Reducing LDL is not as important as reducing ApoB
LDL can be reduced merely by taking statins. LDL is the typical biomarker used to determine heart disease risk. Actual heart disease risk is better determined using ApoB as the biomarker but this often isn't even part of the testing. So the question is what can you do if you think or know you have high ApoB to lower your ApoB and as a result reduce your risk?
It has been shown in a study that exercise can reduce ApoB.
So you've brought your LDL under 100, or even under 70, now what?
It's not enough just to bring your LDL down under 100 or under 70, it is important to always learn the latest science on what causes heart disease and to focus on tracking the most accurate biomarkers of risk. Apob is more accurate than LDL as a biomarker so after you've done the first step of reducing your LDL to under 70 then the next step beyond this is to focus on reducing your Apob.
Another major finding of the AMORIS was that in individuals with concentrations of LDL-C below the median, apoB was a better predictor of risk than LDL-C (according to receiver operating characteristic analysis). This is a very important finding as almost 50% of coronary patients may have plasma cholesterol concentrations of less than 200 mg/dl (5.2 mmol/l) and a large proportion of coronary patients with normal cholesterol levels have elevated apoB concentrations.
Total cholesterol under 120 is ideal. This would be around 60-60 HDL and LDL give or take. But Apob also has to be kept low and reducing it is possible with exercise.
The target range for ApoB is to achieve less than 80
Treatment goals for apoB have been suggested by several groups of experts: in a report of 30 experts/ten countries panel receommending apoB levels of less than 90 mg/dl for high-risk patients and less than 80 mg/dl for very-high-risk patients; in a statement of the American Diabetes Association (ADA)/American College of Cardiology Foundation (ACCF) recommending comparable targets for patients with cardiometabolic risk; and more recently, by an AACC statement recommending an apoB goal of less than 80 mg/dl for both high- and very-high-risk patients.
This is based on the word of experts who recommend an ApoB goal of less than 80 for high and very high risk patients. To be conservative, even if you aren't high risk you might still benefit from keeping your ApoB lower than 80 if you can figure out how to both measure it and bring it to that level. Of course the older you get the higher your risk goes which means the cleaner you must eat, the more you must exercise, to keep ApoB down.