ApoB/HDL cholesterol ratio is the strongest predictor of cardiovascular risk

Current treatment guidelines recommend targeting low-density lipoprotein (LDL) cholesterol. However, new data1 indicate that the ratio of apolipoprotein B (apoB), a marker of atherogenic lipoproteins, to high-density lipoprotein (HDL) cholesterol may be a more appropriate means of assessing cardiovascular risk and determining the need for lipid-modifying therapy.

Researchers conducted a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey to compare the strengths of association among the various lipid-related indices and clinical features consistent with atherosclerosis. The overall analysis included about 9,500 data sets. The ratio of apoB/HDL cholesterol was the strongest correlate of atherosclerosis (odds ratio 1.177 per mg/dL increment, 95%CI 1.063 to 1.302, p<0.01). Analyses showed that neither LDL cholesterol nor the ratio of LDL cholesterol to HDL cholesterol correlated significantly with cardiovascular risk.

The authors concluded that measuring LDL cholesterol might not be the best index for determining cardiovascular risk.

Reference

1. Hsia SH, Pan D, Berookim P et al. A population-based, cross-sectional comparison of lipid- related indexes for symptoms of atherosclerotic disease. Am J Cardiol 2006;98:1047-52.

Commentary

Atherogenic lipoproteins, including very-low density, intermediate-density and low- density lipoproteins (LDL), contain 1 copy of apolipoprotein B (apoB) per particle. By contrast, their content of cholesterol molecules per particle differs widely. Measurement of either non-HDL cholesterol or LDL cholesterol in the clinical laboratory does not accurately reflect the number of circulating atherogenic lipoproteins in a given subject. This study lends credence to the notion that determination of apoB levels may be superior to assay of LDL cholesterol as an index for assessment of cardiovascular risk, and equally as an index of response to lipid- lowering therapy.