Nonfasting Apolipoprotein B and Triglyceride Levels as a Useful Predictor of Coronary Heart Disease Risk in Middle-Aged UK Men

Abstract

Objective-The Apolipoprotein-related Mortality Risk (AMORIS) study concluded that the apolipoprotein (apo)B/apoA-I ratio was the best predictor of coronary heart disease (CHD) risk. We have compared the pairwise combinations of total cholesterol, triglycerides (TGs), apoB, high density lipoprotein (HDL) cholesterol, low density lipoprotein cholesterol, and apoA-I on CHD risk prediction in middle-aged men. Methods and Results-Healthy middle-aged men (nϭ2508), free of CHD at baseline, were examined prospectively. Over 6 years of follow-up, there were 163 CHD events (including acute myocardial infarction, coronary artery surgery, and ECG evidence of silent myocardial infarction). The relative risk (RR) of CHD associated with cholesterol, TGs, apoB, apoA-I, apoB/apoA-I, low density lipoprotein cholesterol, and HDL cholesterol were examined by survival analysis.The apoB/apoA-I ratio was associated with the strongest effect on the RR (3.58, 95% CI 2.08 to 6.19). In multivariate analysis, apoA-I had no significant effect on risk. Examining RR by quartiles, apoB and HDL in combination (RR 8.38, 95% CI 3.21 to 21.92) were better predictors of CHD risk than apoB and TGs (RR 4.05, 95% CI 1.57 to 6.23). However, apoB and TGs in combination added risk information over and above lifestyle factors, whereas apoB and HDL cholesterol did not. Conclusions-The combined evaluation of apoB with TGs provides useful diagnostic criteria for CHD risk. Key Words: follow-up studies Ⅲ apolipoprotein B Ⅲ triglycerides Ⅲ HDL cholesterol Ⅲ apolipoprotein A-I R aised cholesterol, 1 raised triglycerides (TGs), 2 low levels of HDL cholesterol (HDL-C), 3 and small dense LDLs 4 are all considered to be independent predictors of coronary heart disease (CHD) risk. However, there is mounting evidence indicating that measures of plasma apoB and apoA-I, over and above lipid measures, may be better predictors of CHD risk in adults 5,6 and in children. 7 Walldius et al 8 recently published results from the Apolipoprotein-related Mortality Risk (AMORIS) study of 175 553 men and women; these results clearly demonstrate the power of apoB, apoA-I, and the apoB/apoA-I ratio in predicting CHD risk, suggesting that the ratio of apoB/apoA-I helps define cholesterol transport and reverse cholesterol transport to and from the peripheral tissue. Furthermore, in that study, the value of apoB as a risk predictor was evident even at LDL cholesterol (LDL-C) levels below the median, showing the strength of apoB compared with LDL-C in evaluating CHD risk. Making use of the newly derived formulas for HDL-C and LDL-C estimates by Walldius et al, 8 we have examined the combination of TGs and cholesterol, TGs and apoB, HDL-C and apoB, apoB and apoA-I, and HDL-C with LDL-C in predicting CHD risk in a large prospective study of healthy middleaged men in the United Kingdom. Methods Study SampleHealthy men (nϭ3052), aged 50 to 61 years and registered with 9 general medical practices, were recruited for prospective surveillance. The study had full ethical approval, with subjects g...

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