July 1, 2024Open Access
Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice
Key Result
Apolipoprotein B measurement outperforms low-density lipoprotein cholesterol in predicting atherosclerotic cardiovascular disease risk, prompting the proposal of evidence-guided apoB thresholds.
Structured PICO
How should apolipoprotein B (apoB) measurement be interpreted and applied in clinical practice compared to LDL-C for ASCVD risk management?
P
Population
Patients undergoing lipid management for atherosclerotic cardiovascular disease risk assessment
I
Intervention
Apolipoprotein B (apoB) measurement and threshold-guided management
C
Comparator
Low-density lipoprotein cholesterol (LDL-C) measurement
O
Outcome
Atherosclerotic cardiovascular disease risk prediction and treatment targets
This review proposes evidence-guided apolipoprotein B thresholds to facilitate its adoption in routine clinical practice for better ASCVD risk prediction.
Abstract
Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking. In this review, we synthesize existing data regarding the epidemiology of apoB by comparing guideline recommendations regarding use of apoB measurement, describing population percentiles of apoB relative to low-density lipoprotein cholesterol levels, summarizing studies of discordance between low-density lipoprotein cholesterol and apoB levels, and evaluating apoB levels in clinical trials of lipid-lowering therapy to guide potential treatment targets. We propose evidence-guided apoB thresholds for use in cholesterol management and clinical care.