Prevention & lipidsCohort study
Discordance among apolipoprotein B (apoB), non–high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention
- Prospective cohort study
Authors' conclusion
High variability of apoB at individual levels of LDL-C, non-HDL-C, and triglycerides coupled with meaningful differences in 10-year ASCVD rates and significant residual information contained in apoB for prediction of new-onset ASCVD events demonstrate that LDL-C, non-HDL-C, and triglycerides are not adequate proxies for apoB in clinical care.
Study context
- Population
- UK Biobank adults (age 40–73 years, 42% men) free of CVD19,982 atherosclerotic cardiovascular disease (ASCVD) events
- Participants
- 293,876 adults
- Exposure
- High vs low apoB at given levels of low-density lipoprotein cholesterol (LDL-C), non-HDL-C and triglycerides
- Outcome
- New-onset ASCVD; 10-year ASCVD event rates and residual apoB as predictor
- Follow-up
- Median 11 years
Main finding
As reported in the abstract
10-year ASCVD rates, high vs low apoB at levels (±10 mg/dL) of LDL-C, non-HDL-C, triglycerides · 10 years
| Group | At LDL-C 130 mg/dL | At non-HDL-C 160 mg/dL | At triglycerides 115 mg/dL |
|---|---|---|---|
| High apoB | 7.3 | 6.4 | 7.0 |
| Low apoB | 4.0 | 4.6 | 4.6 |
- High apoB vs Low apoB: P < 0.001 — all three comparisons
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Residual apoB as predictor of new-onset ASCVD (adjusted model) — Residual apoB vs Low apoB · after accounting for LDL-C and HDL-C | 1.06 (1.0–1.07) | |
| Residual apoB as predictor of new-onset ASCVD (adjusted model) — Residual apoB vs Low apoB · after accounting for non-HDL-C and HDL-C | 1.04 (1.03–1.06) | |
| Residual apoB as predictor of new-onset ASCVD (adjusted model) — Residual apoB vs Low apoB · after accounting for triglycerides and HDL-C | 1.13 (1.12–1.15) | |
| 0.512Hazard ratio (log scale) |
Residual apoB as predictor of new-onset ASCVD (adjusted model)
- No residual of LDL-C, non-HDL-C or log triglycerides remained significant when apoB was included
Correlation of apoB with LDL-C, non-HDL-C and log triglycerides
- Pearson's r with LDL-C and non-HDL-C (P < .001 for both)
- .96
- r with log triglycerides (P < .001)
- .42
apoB range capturing 95% of observations
- LDL-C 130 mg/dL
- 85.8-108.8 md/dL
- non-HDL-C 160 mg/dL
- 88.3-112.4 mg/dL
- triglycerides 115 mg/dL
- 67.8-147.4 md/dL
Original publication
Discordance among apoB, non–high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention. Eur Heart J. Published 3 May 2024. doi:10.1093/eurheartj/ehae258
Summarised from the published abstract; every number is checked against it