Is Apolipoprotein B and Small, Dense low density lipoprotein a better marker of cardiovascular risk?
30 Oct 2015-International journal of biomedical research (Scholar Science Journals)-Vol. 6, Iss: 10, pp 775-779
TL;DR: Adopting the traditional lipid profile (Triglyceride, HDL, LDL, total cholesterol etc.) will result in an underestimation of the true atherogenic burden as well as serve as a poor assessment of cardiovascular risk in individuals.
Abstract: The association between low density lipoprotein cholesterol and cardiovascular risk is well established However, the measurement of the cholesterol content of this lipoprotein incompletely accounts for the risk of cardiovascular disease As part of its limitations, LDL cholesterol concentration does not precisely count the number of LDL particles, but Apo B does The levels of Apolipoprotein B and small dense low density lipoprotein have been shown to be associated with risk of cardiovascular disease There is one Apo B per LDL particle, hence, LDL-Apo B accurately defines LDL particle number Also, the ratio of cholesterol to Apo B differs from person to person, thereby explaining why LDL-cholesterol level does not necessarily indicate LDL particle number Furthermore, Apo B reflects the concentration of potentially atherogenic particles ie the total Apo B level is a measure of the total number of lipoprotein particles in LDL, IDL and VLDL (non-HDL cholesterol) This implies that if most Apo B-containing lipoproteins in each fraction are atherogenic, the total concentration of Apo B will indicate cardiovascular risk better than LDL cholesterol level does A predominance of small, dense, low-density lipoprotein cholesterol particles has been associated with a 3-fold or even greater risk of coronary heart disease in a collection of cross-sectional studies Recent prospective evidence describes small, dense, low-density lipoprotein cholesterol as predictive of coronary heart disease as most of the traditional risk factors like smoking and elevated blood pressure Cardiovascular risk is more directly related to the number and sizes of circulating atherogenic particles than to the concentration of cholesterol in these particles, therefore, adopting the traditional lipid profile (Triglyceride, HDL, LDL, total cholesterol etc) will result in an underestimation of the true atherogenic burden as well as serve as a poor assessment of cardiovascular risk in individuals
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TL;DR: Non-HDL-C and the ratio of total cholesterol to HDL-C were as good as or better than apolipoprotein fractions in the prediction of future cardiovascular events and high-sensitivity CRP added prognostic information beyond that conveyed by all lipid measures.
Abstract: ContextCurrent guidelines for cardiovascular risk detection are controversial
with regard to the clinical utility of different lipid measures, non–high-density
lipoprotein cholesterol (non–HDL-C), lipid ratios, apolipoproteins,
and C-reactive protein (CRP).ObjectiveTo directly compare the clinical utility of total cholesterol, low-density
lipoprotein cholesterol (LDL-C), HDL-C, non–HDL-C, apolipoproteins A-I
and B100, high-sensitivity CRP, and the ratios of total cholesterol
to HDL-C, LDL-C to HDL-C, apolipoprotein B100 to apolipoprotein
A-I, and apolipoprotein B100 to HDL-C as predictors of future cardiovascular
events in women.Design, Setting, and ParticipantsProspective cohort study of 15 632 initially healthy US women aged
45 years or older (interquartile range, 48-59 years) who were enrolled between
November 1992 and July 1995. All participants were followed up over a 10-year
period for the occurrence of future cardiovascular events.Main Outcome MeasureHazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever
major cardiovascular events (N = 464) according to baseline levels
of each biomarker.ResultsAfter adjustment for age, smoking status, blood pressure, diabetes,
and body mass index, the HRs for future cardiovascular events for those in
the extreme quintiles were 1.62 (95% CI, 1.17-2.25) for LDL-C, 1.75 (95% CI,
1.30-2.38) for apolipoprotein A-I, 2.08 (95% CI, 1.45-2.97) for total cholesterol,
2.32 (95% CI, 1.64-3.33) for HDL-C, 2.50 (95% CI, 1.68-3.72) for apolipoprotein
B100, 2.51 (95% CI, 1.69-3.72) for non–HDL-C, and 2.98 (95%
CI, 1.90-4.67) for high-sensitivity CRP (P<.001
for trend across all quintiles). The HRs for the lipid ratios were 3.01 (95%
CI, 2.01-4.50) for apolipoprotein B100 to apolipoprotein A-I, 3.18
(95% CI, 2.12-4.75) for LDL-C to HDL-C, 3.56 (95% CI, 2.31-5.47) for apolipoprotein
B100 to HDL-C, and 3.81 (95% CI, 2.47-5.86) for the total cholesterol
to HDL-C (P<.001 for trend across all quintiles).
