Is an ApoB of 90 good?
It’s average, and average sits right on the line. An ApoB of 90 mg/dL (0.90 g/L) is the exact middle of untreated US adults. At borderline or intermediate risk the goal is under 90, so you’re on the edge of it. At high risk, where the goal is under 70, you’re 20 over, and after a heart attack or stroke, where it’s under 60, you’re 30 over.
What we’d do
If your risk is borderline or you don’t know it, treat 90 as a nudge. Cut the saturated fat in butter, cheese and fatty meat, and get more of your protein from beans, lentils and tofu, then retest at the same lab 6 to 12 weeks later. At high risk, 20 points is more than any single food change has shown in trials, so do both and let a retest tell you. After a heart attack or stroke, take it to your cardiologist.
Line up 100 untreated American adults by ApoB, and at 90 you’d stand right in the middle.
Half of them are at 90 or more. Fewer than 1 in 10 are under 60.
Why the middle isn’t the goal
The middle comes from the National Lipid Association’s table of 12,696 adults in the national health survey (NHANES 2005 to 2016), none of them on a cholesterol medicine. The goals come from the LDL goals in the 2026 US guideline, which trials tested, translated into ApoB. The two happen to meet at 90.
Being average for an American isn’t the same as being low risk. In the CARDIA study, 2,794 young adults had an average ApoB of about 91 at a mean age of 25. Twenty-five years later, the third with the highest ApoB had 2.28 times the odds of calcium in their heart arteries of the third with the lowest. The guideline also says the slow rise in ApoB through young adulthood, about half a point a year, “should not be perceived as optimal”.
What the food changes do at 90
In a 2019 feeding trial of 113 adults, halving saturated fat, from about 14% of calories to about 7%, lowered ApoB about 6 to 7 mg/dL in four weeks. Moving protein from red or white meat to beans, nuts, grains and soy lowered it about 3 to 4 more. Either one takes a 90 under 90, and the trial’s groups on high saturated fat with red meat and on low saturated fat with plant protein ended 10 points apart.
| Your risk | Goal | At 90 |
|---|---|---|
| Borderline or intermediate | under 90 | on the line |
| High | under 70 | 20 over |
| Heart attack, stroke, stent or bypass | under 60 | 30 over |
| Low | no number goal | higher than half of untreated adults |
One 90 is one test
Your ApoB moves about 6% between tests with nothing changed, and the lab adds a little more. Two tests can differ by about 15% by chance, so a 90 and then an 80 a month later may be the same blood. Judge a change with did my ApoB really change?, and put your number with your risk in the checker below.
6 sources
- Soffer DE, Marston NA, Maki KC and others, Role of apolipoprotein B in the clinical management of cardiovascular risk in adults: an Expert Clinical Consensus from the National Lipid Association, Journal of Clinical Lipidology, 2024pmc.ncbi.nlm.nih.gov
- Blumenthal RS, Morris PB, Gaudino M and others, 2026 ACC/AHA guideline on the management of dyslipidemia, JACC, 2026doi.org
- The same guideline, full text, Circulation, 2026api.iscpcardio.org
- Bergeron N and others, red meat, white meat and plant protein on high and low saturated fat diets, a feeding trial in 113 adults, American Journal of Clinical Nutrition, 2019pmc.ncbi.nlm.nih.gov
- Wilkins JT and others, Discordance between apolipoprotein B and LDL-cholesterol in young adults predicts coronary artery calcification: the CARDIA study, Journal of the American College of Cardiology, 2016pubmed.ncbi.nlm.nih.gov
- Kafonek SD, Derby CA and Bachorik PS, Biological variability of lipoproteins and apolipoproteins in patients referred to a lipid clinic, Clinical Chemistry, 1992pubmed.ncbi.nlm.nih.gov
