No incremental utility of apolipoproteins over traditional risk factors for coronary heart disease risk prediction
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Measuring risk factors for cardiovascular disease (CVD) such as apolipoprotein B (apo-B) and non-high-density lipoprotein-cholesterol (non-HDL-C, defined as total cholesterol minus HDL-C) was recently advocated to quantify cardiovascular risk in predisposed subjects with small and dense low-density lipoprotein (LDL) particles and metabolic syndrome. The ratio of apo-B to apo A-I was recently proposed as a valid and robust alternative to well-established LDL-C/HDL-C ratio in ranking subjects according to their risk of developing CVD. To assess incremental utility of apolipoproteins over traditional lipids for coronary heart disease(CHD) risk prediction, serum total cholesterol, HDL-C, LDL-C, non-HDL-C, apo A-I and apo-B, and 3 lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo-B:apo A-I) were evaluated in 3322 Framingham Offspring Study participants without CVD. Incidence of first cardiovascular event was assessed over a median follow-up period of 15.0 years. After adjusting for nonlipid factors, multivariate models using the apo-B:apo A-I ratio demonstrated performance characteristics comparable with but not better than those of other lipid ratios. Furthermore, the apo-B:apo A-I ratio did not predict CHD risk in a model containing all components of the Framingham risk score including total cholesterol:HDL-C. According to the authors, these data do not support measurement of apo-B or apo A-I in clinical practice when total cholesterol and HDL-C measurements are available.
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