Apolipoprotein B and Non-HDL Cholesterol Better Reflect Residual Risk Than LDL Cholesterol in Statin-Treated Patients

Johannesen, Camilla Ditlev Lindhardt; Mortensen, Martin Bødtker; Langsted, Anne; Nordestgaard, Børge G.

doi:10.1016/j.jacc.2021.01.027

Cited by 216 publications

(133 citation statements)

References 23 publications

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“…These results suggest that LDL-C values may not necessarily capture the variance in atherogenic potential and the differences in subclinical carotid atherosclerosis initiation among young persons with prediabetes, diabetes, and/or metabolic syndrome. Overall, our findings support evidence showing that LDL-C is not independently associated with downstream residual risk and/or all-cause mortality, and that ApoB is a superior predictor of myocardial infarction compared to LDL-C among statin-treated individuals [32] .…”

Section: Discussionsupporting

confidence: 86%

Discordantly normal ApoB relative to elevated LDL-C in persons with metabolic disorders: A marker of atherogenic heterogeneity

Razavi

Bazzano

et al. 2021

American Journal of Preventive Cardiology

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Highlights Not all individuals with prediabetes, T2D and/or MetS develop significant ASCVD. Discordantly normal ApoB relative to high LDL-C may help explain such heterogeneity. 51% of persons with metabolic disorders and high LDL-C had discordantly normal ApoB. Lower ApoB associated with long-term absence of carotid plaque, while LDL-C did not. Measurement of ApoB may be useful in young persons with metabolic disease.

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Section: Discussionsupporting

confidence: 86%

Discordantly normal ApoB relative to elevated LDL-C in persons with metabolic disorders: A marker of atherogenic heterogeneity

Razavi

Bazzano

et al. 2021

American Journal of Preventive Cardiology

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“…Similarly, the same results were obtained in the Women's Health Study [21,26] . The Copenhagen General Population Study, in patients treated with statins, Apo B and non-HDL-C demonstrated better predictive ability than LDL-C for residual cardiovascular risk [27] . The present study adds to this growing body of literature by demonstrating similar results across the China participants, suggesting that measuring Apo B as a marker of lipidassociated atherogenic risk may help identify CVD.…”

Section: Discussionmentioning

confidence: 97%

Discordance Between Circulating Atherogenic Cholesterol Mass and Lipoprotein Particle Concentration in Relation to Future Cardiovascular Disease in China Population

Xin

Zuo

Zhai

et al. 2021

Preprint

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BackgroundIt is uncertain whether measurement of circulating total atherogenic lipoprotein particle cholesterol mass (non-high-density lipoprotein cholesterol [non-HDL-C]) or particle concentration (apolipoprotein B [Apo B]) more accurately reflects risk of incident cardiovascular disease (CVD). We evaluated CVD risk among China population in whom these markers where discordant.MethodsIn total, 7,117 initially healthy participants from the China Health and Nutrition Survey were included. Logistic regressions among Apo B, non-HDL-C, and LDL-C, respectively, were used to examined CVD risk by categories of concordant and discordant values defined by residual differences. Mediation analysis was performed to explore the intermediary effect of Apo B between the obesity and the risk of CVD.ResultsAlthough all 3 biomarkers were correlated (r ≥ 0.81), discordance occurred in approximately 16% of China participants. Participants with discordant high Apo B were more likely to have higher proportion of traditional risk factors and dyslipidemia. During a follow-up of 6 years, 207 CVD cases were identified. High LDL-C, non-HDL-C and Apo B were associated with increased risk of CVD. Participants with discordant high Apo B relative to LDL-C or non-HDL-C had increased CVD risk compared with concordant levels, odds ratios were 1.38 (95% CI: 1.01 to 1.87), 1.40 (95% CI: 1.01 to 1.94), respectively. Furthermore, mediation analyses revealed 16.67% of association between obesity with CVD was mediated by Apo B.ConclusionsDiscordance analysis demonstrates that Apo B is a more accurate marker of CVD risk in China healthy participants than LDL-C and non-HDL-C. Direct measurement of lipoprotein particle concentration might help better inform clinical risk assessment and guide clinical decision making.

