Impact of LDL-C and apolipoprotein B level discordance and associated lipoprotein particle alterations on cardiovascular outcomes in a large primary prevention population
Authors' conclusion
ApoB is a more comprehensive marker of cardiovascular risk than LDL-C. The higher cardiovascular risk in discordantly high ApoB individuals was partly mediated by VLDL; however, no conclusive evidence indicated that VLDL provides additional prognostic value beyond triglyceride measurements alone.
Study context
- Population
- UK Biobank individuals without baseline CVD, not on lipid-lowering therapy, with lipid nuclear magnetic resonance (NMR) dataUK Biobank
- Participants
- 375,544 individuals
- Exposure
- Discordantly high ApoB or discordantly low ApoB vs concordant LDL-C and ApoB
- Outcome
- MACE
Main finding
As reported in the abstract
Each group vs concordantHazard ratio (95% CI)
Discordantly high ApoB
1.11(1.06–1.15)
Discordantly low ApoB
0.87(0.83–0.93)
Observational data: associations, not effects.
Further findings
Discordance defined by NMR data
- Similar trends were observed in the NMR data
Lipoprotein particle composition
- Discordantly high ApoB: highest concentrations of VLDL-C, VLDL-CE and VLDL particles vs the other two groups
- Discordantly high ApoB: lower CE content per LDL, IDL and VLDL particle
Mediation of major adverse cardiovascular events (MACE) risk in discordantly high ApoB
- Mediated by VLDL particles
- 25.5%
- Mediated by triglycerides
- 26.6%
- Both P < 0.001
Original publication
Impact of LDL-C and apolipoprotein B level discordance and associated lipoprotein particle alterations on cardiovascular outcomes in a large primary prevention population. Eur J Prev Cardiol. Published 24 November 2025. doi:10.
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