Should I aim for an ApoB under 60?
Only if your doctor says your risk is very high, which mostly means you’ve had a heart attack or stroke. Under 60 mg/dL (0.60 g/L) is the National Lipid Association’s goal for that group. Fewer than 1 in 10 untreated US adults are there, and no trial has enrolled healthy people and tested under 60 as a target.
What we’d do
Get under the goal for your risk first, which for most people is under 90. Keep the food changes going after that, since in the gene studies every 10 points lower came with lower odds of heart disease. But we wouldn’t add a medicine just to chase 60 without heart disease or a doctor who thinks your risk calls for it.
At 60, you’d be lower than about 91 of 100 untreated American adults.
60 is about the 9th percentile in the national health survey (NHANES 2005 to 2016). The middle is 90.
Who under 60 is for
The NLA matched ApoB to the LDL goals in the 2026 US guideline. Its very high risk group, with the goal of LDL under 55 and ApoB under 60, means people who’ve had more than one major heart or blood vessel event, or one event plus other high risk conditions. The guideline goes one step further for people with heart disease and severe high cholesterol. Once their LDL goals are met, it says checking for an ApoB under 55 may be reasonable.
The case for going lower
Some people aim under 60 whatever their risk, and they have a real argument. People born with genes that lower ApoB had about 23% lower odds of heart disease for every 10 mg/dL lower, in a study of 654,783 people. Those people carried the lower count their whole lives.
Drug trials in people with heart disease have pushed ApoB far lower. In FOURIER, the median ApoB on the added medicine was 38 mg/dL after 48 weeks, and in ODYSSEY OUTCOMES the average was 49. Both trials cut major heart events by 15%.
Why we don’t tell everyone to aim there
Those trials were in people who’d already had heart disease. No trial has taken healthy people at 80, pushed them under 60, and counted heart attacks. It’s a long way from an average number, too. From 90, under 60 is more than 30 points away, and the biggest single food change trials have sized for ApoB takes off about 7.
It’s like the speed limit outside a school. It’s the right number for that road, and it doesn’t make 25 the right speed on every road.
If you’re curious where you stand, the checker below opens on 60. What should my ApoB be? has the goal for each risk band.
4 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
- Ference BA and others, Association of triglyceride-lowering LPL variants and LDL-C-lowering LDLR variants with risk of coronary heart disease, JAMA, 2019pubmed.ncbi.nlm.nih.gov
