How Our Members Cut ApoB Optimal Attainment from 27% to 69%
How Our Members Cut ApoB Optimal Attainment from 27% to 69%
We’re going to show you the data. All of it, including the parts that are less flattering.
Protocol tracks aggregate health outcomes across all members in our clinical analytics pipeline. Not thousands. Not a randomized controlled trial. A real cohort of members who joined a health optimization practice and followed protocolized interventions.
Here’s what the ApoB data shows, what it means, and what it doesn’t mean.
The headline numbers
At intake, 27% of Protocol members had ApoB at their risk-tier-appropriate target.
During membership, 69% do.
That’s a 2.6x improvement in optimal attainment. Median ApoB across all members is 79 mg/dL, against a US population mean of approximately 95 mg/dL (NHANES). 88% of Protocol members have ApoB below 100.
These are real numbers from real people, calculated from the same clinical analytics pipeline we use to manage care. Every member is counted. Nothing excluded.
What ApoB is and why it matters
If you’re unfamiliar with ApoB, here’s the short version. (The longer version is here.)
ApoB — apolipoprotein B — is a protein found on the surface of every lipoprotein particle that can deposit cholesterol into your arterial walls. LDL particles carry one. VLDL particles carry one. Lp(a) particles carry one.
ApoB counts those particles. LDL-C, the number on your standard cholesterol panel, measures the cholesterol mass inside LDL particles. When the two disagree (which happens in 20-30% of people), ApoB is the better predictor of cardiovascular events. The Emerging Risk Factors Collaboration, whose analyses have been published in JAMA and The Lancet across 300,000+ participants, confirmed this.
50% of people hospitalized for a coronary event had LDL-C below 100 mg/dL. Their LDL looked fine. Their particle count did not.
Protocol uses ApoB, not LDL-C, as the primary target in our Cardiovascular Risk protocol.
How the improvement happened
Here’s the honest version.
We tested what most practices don’t. Most annual physicals include a standard lipid panel: total cholesterol, LDL-C, HDL-C, triglycerides. ApoB is not on that panel. Neither is Lp(a), fasting insulin, hsCRP, or ApoE genotype. Every Protocol member gets these tested as part of their Foundation Assessment. For many, this was the first time anyone had checked their ApoB.
We risk-stratified every member. ApoB targets are not one-size-fits-all. A member with established cardiovascular disease, elevated Lp(a), and a family history of early heart attacks needs an ApoB below 55 mg/dL. A member with no risk factors and clean imaging may have a target below 100.
Protocol uses a 4-tier risk stratification system (Tier A through D) informed by the AHA PREVENT equations (2023), Lp(a) levels, family history, coronary artery calcium scores, and inflammatory markers. Each member gets a specific ApoB target based on their individual risk profile. Reporting that 69% of members are “at target” means 69% are at their target, not a single blanket number.
We built a protocol and followed it. Each member in the Cardiovascular Risk protocol gets a specific plan:
- Dietary changes matched to their ApoE genotype (how your body processes lipids varies by genotype)
- Exercise prescription coordinated across protocols
- Supplement protocol if indicated (omega-3, when supported by the evidence)
- Pharmacotherapy when the gap between current ApoB and target is too large for lifestyle alone
Three sessions over 6 weeks. A recheck at 12 weeks if pharmacotherapy was started. Ongoing monitoring every 6-12 months after that.
We checked whether it worked. Most practices skip this step. You start a statin. Nobody rechecks ApoB. Nobody verifies that the medication brought you to target. Nobody adjusts the dose if it didn’t.
Protocol rechecks every member. If the first intervention doesn’t close the gap, we escalate: dose adjustment, combination therapy (adding ezetimibe), or referral to a lipidologist for complex cases. The protocol doesn’t stop until the member is at target or we’ve exhausted the evidence-based options.
What we don’t claim
This is the section that matters most if you’re the kind of person who reads the methodology before trusting the results. We hope you are.
The improvement is largely medication-driven. The majority of the ApoB improvement in our members involves pharmacotherapy. Statins. Ezetimibe. Well-established medications with decades of clinical trial data.
Protocol did not invent a new drug or discover a novel dietary intervention that replaces medication. What Protocol built is a system that ensures the right test gets ordered, the right target gets set, the right medication gets prescribed when needed, and someone checks whether it worked. That pipeline (assess, stratify, intervene, verify) is the intervention. The medications are the tools. The system that makes sure they get used correctly is the difference.
There is no control group. These are observational outcomes from our membership. We don’t have a matched group of similar people who didn’t join Protocol, so we can’t isolate what would have happened without our intervention. Some members may have eventually gotten their ApoB tested and treated elsewhere. Some may not have. We don’t know, and we don’t pretend to.
The population is also self-selected. People who join a health optimization practice at $695/month are not a random sample of the US population. They’re health-motivated, higher-income, and more likely to follow through on interventions. Some of Protocol’s numbers reflect who joins, not just what Protocol does. We acknowledge this because it’s true, and because pretending otherwise would undermine everything we’re trying to build.
Metabolic data tells a more complicated story. We’re including this because cherry-picking the best numbers and ignoring the rest is exactly what we’re arguing against. Longitudinal A1c data across 34 members with readings at least 60 days apart shows A1c essentially flat on average. 29% improved, 38% stayed stable, 32% worsened slightly. Metabolic change varies widely between individuals.
We publish this because transparency matters more than marketing. If we only showed you ApoB and hid the A1c data, you should trust us less.
We do not claim to extend lifespan. There is no mortality data. Our cohort over a few years cannot demonstrate lifespan extension. What we can show is that specific, measurable biomarkers moved in the direction that decades of epidemiological research associates with lower cardiovascular risk. That’s a meaningful claim. It’s not the same as “you’ll live longer.”
What the data does show
With all caveats stated, here’s what we stand behind.
The assessment-to-action pipeline works. When you test the right biomarker, set a risk-appropriate target, intervene with evidence-based protocols, and verify the result, people get measurably healthier. 27% to 69% optimal attainment is a real improvement in a real cohort.
At intake, 73% of members had suboptimal ApoB. These are health-conscious people, many of whom had annual physicals and were told their labs were “normal.” The right test told a different story.
Prescribing a statin is not the same as getting someone to target. Checking, adjusting, following up. That’s where the gap between standard care and Protocol’s model shows up most clearly.
The broader picture holds up too. 95% of members’ cardiovascular risk (measured by the AHA PREVENT equations, age-adjusted) is stable or improved. Biological age averages 3.8 years younger than chronological age across 68 members, estimated using Levine PhenoAge, a validated algorithm published in Aging (2018). 72% of members are biologically younger than their calendar age.
Why we publish all of this
Most health practices don’t publish their aggregate outcomes. Small sample sizes, variable methodology, legal caution. We understand the hesitation.
We publish anyway because we think transparency is a competitive advantage. If you’re comparing health practices, you should be able to see the numbers, understand how they were generated, and evaluate the methodology yourself.
This is not a clinical trial. But it’s a real cohort with real data, and every number on this page is defensible. We’d rather show you imperfect data honestly than perfect marketing that hides the caveats.
The full breakdown and individual member outcomes are on our Case Studies page.
Book a Discovery Call
These are aggregate outcomes. Your numbers will be different, better in some areas, worse in others. The Foundation Assessment shows you where you stand. A discovery call is 15 minutes, no commitment. We’ll tell you what to expect for your situation.