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Excess Apolipoprotein B and Cardiovascular Risk
Quick Takes
- Increases in excess apolipoprotein B (apoB) values were observed with increases in current smoking, systolic blood pressure, BMI, and diabetes.
- There was a dose-dependent association between excess apoB with the risk of MI and ASCVD in both women and men and with the risk of all-cause mortality in women.
- Blood levels of apoB provide additional atherosclerotic risk information beyond LDL-C across the entire range of LDL-C levels.
Study Questions:
Is excess apolipoprotein B (apoB) associated with an increased risk of myocardial infarction (MI), atherosclerotic cardiovascular disease (ASCVD), and all-cause mortality?
Methods:
Data from the Copenhagen General Population Study and the Copenhagen City Heart Study were used for the present analysis. Participants were included if they were not taking statins. Excess apoB was defined as measured levels of apoB minus expected levels of apoB from low-density lipoprotein cholesterol (LDL-C) alone. Expected levels were defined by linear regressions of LDL-C levels versus apoB levels in individuals with triglycerides ≤1 mmol/L (89 mg/dL). LDL-C was calculated using the Friedewald equation. Outcomes of interest included MI, ASCVD, and all-cause mortality. MI and ASCVD events were identified through the National Danish Patient Registry and the National Causes of Death Registry using International Classification of Diseases (ICD) codes. All-cause mortality was obtained through the Danish Central Person Registry.
Results:
A total of 95,108 adults (53,484 women and 41,624 men) who were not taking statins at baseline were included in the present analysis. Increases in excess apoB values were observed with increases in current smoking, systolic blood pressure, body mass index (BMI), and diabetes. During a median follow-up of 9.6 years, 2,048 MIs, 4,282 ASCVD events, and 8,873 deaths occurred. There was a dose-dependent association between excess apoB with the risk of MI and ASCVD in both women and men and with the risk of all-cause mortality in women.
For ASCVD in women compared to those with excess apoB <11 mg/dL (reference group), the multivariable adjusted hazard ratio (HR) was 1.08 (95% confidence interval [CI], 0.97-1.21) for those with an excess apoB between 11-25 mg/dL. For those with an excess apoB between 26-45 mg/dL, the HR was 1.30 (95% CI, 1.14-1.48). For those with an excess apoB between 46-100 mg/dL or >100 mg/dL, the HRs were 1.34 (95% CI, 1.14-1.58) and 1.75 (95% CI, 1.08-2.83), respectively. Corresponding HRs in men were 1.14 (95% CI, 1.02-1.26), 1.41 (95% CI, 1.26-1.57), 1.41 (95% CI, 1.25-1.60), and 1.52 (95% CI, 1.13-2.05), respectively. Results were robust across the entire LDL-C spectrum.
Conclusions:
The investigators conclude that excess apoB, defined as the value of apoB above that contributed by LDL levels alone, is associated dose-dependently with increased risk of MI and ASCVD in women and men. These data demonstrate that apoB provides important predictive value beyond LDL-C across the entire LDL-C spectrum.
Perspective:
These data support the use of measuring apoB, particularly among those with CV risk factors such as diabetes. The cost-effectiveness of such an approach would be important to understand. In addition, further data on additional populations are warranted to understand the generalizability of these findings.
Clinical Topics: Dyslipidemia, Lipid Metabolism, Prevention
Keywords: Apolipoproteins B, Heart Disease Risk Factors
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