The American Journal of Cardiology

2003

DOI: 10.1016/s0002-9149(03)00262-5

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Concordance/discordance between plasma apolipoprotein B levels and the cholesterol indexes of atherosclerotic risk

Allan D. Sniderman

¹

,

Annie St‐Pierre

²

,

³

et al.

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Improvement In a Comprehensive Set Of Cardiometabolic Risk M1

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Cited by 206 publications

(143 citation statements)

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“…This is the scenario where apoB may be most useful, 1 and where direct comparisons with non-HDL-C are meaningful. Thus, concordances with LDL-C levels, as has been reported elsewhere, 7 are not clinically meaningful among our study patients with high TG values, as non-HDL-C is the ATP III lipid goal and in most situations more difficult to treat (i.e., LDL-C goal will be met in almost all patients at non-HDL-C target). 4 Relationships between lipoprotein values were determined by Pearson and Spearman (if non-normal distribution) correlation coefficients.…”

Section: Methodssupporting

confidence: 77%

“…However, discordances between non-HDL-C and apoB have been shown to occur in population studies. 6,7,8 The apoB concentration is more biologically linked to the genesis of atherosclerosis than is the simple level of cholesterol within any subset of particles. 1 Some epidemiological studies confirm that apoB may be superior to both LDL-C and non-HDL-C in predicting CV risk.…”

Section: Introductionmentioning

confidence: 99%

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Potential Effect of an Apoprotein B‐based Algorithm on Management of New Patients with Hypertriglyceridemia Referred to a Specialty Lipid Clinic

et al. 2009

Clinical Cardiology

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Background: In patients with hypertriglyceridemia, non-high density lipoprotein cholesterol (nonHDL-C) is a targeted goal. However, apoprotein B100 (apoB) may be superior in predicting cardiovascular risk so we assessed the utility of an apoB-based. Methods: New patients (n=125) who had both apoB and standard lipids measured on the same day were included and we determined the concordances of having achieved goal lipid levels based upon proposed apoB versus nonHDL-C (ATP III) targets in patients with elevated TG (>150 mg·dl −1 ) levels.Results: Although apoB was correlated with nonHDL-C (r = 0.47, p<0.001), the tests had only a fair level of agreement when categorizing the percentage of patients achieving lipid goals for their degree of cardiovascular risk (κ = 0.22). Among patients with an elevation in nonHDL-C above ATP III goals, between 12-42% had achieved target apoB. On the contrary, between 44-50% of patients were found to be at nonHDL-C but not apoB target. The results were not substantively altered if the analyses were confined to patients with TG values between 200-499 mg·dl −1 , rather than all patients with TG levels >150 mg·dl −1 , as specifically outlined in ATP III guidelines. In total, >50% of all subjects would have been treated either more or less aggressively following an apoB-based therapeutic algorithm. Conclusions: Our findings confirm that the majority of patients referred with hypertriglyceridemia would be managed differently by following an apoB-based treatment algorithm compared to ATP III guidelines. Although many patients would be candidates for more intense therapy, many would be treated less aggressively.

“…This is the scenario where apoB may be most useful, 1 and where direct comparisons with non-HDL-C are meaningful. Thus, concordances with LDL-C levels, as has been reported elsewhere, 7 are not clinically meaningful among our study patients with high TG values, as non-HDL-C is the ATP III lipid goal and in most situations more difficult to treat (i.e., LDL-C goal will be met in almost all patients at non-HDL-C target). 4 Relationships between lipoprotein values were determined by Pearson and Spearman (if non-normal distribution) correlation coefficients.…”

Section: Methodssupporting

confidence: 77%

“…However, discordances between non-HDL-C and apoB have been shown to occur in population studies. 6,7,8 The apoB concentration is more biologically linked to the genesis of atherosclerosis than is the simple level of cholesterol within any subset of particles. 1 Some epidemiological studies confirm that apoB may be superior to both LDL-C and non-HDL-C in predicting CV risk.…”

Section: Introductionmentioning

confidence: 99%

Potential Effect of an Apoprotein B‐based Algorithm on Management of New Patients with Hypertriglyceridemia Referred to a Specialty Lipid Clinic

et al. 2009

Clinical Cardiology

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Background: In patients with hypertriglyceridemia, non-high density lipoprotein cholesterol (nonHDL-C) is a targeted goal. However, apoprotein B100 (apoB) may be superior in predicting cardiovascular risk so we assessed the utility of an apoB-based. Methods: New patients (n=125) who had both apoB and standard lipids measured on the same day were included and we determined the concordances of having achieved goal lipid levels based upon proposed apoB versus nonHDL-C (ATP III) targets in patients with elevated TG (>150 mg·dl −1 ) levels.Results: Although apoB was correlated with nonHDL-C (r = 0.47, p<0.001), the tests had only a fair level of agreement when categorizing the percentage of patients achieving lipid goals for their degree of cardiovascular risk (κ = 0.22). Among patients with an elevation in nonHDL-C above ATP III goals, between 12-42% had achieved target apoB. On the contrary, between 44-50% of patients were found to be at nonHDL-C but not apoB target. The results were not substantively altered if the analyses were confined to patients with TG values between 200-499 mg·dl −1 , rather than all patients with TG levels >150 mg·dl −1 , as specifically outlined in ATP III guidelines. In total, >50% of all subjects would have been treated either more or less aggressively following an apoB-based therapeutic algorithm. Conclusions: Our findings confirm that the majority of patients referred with hypertriglyceridemia would be managed differently by following an apoB-based treatment algorithm compared to ATP III guidelines. Although many patients would be candidates for more intense therapy, many would be treated less aggressively.

