Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: Findings from a multi-ethnic US population

Justo Sierra-Johnson, Rachel M. Fisher, Abel Romero-Corral, Virend Somers, Francisco Lopez-Jimenez, John Öhrvik, Göran Walldius, Mai Lis Hellenius, Anders Hamsten

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Abstract

AimsProspective studies indicate that apolipoprotein measurements predict coronary heart disease (CHD) risk; however, evidence is conflicting, especially in the US. Our aim was to assess whether measurements of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) can improve the ability to predict CHD death beyond what is possible based on traditional cardiovascular (CV) risk factors and clinical routine lipid measurements.Methods and resultsWe analysed prospectively associations of apolipoprotein measurements, traditional CV risk factors, and clinical routine lipid measurements with CHD mortality in a multi-ethnic representative subset of 7594 US adults (mean age 45 years; 3881 men and 3713 women, median follow-up 124 person-months) from the Third National Health and Nutrition Examination Survey mortality study. Multiple Cox-proportional hazards regression was applied. There were 673 CV deaths of which 432 were from CHD. Concentrations of apoB [hazard ratio (HR) 1.98, 95 confidence interval (CI) 1.09-3.61], apoA-I (HR 0.48, 95 CI 0.27-0.85) and total cholesterol (TC) (HR 1.17, 95 CI 1.02-1.34) were significantly related to CHD death, whereas high density lipoprotein cholesterol (HDL-C) (HR 0.68, 95 CI 0.45-1.05) was borderline significant. Both the apoB/apoA-I ratio (HR 2.14, 95 CI 1.11-4.10) and the TC/HDL-C ratio (HR 1.10, 95 CI 1.04-1.16) were related to CHD death. Only apoB (HR 2.01, 95 CI 1.05-3.86) and the apoB/apoA-I ratio (HR 2.09, 95 CI 1.04-4.19) remained significantly associated with CHD death after adjusting for CV risk factors.ConclusionIn the US population, apolipoprotein measurements significantly predict CHD death, independently of conventional lipids and other CV risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes and C-reactive protein). Furthermore, the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements. Inclusion of apolipoprotein measurements in future clinical guidelines should not be discarded.

Original languageEnglish (US)
Pages (from-to)710-717
Number of pages8
JournalEuropean Heart Journal
Volume30
Issue number6
DOIs
StatePublished - Mar 2009

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Apolipoprotein A-I
Apolipoproteins B
Coronary Disease
Lipids
Confidence Intervals
Mortality
Apolipoproteins
Population
HDL Cholesterol
Cholesterol
Aptitude
Nutrition Surveys
Dyslipidemias
C-Reactive Protein
Obesity
Smoking
Guidelines
Hypertension

Keywords

  • ApoB/apoA-I ratio
  • Apolipoprotein A-I
  • Apolipoprotein B
  • Cardiovascular mortality
  • Cardiovascular risk factors
  • Coronary heart disease
  • HDL-cholesterol
  • NHANES
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality : Findings from a multi-ethnic US population. / Sierra-Johnson, Justo; Fisher, Rachel M.; Romero-Corral, Abel; Somers, Virend; Lopez-Jimenez, Francisco; Öhrvik, John; Walldius, Göran; Hellenius, Mai Lis; Hamsten, Anders.

In: European Heart Journal, Vol. 30, No. 6, 03.2009, p. 710-717.

Research output: Contribution to journalArticle

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title = "Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: Findings from a multi-ethnic US population",
abstract = "AimsProspective studies indicate that apolipoprotein measurements predict coronary heart disease (CHD) risk; however, evidence is conflicting, especially in the US. Our aim was to assess whether measurements of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) can improve the ability to predict CHD death beyond what is possible based on traditional cardiovascular (CV) risk factors and clinical routine lipid measurements.Methods and resultsWe analysed prospectively associations of apolipoprotein measurements, traditional CV risk factors, and clinical routine lipid measurements with CHD mortality in a multi-ethnic representative subset of 7594 US adults (mean age 45 years; 3881 men and 3713 women, median follow-up 124 person-months) from the Third National Health and Nutrition Examination Survey mortality study. Multiple Cox-proportional hazards regression was applied. There were 673 CV deaths of which 432 were from CHD. Concentrations of apoB [hazard ratio (HR) 1.98, 95 confidence interval (CI) 1.09-3.61], apoA-I (HR 0.48, 95 CI 0.27-0.85) and total cholesterol (TC) (HR 1.17, 95 CI 1.02-1.34) were significantly related to CHD death, whereas high density lipoprotein cholesterol (HDL-C) (HR 0.68, 95 CI 0.45-1.05) was borderline significant. Both the apoB/apoA-I ratio (HR 2.14, 95 CI 1.11-4.10) and the TC/HDL-C ratio (HR 1.10, 95 CI 1.04-1.16) were related to CHD death. Only apoB (HR 2.01, 95 CI 1.05-3.86) and the apoB/apoA-I ratio (HR 2.09, 95 CI 1.04-4.19) remained significantly associated with CHD death after adjusting for CV risk factors.ConclusionIn the US population, apolipoprotein measurements significantly predict CHD death, independently of conventional lipids and other CV risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes and C-reactive protein). Furthermore, the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements. Inclusion of apolipoprotein measurements in future clinical guidelines should not be discarded.",
keywords = "ApoB/apoA-I ratio, Apolipoprotein A-I, Apolipoprotein B, Cardiovascular mortality, Cardiovascular risk factors, Coronary heart disease, HDL-cholesterol, NHANES, Outcomes",
author = "Justo Sierra-Johnson and Fisher, {Rachel M.} and Abel Romero-Corral and Virend Somers and Francisco Lopez-Jimenez and John {\"O}hrvik and G{\"o}ran Walldius and Hellenius, {Mai Lis} and Anders Hamsten",
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T1 - Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality

