Key result
ApoB outperforms LDL-C and non-HDL-C in predicting coronary events and residual risk.
Why the study?
Does measurement of apoB better predict CAD events compared to LDL-C in patients with coronary artery disease?
Does measurement of apoB better predict CAD events compared to LDL-C in patients with coronary artery disease?
ApoB and the apoB/apoA-I ratio are superior predictors of CAD events compared to LDL-C and should be measured to better assess residual risk and treatment efficacy.
Recent clinical trials in patients with coronary artery disease (CAD) provide evidence that low-density lipoprotein cholesterol (LDL-C) levels should be lowered even further to prevent recurrent CAD. However, despite more aggressive interventions for lowering LDL-C levels, the majority of CAD events go undeterred, perhaps related to the fact that intervention was not started earlier in life or that LDL-C levels represent an incomplete picture of atherogenic potential. Nevertheless, LDL-C remains the contemporary standard as the primary goal for aggressive LDL reduction. If triglycerides are >200 mg/dl, the measurement of non-high-density lipoprotein cholesterol (HDL-C) is recommended. Measurement of apolipoprotein (apo)B has been shown in nearly all studies to outperform LDL-C and non-HDL-C as a predictor of CAD events and as an index of residual CAD risk. This is because apoB reflects the total number of atherogenic apoB-containing lipoproteins and is a superior predictor of the number of low-density lipoprotein particles (LDL-P). Estimates of LDL-P and size can also be made by nuclear magnetic resonance spectroscopy, density gradient ultracentrifugation, and gradient gel electrophoresis. Although a number of studies show that such estimates predict CAD, LDL-P, and size often accompany low HDL-C and high triglyceride levels, and therefore such additional lipoprotein testing has not been recommended for routine screening and follow-up. Because apoB is a superior predictor of LDL-P, we recommend that apoB and the apoB/apoA-I ratio be determined after measurement of LDL-C, non-HDL-C, and the ratio of total cholesterol/HDL-C to better predict CAD and assess efficacy of treatment.
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Mudd et al. (2007) conducted a review in Coronary artery disease (CAD). Apolipoprotein B (apoB) measurement vs. LDL-C and non-HDL-C was evaluated on Prediction of CAD events and index of residual CAD risk. Measurement of apolipoprotein B outperforms LDL-C and non-HDL-C as a predictor of coronary artery disease events and as an index of residual risk.