MedWire News: The ability of apolipoprotein (apo) B is significantly better than that of any routine lipid measurements for predicting coronary heart disease (CHD) death, report investigators in the European Heart Journal.
"Prospective studies indicate that apolipoprotein measurements predict CHD risk; however, evidence is conflicting, especially in the USA," say Anders Hamsten (Karolinska University Hospital Solna, Stockholm, Sweden) and colleagues. Indeed, MedWire News has reported on several such studies in the past.
In this study, Hamsten and colleagues prospectively analyzed links between apolipoprotein measurements, traditional cardiovascular risk factors, and traditional lipid measurements taken at baseline and CHD mortality in a group of 7594 men and women aged 45 years on average who formed part of the Third National Health and Nutrition Examination Survey mortality study during 1988-1994.
Following a search of the National Death Index in 2000, the researchers found that 673 cardiovascular-related deaths occurred in this cohort, 432 of which were due to CHD.
They calculated that each standard deviation increase in apoB and total cholesterol levels increased the risk for CHD death 1.98 and 1.17 fold, respectively, while each increase in apoA-I reduced risk by 48%. However, high-density lipoprotein (HDL) cholesterol was only borderline significant, at a hazard ratio for CHD death of 0.68 per standard deviation increment.
In addition, the ratios of apoB to apoA-I and of total cholesterol to HDL cholesterol were also related to CHD mortality, at hazard ratios of 2.14 and 1.10 per standard deviation increase, respectively.
Of note, following adjustment for cardiovascular risk factors, only apoB and the ratio of apoB to apoA-I were significantly associated with CHD death, at respective hazard ratios of 2.01 and 2.14 per standard deviation increase.
Hamsten and co-authors conclude that their "study shows that apos provide clinical information regarding CHD death that could neither be obtained with traditional risk factors nor with clinical routine lipid measurements."
They add that "the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements."
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