T2 - Findings from a multi-ethnic US population

AU - Sierra-Johnson, Justo

AU - Fisher, Rachel M.

AU - Romero-Corral, Abel

AU - Somers, Virend

AU - Lopez-Jimenez, Francisco

AU - Öhrvik, John

AU - Walldius, Göran

AU - Hellenius, Mai Lis

AU - Hamsten, Anders

PY - 2009/3

Y1 - 2009/3

N2 - AimsProspective studies indicate that apolipoprotein measurements predict coronary heart disease (CHD) risk; however, evidence is conflicting, especially in the US. Our aim was to assess whether measurements of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) can improve the ability to predict CHD death beyond what is possible based on traditional cardiovascular (CV) risk factors and clinical routine lipid measurements.Methods and resultsWe analysed prospectively associations of apolipoprotein measurements, traditional CV risk factors, and clinical routine lipid measurements with CHD mortality in a multi-ethnic representative subset of 7594 US adults (mean age 45 years; 3881 men and 3713 women, median follow-up 124 person-months) from the Third National Health and Nutrition Examination Survey mortality study. Multiple Cox-proportional hazards regression was applied. There were 673 CV deaths of which 432 were from CHD. Concentrations of apoB [hazard ratio (HR) 1.98, 95 confidence interval (CI) 1.09-3.61], apoA-I (HR 0.48, 95 CI 0.27-0.85) and total cholesterol (TC) (HR 1.17, 95 CI 1.02-1.34) were significantly related to CHD death, whereas high density lipoprotein cholesterol (HDL-C) (HR 0.68, 95 CI 0.45-1.05) was borderline significant. Both the apoB/apoA-I ratio (HR 2.14, 95 CI 1.11-4.10) and the TC/HDL-C ratio (HR 1.10, 95 CI 1.04-1.16) were related to CHD death. Only apoB (HR 2.01, 95 CI 1.05-3.86) and the apoB/apoA-I ratio (HR 2.09, 95 CI 1.04-4.19) remained significantly associated with CHD death after adjusting for CV risk factors.ConclusionIn the US population, apolipoprotein measurements significantly predict CHD death, independently of conventional lipids and other CV risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes and C-reactive protein). Furthermore, the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements. Inclusion of apolipoprotein measurements in future clinical guidelines should not be discarded.

AB - AimsProspective studies indicate that apolipoprotein measurements predict coronary heart disease (CHD) risk; however, evidence is conflicting, especially in the US. Our aim was to assess whether measurements of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) can improve the ability to predict CHD death beyond what is possible based on traditional cardiovascular (CV) risk factors and clinical routine lipid measurements.Methods and resultsWe analysed prospectively associations of apolipoprotein measurements, traditional CV risk factors, and clinical routine lipid measurements with CHD mortality in a multi-ethnic representative subset of 7594 US adults (mean age 45 years; 3881 men and 3713 women, median follow-up 124 person-months) from the Third National Health and Nutrition Examination Survey mortality study. Multiple Cox-proportional hazards regression was applied. There were 673 CV deaths of which 432 were from CHD. Concentrations of apoB [hazard ratio (HR) 1.98, 95 confidence interval (CI) 1.09-3.61], apoA-I (HR 0.48, 95 CI 0.27-0.85) and total cholesterol (TC) (HR 1.17, 95 CI 1.02-1.34) were significantly related to CHD death, whereas high density lipoprotein cholesterol (HDL-C) (HR 0.68, 95 CI 0.45-1.05) was borderline significant. Both the apoB/apoA-I ratio (HR 2.14, 95 CI 1.11-4.10) and the TC/HDL-C ratio (HR 1.10, 95 CI 1.04-1.16) were related to CHD death. Only apoB (HR 2.01, 95 CI 1.05-3.86) and the apoB/apoA-I ratio (HR 2.09, 95 CI 1.04-4.19) remained significantly associated with CHD death after adjusting for CV risk factors.ConclusionIn the US population, apolipoprotein measurements significantly predict CHD death, independently of conventional lipids and other CV risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes and C-reactive protein). Furthermore, the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements. Inclusion of apolipoprotein measurements in future clinical guidelines should not be discarded.

KW - ApoB/apoA-I ratio

KW - Apolipoprotein A-I

KW - Apolipoprotein B

KW - Cardiovascular mortality

KW - Cardiovascular risk factors

KW - Coronary heart disease

KW - HDL-cholesterol

KW - NHANES

KW - Outcomes

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DO - 10.1093/eurheartj/ehn347

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SN - 0195-668X

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