The correlation coefficients between high-sensitivity CRP and the lipid parameters
ranged from −0.33 to 0.15, and the clinical cut points for CRP of less
than 1, 1 to 3, and higher than 3 mg/L provided prognostic information on
risk across increasing levels of each lipid measure and lipid ratio.ConclusionsNon–HDL-C and the ratio of total cholesterol to HDL-C were as
good as or better than apolipoprotein fractions in the prediction of future
cardiovascular events. After adjustment for age, blood pressure, smoking,
diabetes, and obesity, high-sensitivity CRP added prognostic information beyond
that conveyed by all lipid measures.
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01 Jan 2011
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...family history of cardiovascular diseases [11-15]....
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TL;DR: Based on combined data from prospective studies, triglyceride is a risk factor for cardiovascular disease for both men and women in the general population, independent of HDL cholesterol.
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TL;DR: Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk, however, further studies are needed to help assess the nature of any independent associations.
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"Is Apolipoprotein B and Small, Dens..." refers background in this paper
...Dyslipidemia, alongside with elevated blood pressure/hypertension, abdominal obesity and glucose intolerance/diabetes mellitus, is a component of metabolic syndrome and has been established as a risk factor for cardiovascular disease [9][10]....
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TL;DR: Serum triglyceride concentration has prognostic value, both for assessing coronary heart disease risk and in predicting the effect of gemfibrozil treatment, especially when used in combination with HDL-C and LDL-C.
Abstract: BACKGROUND We studied the joint effect of baseline triglyceride and lipoprotein cholesterol levels on the incidence of cardiac end points in the trial group (n = 4,081) of the Helsinki Heart Study, a 5-year randomized coronary primary prevention trial among dyslipidemic middle-aged men. The relative risks (RR) were calculated using Cox proportional hazards models with a dummy variable technique that allows simultaneous study of subgroup combinations from the placebo and treatment groups. METHODS AND RESULTS In the placebo group (n = 2,045), the low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio was the best single predictor of cardiac events. This ratio in combination with the serum triglyceride level revealed a high-risk subgroup: subjects with LDL-C/HDL-C ratio greater than 5 and triglycerides greater than 2.3 mmol/l had a RR of 3.8 (95% CI, 2.2-6.6) compared with those with LDL-C/HDL-C ratio less than or equal to 5 and triglyceride concentration less than or equal to 2.3 mmol/l. In subjects with triglyceride concentration greater than 2.3 mmol/l and LDL-C/HDL-C ratio less than or equal to 5, RR was close to unity (1.1), whereas in those with triglyceride level less than or equal to 2.3 mmol/l and LDL-C/HDL-C ratio greater than 5, RR was 1.2. The high-risk group with LDL-C/HDL-C ratio greater than 5 and triglyceride level greater than 2.3 mmol/l profited most from treatment with gemfibrozil, with a 71% lower incidence of coronary heart disease events than the corresponding placebo subgroup. In all other subgroups, the reduction in CHD incidence was substantially smaller. CONCLUSIONS Serum triglyceride concentration has prognostic value, both for assessing coronary heart disease risk and in predicting the effect of gemfibrozil treatment, especially when used in combination with HDL-C and LDL-C.
1,358 citations