Central Adiposity and Apolipoprotein B-Related Atherogenic Phenotypes: A Nationally Representative Cross-Sectional Study in Taiwan

Background/Objectives: Low-density lipoprotein cholesterol (LDL-C) remains central to atherosclerotic cardiovascular disease prevention, but in obesity it may not fully reflect atherogenic particle burden because cholesterol content per particle can vary. We examined whether central adiposity is more consistently associated with apolipoprotein B (ApoB)-related atherogenic phenotypes than with elevated LDL-C in Taiwanese adults. Methods: Cross-sectional analyses used data from the nationally representative Taiwan Survey on Hypertension, Hyperglycemia, and Hyperlipidemia. Waist circumference (WC) analyses included 6771 adults (3162 men and 3609 women), and 6061 of these participants (2975 men and 3086 women) had available body mass index (BMI) data for BMI-based analyses. Survey-weighted, sex-specific multivariable logistic regression was performed. High LDL-C and high ApoB were defined as ≥130 mg/dL, and dysapolipoproteinemia as an ApoB/ApoA-I ratio ≥ 75th percentile. Results: Increasing BMI and WC were associated with higher triglycerides, ApoB, and ApoB/ApoA-I ratios, whereas LDL-C gradients were less consistent. Among women, WC ≥ 90 cm was associated with high ApoB (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4–3.7) and dysapolipoproteinemia (OR, 1.6; 95% CI, 1.2–2.2), but not with high LDL-C. Among men, WC 90–100 cm and ≥100 cm were associated with dysapolipoproteinemia (OR, 1.6; 95% CI, 1.3–1.9; and OR, 2.0; 95% CI, 1.4–2.8, respectively), whereas associations with high LDL-C were not significant. Conclusions: In this cross-sectional dataset, central adiposity showed a pattern of more consistent associations with ApoB-related phenotypes than with high LDL-C, particularly for the ApoB/ApoA-I ratio; however, no formal statistical test directly compared effect sizes across lipid outcomes, and higher WC was not significantly associated with high ApoB in men. These findings are descriptive and hypothesis-generating and require confirmation in contemporary prospective cohorts before clinical implementation.