Apolipoprotein B/A-I Ratio

When high

When elevated (>0.80):

The ratio improves by lowering ApoB AND raising ApoA-1 simultaneously:

To lower ApoB (numerator):

• Citrus Bergamot -- 500mg 2x/day
• Psyllium Husk -- 10-15g/day (binds bile acids, reduces LDL particle count)
• Plant Sterols/Stanols -- 2g/day (blocks intestinal cholesterol absorption)
• Reduce refined carbohydrates and sugar (lowers VLDL particle production)

To raise ApoA-1 (denominator):

• Niacin (Extended-Release) -- 1500-2000mg/day (improves both sides of the ratio)
• Omega-3 (EPA/DHA) -- 3-4g/day
• Aerobic exercise -- 30-45 min, 3-5x/week

Critical interventions:

• Eliminate oral AAS if ratio exceeds 1.0 — non-negotiable for cardiovascular safety
• Favour injectable compounds with lower lipid impact (testosterone, nandrolone) over orals
• Do not stack multiple oral AAS (e.g., Dianabol + Winstrol is a lipid catastrophe)
• Monitor pre-cycle, mid-cycle (week 6-8), and 6-8 weeks post-cycle. Do not start a new cycle until ratio is below 0.80

Pharmacological options (when supplements and lifestyle are insufficient):

• The ratio improves by lowering ApoB and raising ApoA-1 concurrently; address both sides with prescription therapy if needed
• Rosuvastatin -- 5-20mg/day; first-line for lowering ApoB (numerator); preferred over atorvastatin/simvastatin in AAS users (lower CK impact)
• Ezetimibe -- 10mg/day; additive ApoB reduction; minimal side effects
• Bempedoic acid -- 180mg/day; statin alternative with no muscle uptake
• PCSK9 inhibitors (alirocumab, evolocumab) -- 75-150mg subQ q2 weeks; ~50-60% ApoB reduction for resistant cases
• Pemafibrate -- 0.2mg 2x/day where available; raises ApoA-1/HDL with minimal LDL impact
• All require physician oversight and baseline liver/CK panel