Residual Risk of Coronary Atherosclerotic Heart Disease and Severity of Coronary Atherosclerosis Assessed by ApoB and LDL-C in Participants With Statin Treatment: A Retrospective Cohort Study

Abstract

BackgroundLow-density lipoprotein cholesterol (LDL-C) is the primary target of lipid-lowering therapy on the management of hypercholesterolemia in the United States and European guidelines, while apolipoprotein B (apoB) is the secondary target. The objective was to determine if elevated levels of apoB is superior to LDL-C in assessing residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment.MethodsThis study included 131 participants with statin treatment. The generalized linear model and relative risk regression (generalized linear Poisson model with robust error variance) were used to analyze the association of the levels of apoB and LDL-C with the severity of coronary atherosclerosis and residual risk of coronary atherosclerotic heart disease.ResultsCategorizing apoB and LDL-C based on tertiles, higher levels of apoB were significantly associated with the severity of coronary atherosclerosis (Ptrend = 0.012), whereas no such associations were found for elevated levels of LDL-C (Ptrend = 0.585). After multivariate adjustment, higher levels of apoB were significantly associated with residual risk of coronary atherosclerotic heart disease. When compared with low-level apoB (≤0.66 g/L), the multivariate adjusted RR and 95% CI of intermediate-level apoB (0.67–0.89 g/L) and high-level apoB (≥0.90 g/L) were 1.16 (1.01, 1.33) and 1.31 (1.08, 1.60), respectively (Ptrend = 0.011). There was a 45% increased residual risk of coronary atherosclerotic heart disease per unit increment in natural log-transformed apoB (Ptrend <0.05). However, higher levels of LDL-C were not significantly associated with residual risk of coronary atherosclerotic heart disease. When compared with low-level LDL-C (≤1.56 mmol/L), the multivariate adjusted RR and 95% CI of intermediate-level LDL-C (1.57–2.30 mmol/L) and high-level LDL-C (≥2.31 mmol/L) were 0.99 (0.84, 1.15) and 1.10 (0.86, 1.42), respectively (Ptrend = 0.437). Similar results were observed in the stratified analyses and sensitivity analyses. No significant interactions were detected for both apoB and LDL-C (all Pinteraction>0.05).ConclusionsElevated apoB are superior in assessing the residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment.

Apolipoprotein B is associated with CT-angiographic progression beyond low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol in patients with coronary artery disease

“…However, there was no association between the progression risk and elevated LDL-C levels while receiving statins therapy, which was in line with a previous study conducted by Yao et al [ 31 ]. They concluded that higher apoB levels, rather than LDL-C levels were significantly correlated with new-onset CAD in participants who received statins therapy.…”

The LDL-C/Apo B predicts coronary atherosclerotic heart disease in non-diabetic patients without high LDL-C

“…Apo B is a key structural protein component of all major atherosclerotic lipoproteins (LDL-C, VLDL-C, IDL-C, and Lp [a]). [ 3 ] It has been shown to be a better predictor of ASCVD than LDL-C. [ 19 , 20 ] The Apo B/A1 ratio is also a good predictor of ASCVD. The Apo A1 is an anti-atherosclerotic lipoprotein and the main apolipoprotein incorporated into HDL-C.…”

“…[17,18] However, biomarkers ). [3] It has been shown to be a better predictor of ASCVD than LDL-C. [19,20] The Apo B/A1 ratio is also a good predictor of ASCVD. The Apo A1 is an anti-atherosclerotic lipoprotein and the main apolipoprotein incorporated into HDL-C.…”

Apolipoprotein B - An ideal biomarker for atherosclerosis?

“…ApoB/ApoA1 and GDF-15 may be helpful for predicting the occurrence of CAD in patients with T2DM. Yao T, 2022 41 Not mentioned Cohort Coronary atherosclerotic heart disease To determine if elevated levels of apoB is superior to LDL-C in assessing residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment. NA 131 Elevated apoB are superior in assessing the residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment.…”