“…Unlike TG, non-HDL-C is not subject to wide intra-individual variations or the effects of incomplete fasting and, thus, may be a more convenient screening tool [18]. However, non-HDL-C is not always strongly associated with apoB100, particularly in the presence of hypertriglyceridaemia [19]. Although few studies have evaluated the non-HDL-C/HDL-C ratio for predicting CHD, it is assumed to have similar effects as those of the TC/HDL-C and LDL-C/HDL-C ratios [20].…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people

¹

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²

,

³

et al. 2015

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A b s t r a c tBackground and aim: Dyslipidaemia is the main risk factor for coronary heart disease (CHD). Plasma lipid levels are conventionally used to predict coronary risk globally, but further studies are required to investigate whether the lipoprotein ratios are superior to conventional lipid parameters as predictors for CHD. Methods:A hospital-based case-control study consisting of 738 CHD patients and 157 control subjects was conducted in a Chinese Han population. Demographic characteristics and plasma lipid or apolipoprotein data were collected. Univariate and multivariate logistic regression analyses were carried out to examine the relationship between the lipoprotein ratios and CHD risk. Results:The CHD group had significantly higher age, non-high-density lipoprotein cholesterol (non-HDL-C), lipoprotein (a) [Lp(a)], triglyceride (TG)/HDL-C, total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, non-HDL-C/HDL-C, very low-density lipoprotein cholesterol (VLDL-C)/HDL-C, and apolipoprotein B100/apolipoprotein AI (apoB100/apoAI) than the control group (p < 0.05 for all). Moreover, the prevalence of male sex, smoking, and hypertension in the CHD group was significantly higher than in the control group. The results from univariate logistic regression analysis showed that the ratios of TC/HDL-C (OR 1.135, 95% CI 1.019-1.265), LDL-C/HDL-C (OR 1.216, 95% CI 1.033-1.431), non-HDL-C/HDL-C (OR 1.135, 95% CI 1.019-1.265), and apoB100/apoAI (OR 1.966, 95% CI 1.013-3.817) significantly increased the risk for CHD. By multivariate logistic regression analysis, the results were not materially altered and each of the four ratios was independently associated with CHD after adjustment for non-lipid coronary risk factors. ApoB100/apoAI showed the strongest association with CHD in both the univariate and multivariate logistic regression analyses. Conclusions:Our data indicate that the lipoprotein ratios are superior to conventional lipid parameters as predictors for CHD. Of the ratios, apoB100/apoAI is the best to predict CHD risk.

“…However, because each LDL particle carries one apolipoprotein B molecule, subjects with visceral obesity have an elevated apolipoprotein B despite a normal LDL-cholesterol level (32). The apolipoprotein B level is therefore a better risk marker than LDL-cholesterol to reflect the atherogenic lipoprotein-lipid profile of viscerally obese men (33). After 1 year the apolipoprotein B levels of viscerally obese men decreased whereas LDL-cholesterol levels significantly increased presumably reflecting the production of LDL particles of large size which are considered less atherogenic (34).…”

Section: Improvement In a Comprehensive Set Of Cardiometabolic Risk Mmentioning

confidence: 99%

Visceral and Not Subcutaneous Abdominal Adiposity Reduction Drives the Benefits of a 1‐Year Lifestyle Modification Program

¹

,

²

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³

et al. 2012

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Excess visceral adipose tissue (VAT) is associated with an increased cardiometabolic risk. The study examined whether changes in cardiometabolic risk markers after a 1-year lifestyle intervention in viscerally obese men were associated with changes in VAT or with changes in subcutaneous abdominal adipose tissue (SAT). The relative contributions of changes in global adiposity vs. changes in cardiorespiratory fitness to changes in VAT were also quantified. One hundred and forty four men were selected on the basis of an increased waist circumference (≥90 cm) associated with dyslipidemia (triglycerides ≥1.69 and/or high-density lipoprotein (HDL)-cholesterol <1.03 mmol/l); 117 men completed the 1-year intervention which consisted in a healthy eating, physical activity/exercise program. Body weight, body composition, and fat distribution were assessed by anthropometry and dual-energy X-ray absorptiometry (DEXA)/computed tomography. Cardiorespiratory fitness, plasma adipokine/inflammatory markers, fasting lipoprotein-lipid profile, and oral glucose tolerance test (OGTT) were assessed. VAT volume decreased by 26%, cardiorespiratory fitness improved by 20% (P < 0.0001) after 1 year. Plasma adipokine/inflammatory markers, lipids/ lipoproteins, and glucose homeostasis were improved. One-year changes in triglyceride (r = 0.29), apolipoprotein B (r = 0.21), 120-min OGTT-glucose (r = 0.27), and fasting insulin (r = 0.27) levels correlated with changes in VAT (all P < 0.05) after adjustment for changes in SAT. Using a multilinear regression model, VAT reduction was independently associated with SAT reduction and with improvement in cardiorespiratory fitness (R 2 = 0.58, P < 0.0001). Therefore, this healthy eating-physical activity/exercise program improved the cardiometabolic risk profile of viscerally obese men in relation to the reduction of VAT. Furthermore, the reduction in VAT was independently related to the reduction in global adiposity and to the improvement in cardiorespiratory fitness.

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