apoB and non-HDL cholesterol and cardiovascular risk

Last edited 08/2021 and last reviewed 08/2021

In cholesterol guidelines, low-density lipoprotein (LDL) cholesterol remains the primary target while apolipoprotein B (apoB) and non-high-density lipoprotein (non-HDL) cholesterol are secondary targets

  • in a study of 13,015 statin-treated patients (1)
    • with 8 years median follow-up.Cox regressions among apoB, non-HDL cholesterol, and LDL cholesterol, respectively, and all-cause mortality or myocardial infarction were examined
    • study findings revealed that
      • in statin-treated patients
        • elevated apoB and non-HDL cholesterol, but not LDL cholesterol, are associated with residual risk of all-cause mortality and myocardial infarction
      • analysis demonstrates that apoB is a more accurate marker of all-cause mortality risk in statin-treated patients than LDL cholesterol or non-HDL cholesterol, and apoB in addition is a more accurate marker of risk of myocardial infarction than LDL cholesterol

Drexel et al determined the LDL-C/ApoB ratio in a cohort of 1687 subjects with established atherosclerosis

  • prospectively, major cardiovascular events (MACE) including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke were recorded over a period of 9.9 +/- 4.6 years
  • main results
    • strongest predictors of LDL-c/ApoB ratio were T2DM and age, followed by gender, smoking and hypertension.
    • patients in the highest tertile of LDL-c/ApoB ratio had significant better outcome than those in the lower tertiles (log rank p=0.005).
    • in a fully adjusted model, high LDL-c/ApoB ratio was associated with lower MACE (HR 0.87, 95%IC: 0.78-0.97, P=0.013).
    • high LDL-c/ApoB ratio was also associated with lower all-cause mortality and total CV events (HR 0.88, ,95%CI: 0.80-0.97, P=0.012 and HR 0.88, 95%CI: 0.80-0.95, P=0.0003, respectively)
  • concluded that LDL-C/ApoB ratio is independently predictive of MACE in subjects with established atherosclerosis

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