The lipid measure apolipoprotein (apo) B: apo A-I ratio is not a better predictor of coronary heart disease risk than traditional lipid ratios that include total cholesterol and HDL-C, according to a study in the August 15 issue of JAMA.
Current risk-prediction instruments and guidelines for coronary heart disease (CHD) prevention emphasize the use of low-density lipoprotein cholesterol (LDL-C), total cholesterol, or both for CHD risk assessment. But in recent years, some evidence has suggested that higher apo B (the primary protein component of LDL) and lower apo A-I (the primary protein component of high-density lipoprotein [HDL]) levels play a role in the development of CHD, and that these measures might be superior to traditional lipid measures for CHD risk prediction, according to background information in the article.
Erik Ingelsson, M.D., Ph.D., of the Framingham Study, Boston University School of Medicine, Framingham, Mass., and colleagues evaluated whether apolipoproteins (the protein component of serum lipoproteins) could be used instead of traditional lipid measures for CHD risk prediction in a large group of men and women who were part of the Framingham Offspring Study. The researchers evaluated serum total cholesterol, HDL cholesterol (HDL-C), LDL-C, nonHDL-C, apo A-I and apo B, and three lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo B:apo A-I) in 3,322 middle-aged white participants who were examined between 1987-1991 and were without cardiovascular disease. Fifty-three percent of the participants were women. After a median (midpoint) follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD.
Our principal findings are 3-fold. First, even though the apo B:apo A-I ratio performed well overall in terms of CHD risk prediction and model performance measures in both sexes, the differences compared with other lipid variables were small and statistically nonsignificant. Non-HDL-C performed r
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