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Comparison of apolipoprotein B and non-high-density lipoprotein cholesterol for identifying coronary artery disease
1Department of Pathology and Laboratory Medicine, University of Louisville, and Laboratory Service, Department of Veterans Affairs Medical Center, Louisville, KY 40206, USA.
Insights
Apolipoprotein B (apo B) and non-high-density lipoprotein cholesterol show minimal differences in cardiovascular risk screening. Receiver operating characteristic (ROC) curves reveal a 1% absolute difference, challenging relative risk assessments.
Area of Science:
- Cardiovascular disease risk assessment
- Lipidology
- Biomarker analysis
Background:
- The equivalence of non-high-density lipoprotein cholesterol and apolipoprotein B (apo B) for cardiovascular risk screening is debated.
- Existing studies often rely on relative risk metrics (odds ratios, hazard ratios) which may misrepresent diagnostic accuracy.
Purpose of the Study:
- To compare the diagnostic performance of apolipoprotein B (apo B) and lipoprotein lipids for cardiovascular risk screening.
- To evaluate the utility of receiver operating characteristic (ROC) curves versus relative risk measures in assessing biomarker equivalence.
Main Methods:
- Comparison of apo B and lipoprotein lipid levels in 437 men.
- Analysis of results using multivariate techniques.
- Evaluation of diagnostic performance using receiver operating characteristic (ROC) curves.
Main Results:
- Relative risk analysis (odds ratios) suggested a ~14% difference between apo B and lipoprotein lipids after adjustment.
- ROC curve analysis revealed a substantially smaller absolute difference of only ~1% between the two markers.
- This discrepancy highlights the limitations of relative risk metrics in reflecting true diagnostic value.
Conclusions:
- Receiver operating characteristic (ROC) curves provide a more accurate absolute measure of risk assessment compared to relative indexes.
- Clinical studies should prioritize absolute risk measures like ROC curves for evaluating biomarkers such as apo B and non-high-density lipoprotein cholesterol.
- The small absolute difference observed may explain inconsistencies across previous studies on lipid screening equivalence.
Abstract:
Whether or non-high-density lipoprotein cholesterol is equivalent to apolipoprotein B (apo B) for screening remains controversial. One reason for continued controversy is that most studies express results as relative risk/hazard or odds ratios based on P values that reflect diagnostic values poorly. Apo B and lipoprotein lipids were compared in 437 men. The results were evaluated by multivariate techniques and by receiver operating characteristic (ROC) curves. When analyzed by ROC curves, the difference between Apo B and lipoprotein lipids proved to be less than would be anticipated from the odds ratios. Although, after adjustment, the difference was about 14% by odds ratios, ROC analysis showed only a small difference of about 1%. These data show that clinical studies should analyze the data using an absolute measure of risk such as ROC curves rather than just relative indexes. Such a small absolute difference may also explain discrepancies between studies.
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