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“…Several cohort studies [11,12,29] and randomized clinical trials [10] investigating the relationship between RC, non-HDL-C and the outcomes of CAD have been conducted over recent years. Castañer et al enrolled 6,901 patients from the PREDIMED (Prevención con Dieta Mediterránea) study [10], while Langsted et al enrolled patients from the Copenhagen General Population Study (CGPS), a cohort study consisting of 109,574 individuals [29].…”

Section: The Relationship Between Remnant Cholesterol and Coronary Artery Diseasementioning

confidence: 99%

“…It showed that a 1 mmol/l (39 mg/dl) non-fasting RC increased may lead to a 2.8-fold causal risk for ischemic heart disease [12]. Moreover, Johannesen et al suggested that non-HDL-C, but not LDL-C, was related to an increasing risk of all-cause mortality of CAD [11]. Similarly, with different models of multivariate logistic regression analyses, our study concluded that remnant cholesterol was an independent causal risk for CAD, which was consistent with the results of former studies.…”

Section: The Relationship Between Remnant Cholesterol and Coronary Artery Diseasementioning

confidence: 99%

“…Remnant cholesterol, de ned as the cholesterol content of triglyceride-rich lipoproteins, is consist of very low-density lipoproteins and intermediate-density lipoproteins (VLDL and IDL) in fasting state, and chylomicron remnants in non-fasting state [8][9][10]. Recently, several studies have demonstrated that the elevated level of remnant cholesterol in serum is a signi cant risk factor for atherosclerosis, and it is remnant cholesterol and non-HDL-C, but not LDL-C, which better re ect the outcome of CAD, independently [10][11][12][13][14]. Therefore, in this clinical retrospective study, we aimed to test the hypothesis that elevated RC and non-HDL-C index had strong associations with CAD, and to explore whether the level of RC is more capable to predict the risk of CAD than LDL-C and non-HDL-C.…”

Section: Introductionmentioning

confidence: 99%

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Association of Increased Remnant Cholesterol and The Risk of Coronary Artery Disease: A Retrospective Study

Wang

Ding

Gao³

et al. 2021

Preprint

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Background and AimsLow-density lipoprotein cholesterol (LDL-C) is the primary target in lipid-lowering therapy in coronary artery disease (CAD). But some patients with normal levels of LDL-C still suffer from CAD progression and malignant outcomes (e.g., MACEs), and the mechanism is unclear. Previous prospective studies demonstrated that remnant cholesterol (RC) and non-HDL-C were capable to predict the risk of CAD. This study evaluated the association between RC and non-HDL-C with the risk of CAD.Methods12,563 patients were enrolled in our study. We categorized patients into four concordance/discordance groups according to the median of RC, LDL-C and non-HDL-C. Then we performed a propensity score matching (PSM) strategy. Unadjusted and adjusted multivariate logistic regression models were used to evaluate the relationship between lipid concentrations.Results8,658 (68.9%) patients were male with a median age of 61 (54,67) years. The multivariate logistic regression showed the OR of RC was 1.952 (CI=1.276-2.988, p＝0.002). The OR of low RC/high LDL-C group was 0.574 (CI=0.462-0.714, p＜0.001) and the OR of low RC/high non-HDL-C group was 0.574 (CI=0.462-0.714, p＜0.001). The p for interaction between RC and hypertension, diabetes were both <0.001.ConclusionsOur study showed a significant association between RC and CAD. The level of RC was more capable to reflect the risk of CAD than LDL-C and non-HDL-C. There was an interaction relationship between remnant cholesterol and age, gender, hypertension, diabetes in CAD. But we didn’t find whether there was a relationship between non-HDL-C and CAD.

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Apolipoprotein B and Non-HDL Cholesterol Better Reflect Residual Risk Than LDL Cholesterol in Statin-Treated Patients

Cited by 216 publications

References 23 publications

Discordantly normal ApoB relative to elevated LDL-C in persons with metabolic disorders: A marker of atherogenic heterogeneity

Discordantly normal ApoB relative to elevated LDL-C in persons with metabolic disorders: A marker of atherogenic heterogeneity

Discordance Between Circulating Atherogenic Cholesterol Mass and Lipoprotein Particle Concentration in Relation to Future Cardiovascular Disease in China Population

Association of Increased Remnant Cholesterol and The Risk of Coronary Artery Disease: A Retrospective Study

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