What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Normal glucose tolerance (n=6069). Intervention: Serum apolipoprotein B vs. Lower levels of apolipoprotein B. Primary outcome: Elevated Carotid Intima-Media Thickness (≥0.7 mm) (OR 1.23, 95% CI 1.00-1.51, p=0.049).

January 24, 2013Open Access

Both Serum Apolipoprotein B and the Apolipoprotein B/Apolipoprotein A-I Ratio Are Associated with Carotid Intima-Media Thickness

Key Result

Serum apolipoprotein B was independently associated with elevated carotid intima-media thickness (OR 1.23 per standard deviation increment) in Chinese adults with normal glucose tolerance.

Study Design

Type

Cross-Sectional (n=6,069)

Structured PICO

Are serum apoB and the apoB/apoA-I ratio associated with elevated carotid intima-media thickness in adults with normal glucose tolerance?

Population

6,069 community-dwelling Chinese adults aged 40 years or older with normal glucose tolerance.

Outcome

Elevated carotid intima-media thickness (CIMT), defined as values above the upper tenth of CIMT (≥0.7 mm)surrogate

Serum apoB and the apoB/apoA-I ratio are independently associated with elevated carotid intima-media thickness in adults with normal glucose tolerance, suggesting they may be better markers of early atherosclerosis than traditional lipids.

Main Result

Odds Ratio: 1.23 (95% CI 1–1.51)

p-value: p=0.049

Limitations

Cross-sectional design cannot determine causality or predict progression of CIMT
Cannot compare associations with clinical CVD events
Population included subjects with dyslipidemia who might have been treated
Only one test for apoB was used, without differentiating apoB-48 and apoB-100
Possible selection bias as most participants were from a rural community in Shanghai

Abstract

BACKGROUND: Previous studies indicated that apolipoprotein measurements predicted cardiovascular disease (CVD) risk; however, associations between apolipoproteins and carotid intima-media thickness (CIMT) were less explored. METHODOLOGY AND PRINCIPAL FINDINGS: The cross-sectional study included 6069 participants aged 40 years or older with NGT from Shanghai, China. Serum fasting traditional lipids (total cholesterol TC, low-density lipoprotein cholesterol LDL-C, high-density lipoprotein cholesterol HDL-C and triglycerides TG), apoA-I and apoB were assessed. A high-resolution B-mode ultrasonography was performed to measure CIMT. We found CIMT increased progressively across the quartiles of serum apoB (p for trend <0.0001). In logistic regression, concentrations of apoB (odds ratio OR 1.27, 95% confidence interval CI 1.18-1.36), TC (OR 1.23, 95% CI 1.14-1.32), LDL-C (OR 1.25, 95% CI 1.16-1.34) and TG (OR 1.11, 95% CI 1.04-1.20) were significantly related to elevated CIMT after adjusted for age and sex. Meanwhile, the apoB/apoA-I ratio (OR 1.25, 95% CI 1.17-1.34) related to elevated CIMT. ApoB (OR 1.23, 95% CI 1.00-1.51) and the apoB/apoA-I ratio (OR 1.19, 95% CI 1.04-1.36) remained significantly associated with elevated CIMT, after adjusted for the traditional CVD risk factors including traditional lipids. CONCLUSIONS AND SIGNIFICANCE: There were significant associations between serum apoB, the apoB/apoA-I ratio and elevated CIMT. Serum apoB and the apoB/apoA-I ratio might be independent predictors of early atherosclerosis in NGT.

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