November 29, 2005Circulation521 citationsOpen Access
View Full PaperNon–High-Density Lipoprotein Cholesterol and Apolipoprotein B in the Prediction of Coronary Heart Disease in Men
Key Result
Apolipoprotein B was a stronger predictor of coronary heart disease than non-HDL-C or LDL-C, with a relative risk of 3.01 (95% CI 1.81-5.00; P trend <0.001) for the highest versus lowest quintile.
Study Design
Type
Case-Control (n=18,225)
Structured PICO
Do Apolipoprotein B and non-HDL-C levels predict the development of coronary heart disease in men?
P
Population
18,225 men free of diagnosed cardiovascular disease at baseline, followed for 6 years to assess lipid markers as predictors of incident coronary heart disease.
E
Exposure
Highest quintile of Apolipoprotein B (apoB) and non-HDL-C levels
C
Comparator
Lowest quintile of Apolipoprotein B (apoB) and non-HDL-C levels
O
Outcome
Nonfatal myocardial infarction or fatal coronary heart disease (CHD)hard clinical
Apolipoprotein B is a stronger predictor of coronary heart disease than non-HDL-C or LDL-C, supporting the concept that atherogenic lipoprotein particle concentration is more predictive of risk than the cholesterol carried by these particles.
Main Result
Relative Risk: 3.01 (95% CI 1.81–5)
p-value: p=<0.001
Abstract
BACKGROUND: Apolipoprotein B (apoB) plasma levels reflect the concentration of proatherogenic lipoproteins very low-density lipoprotein and low-density lipoprotein (LDL), whereas non-high-density lipoprotein cholesterol (non-HDL-C) levels reflect the concentration of cholesterol transported by these particles. METHODS AND RESULTS: The aim of our study was to compare apoB, non-HDL-C, LDL cholesterol (LDL-C), and other lipid markers as predictors of coronary heart disease (CHD) in a nested case-control study among 18 225 participants in the Health Professionals Follow-up Study. Among men who were free of diagnosed cardiovascular disease at the time of blood collection, 266 had nonfatal myocardial infarction or fatal CHD during 6 years of follow-up. Through the use of risk set sampling, control subjects were selected at a 2:1 ratio and matched with regard to age, date of blood collection, and smoking status. After adjustment for matching factors, the relative risk of CHD in the highest quintile compared with the lowest quintile was 2.76 (95% confidence interval CI, 1.66 to 4.58) for non-HDL-C, 3.01 (95% CI, 1.81 to 5.00) for apoB, 1.81 (95% CI, 1.12 to 2.93) for LDL-C, 0.31 (95% CI, 0.18 to 0.52) for HDL-C, 2.41 (95% CI, 1.43 to 4.07) for triglycerides (all P trend <0.001), and 1.42 (95% CI, 0.86 to 2.32, P trend =0.19) for lipoprotein(a). When non-HDL-C and LDL-C were mutually adjusted, only non-HDL-C was predictive of CHD. When non-HDL-C and apoB were mutually adjusted, only apoB was predictive; the relative risk was 4.18 (95% CI, 1.30 to 13.49; P trend =0.02) for apoB compared with 0.70 (95% CI, 0.21 to 2.27; P trend =0.72) for non-HDL-C. Triglycerides added significant information to non-HDL-C but not to apoB for CHD risk prediction. CONCLUSIONS: Although non-HDL-C and apoB were both strong predictors of CHD in this male cohort, more so than LDL-C, the findings support the concept that the plasma concentration of atherogenic lipoprotein particles measured by apoB is more predictive in development of CHD than the cholesterol carried by these particles, measured by non-HDL-C.