Key result
Triglycerides ≥150 mg/dL were associated with higher odds of residual ApoB ≥90 mg/dL despite LDL-C <100 and non-HDL-C <130 mg/dL (18.2% vs 2.9%; OR 6.23; 95% CI 3.68-10.53; P<0.001).
Why the study?
LDL-C and non-HDL-C reflect cholesterol mass whereas ApoB reflects atherogenic particle number, prompting examination of residual ApoB elevation across triglyceride levels after both cholesterol thresholds are met.
Does a triglyceride level ≥1.69 mmol/L [150 mg/dL] identify a higher prevalence of residual apolipoprotein B elevation (≥0.90 g/L) in adults aged 30–79 years who have achieved both LDL-C <2.59 mmol/L and non-HDL-C <3.36 mmol/L?
Cross-Sectional (n=10,451)
Yes
Does a triglyceride level ≥1.69 mmol/L [150 mg/dL] identify a higher prevalence of residual apolipoprotein B elevation (≥0.90 g/L) in adults aged 30–79 years who have achieved both LDL-C <2.59 mmol/L and non-HDL-C <3.36 mmol/L?
In adults who have already achieved both LDL-C (<100 mg/dL) and non-HDL-C (<130 mg/dL) goals, elevated triglycerides (≥150 mg/dL) identify a subgroup with significantly higher odds (OR 6.23) of residual ApoB elevation (≥90 mg/dL), helping target ApoB testing.
May support selective ApoB testing in patients at LDL-C/non-HDL-C goals; leaves open outcome benefits of ApoB-guided therapy.
Background: Low-density lipoprotein cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) reflect cholesterol mass, whereas apolipoprotein B (ApoB) reflects atherogenic particle number. We examined residual ApoB elevation after both cholesterol thresholds had been met and its distribution across triglyceride levels. Methods: We analysed the 2005–2016 fasting subsample of the National Health and Nutrition Examination Survey (NHANES) among adults aged 30–79 years. The primary subgroup had LDL-C <2.59 mmol/L [100 mg/dL] and non-HDL-C <3.36 mmol/L [130 mg/dL]; residual elevation was defined as ApoB ≥0.90 g/L [90 mg/dL]. NHANES estimates and regressions accounted for the complex survey design. CHNS 2009 provided an unweighted consistency assessment. Results: Of 10,451 NHANES participants, 3,132 met both thresholds and 163 had ApoB ≥0.90 g/L. Weighted prevalence was 5.4% (95% CI 4.4–6.4), rising to 18.2% with triglycerides ≥1.69 mmol/L [150 mg/dL], compared with 2.9% below this threshold. The clinical model yielded an odds ratio of 6.23 (95% CI 3.68–10.53; P<0.001). Prevalence varied by ApoB threshold (22.9% at ≥0.80 g/L; 0.9% at ≥1.00 g/L). In CHNS, corresponding triglyceride-stratified prevalences were 8.9% and 1.9%. Conclusions: Residual ApoB elevation after simultaneous LDL-C and non-HDL-C threshold attainment was concentrated in adults with higher triglycerides. Triglyceride levels offer a readily available means of identifying a subgroup with substantially greater yield from ApoB measurement.
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Wang et al. (2026) conducted a cross-sectional in Residual apolipoprotein B elevation after LDL-C and non-HDL-C threshold attainment (n=10,451). Triglycerides ≥1.69 mmol/L (150 mg/dL) vs. Triglycerides <1.69 mmol/L (150 mg/dL) was evaluated on Residual ApoB elevation (ApoB ≥0.90 g/L [90 mg/dL]) among adults meeting LDL-C <2.59 mmol/L and non-HDL-C <3.36 mmol/L (OR 6.23, 95% CI 3.68-10.53, p=<0.001). Triglycerides ≥150 mg/dL were associated with higher odds of residual ApoB ≥90 mg/dL despite LDL-C <100 and non-HDL-C <130 mg/dL (18.2% vs 2.9%; OR 6.23; 95% CI 3.68-10.53; P<0.001).
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