ApoB is ‘best predictor’ of CV events
MedWire News: Apolipoprotein (apo)B is a better marker of cardiovascular (CV) risk than low-density lipoprotein (LDL) or non-high-density lipoprotein (nonHDL) cholesterol, show results from a meta-analysis.
Previous studies have found the hazard ratios of apoB and nonHDL cholesterol and of nonHDL and LDL cholesterol to be indistinguishable, explain Allan Sniderman (McGill University Health Centre, Quebec, Canada) and colleagues in the journal Circulation: Cardiovascular Quality Outcomes.
In the present study, however, apoB was the most "potent" marker of CV risk, whether analyzed individually or in head-to-head comparisons, they say.
"Moreover, we have shown that if apoB measurement is introduced into routine care, many more events would be prevented than if diagnosis and therapy were based on either LDL or nonHDL cholesterol levels."
The researchers performed a meta-analysis of 12 published studies, including a total of 233,455 patients and 22,950 fatal or nonfatal ischemic CV events.
They report that there was a hierarchy of accuracy among the three risk markers. Each standard deviation (SD) increase in apoB corresponded to a 43% increased risk for a CV event. This compared with a 34% and 25% increased risk with every SD increase in nonHDL and LDL cholesterol, respectively.
Furthermore, the authors show that, on average, across all studies, the apoB relative risk was 5.7% higher than the nonHDL cholesterol relative risk and 12.0% higher than the LDL cholesterol relative risk, while the relative risk of nonHDL cholesterol was 5.0% greater than that of LDL cholesterol.
"These head-to-head analyses rank order the three markers as follows: apoB>nonHDL cholesterol>LDL cholesterol," writes the team.
Finally, when Sniderman et al considered the population implications of their study, they found that using nonHDL cholesterol rather than LDL cholesterol could potentially reduce the number of incident CV cases among adult US residents by an additional 300,000 over 10 years (1.8 million vs 1.5 million).
Using apoB rather than nonHDL cholesterol would prevent another 500,000 patients from experiencing a coronary event (2.3 million vs 1.8 million), they say.
Therefore, the team concludes that apoB levels should be monitored routinely in the care of individual patients at risk for CVD.
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By Nikki Withers