance. Therefore, restoring healthy cholesterol levels with supplementation alone is unthinkable. However, dietary supplements can help improve your levels more quickly and maintain them over time.
The most useful supplements in controlling cholesterol are:
Monacolin K: Monacolin K is an active ingredient produced during the fermentation of red rice by the yeast Monascus purpureus . This molecule works by inhibiting HMG-CoA reductase (an enzyme responsible for cholesterol biosynthesis), just like statins but with fewer side effects. It has greater bioavailability and can achieve greater effects with a lower dosage.
Lecithin : it is a phospholipid (phosphatidylcholine) capable of binding cholesterol in the periphery and making it recognisable by HDL to bring it back to the liver, preventing it from settling in the arteries.
Omega 3 : stimulates the production of HDL, improving the ratio between LDL and HDL
Policosanols : are mixtures of aliphatic alcohols present in rice bran, sugar cane, beeswax capable of reducing the gene expression of HMG-CoA reductase, thus reducing the biosynthesis of cholesterol.
Phytosterols : These are plant molecules with a structure similar to that of cholesterol, capable of competing with intestinal absorption. They thus increase cholesterol excretion.
Fibers : beta-glucans, psyllium, pectin, chiosan, glucomannan, raffinose, verbascose, stancase... are all fibers present in vegetables capable of reducing absorption and fueling excretion.
If you too want to reduce cholesterol and eliminate statins naturally with a personalized 3-6 month program, book your Functional Nutrition consultation with the GR® Team now.
Hear the testimony of one of our patients, who we eliminated from statins with diet and supplementation alone.
⬇️ All from the comfort of your home ⬇️
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