TY - JOUR
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 K.
AU - Lopez-Jimenez, Francisco
AU - Öhrvik, John
AU - Walldius, Göran
AU - Hellenius, Mai Lis
AU - Hamsten, Anders
N1 - Funding Information:
J.S.-J. was supported in part by faculty funds from the Board of Post-Graduate Education of the Karolinska Institutet (KID Award), the European Foundation for the Study of Diabetes Lilly Research Fellowship and the Swedish Heart and Lung Foundation. Prof. A.H. was supported in part by the Swedish Heart and Lung Foundation and the Stockholm County Council. R.M.F. was supported in part by the Swedish Research Council (project 15352) and the Swedish Diabetes Association. A.R.-C. was supported by American Heart Association Award. Prof. V.K.S. was supported in part by NIH R01 HL73211. Prof. M.-L.H. was supported in part by the Swedish Heart and Lung Foundation, the Stockholm County Council and the Swedish Council for Working Life and Social Research. The funding bodies had no role in the study design, data collection, data analysis, data interpretation or writing the report.
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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U2 - 10.1093/eurheartj/ehn347
DO - 10.1093/eurheartj/ehn347
M3 - Article
C2 - 18676970
AN - SCOPUS:64949084931
SN - 0195-668X
VL - 30
SP - 710
EP - 717
JO - European heart journal
JF - European heart journal
IS - 6
ER -