apoB and non-HDL cholesterol and cardiovascular risk

Last edited 08/2021 and last reviewed 08/2021

In cholesterol guidelines, low-density lipoprotein (LDL) cholesterol remains the primary target while apolipoprotein B (apoB) and non-high-density lipoprotein (non-HDL) cholesterol are secondary targets

• in a study of 13,015 statin-treated patients (1)
  • with 8 years median follow-up.Cox regressions among apoB, non-HDL cholesterol, and LDL cholesterol, respectively, and all-cause mortality or myocardial infarction were examined
  • study findings revealed that
    • in statin-treated patients
      • elevated apoB and non-HDL cholesterol, but not LDL cholesterol, are associated with residual risk of all-cause mortality and myocardial infarction
    • analysis demonstrates that apoB is a more accurate marker of all-cause mortality risk in statin-treated patients than LDL cholesterol or non-HDL cholesterol, and apoB in addition is a more accurate marker of risk of myocardial infarction than LDL cholesterol

Drexel et al determined the LDL-C/ApoB ratio in a cohort of 1687 subjects with established atherosclerosis

• prospectively, major cardiovascular events (MACE) including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke were recorded over a period of 9.9 +/- 4.6 years
• main results
  • strongest predictors of LDL-c/ApoB ratio were T2DM and age, followed by gender, smoking and hypertension.
  • patients in the highest tertile of LDL-c/ApoB ratio had significant better outcome than those in the lower tertiles (log rank p=0.005).
  • in a fully adjusted model, high LDL-c/ApoB ratio was associated with lower MACE (HR 0.87, 95%IC: 0.78-0.97, P=0.013).
  • high LDL-c/ApoB ratio was also associated with lower all-cause mortality and total CV events (HR 0.88, ,95%CI: 0.80-0.97, P=0.012 and HR 0.88, 95%CI: 0.80-0.95, P=0.0003, respectively)
• concluded that LDL-C/ApoB ratio is independently predictive of MACE in subjects with established atherosclerosis

Reference:

• Lindhart CD et al. Apolipoprotein B and Non-HDL Cholesterol Better Reflect Residual Risk Than LDL Cholesterol in Statin-Treated Patients.J Am Coll Cardiol. 2021 Mar, 77 (11) 1439-1450
• Drexel H, Larcher B, Mader A, et al. The LDL-C/ApoB ratio predicts major cardiovascular events in patients with established atherosclerotic cardiovascular disease . Atherosclerosis 2021, doi.org/10.1016/j.atherosclerosis.2021.05.010