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Apolipoproteins A-I and B-markers in coronary risk evaluation
Lucica Agoston-Coldea1, D Zdrenghea, Dana Pop
1Department of Internal Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. lucicoldea@yahoo.fr
Insights
Apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) are significant independent risk factors for coronary heart disease. Their predictive value for cardiovascular events surpasses traditional lipid fractions, suggesting clinical utility.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Epidemiology
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Traditional lipid profiles (e.g., cholesterol, LDL-C, HDL-C, triglycerides) are used to assess cardiovascular risk.
- The role of specific apolipoproteins, such as apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I), as independent risk factors requires further investigation.
Purpose of the Study:
- To determine if apoB, apoA-I, and their ratio are independent risk factors for CHD.
- To evaluate the predictive value of apoB and apoA-I compared to serum lipid fractions in assessing coronary event risk.
Main Methods:
- A comparative observational study was conducted on 289 subjects.
- Subjects were divided into two groups: 144 with previous myocardial infarction and 145 without CHD but with cardiovascular risk factors.
- Lipid fractions, apoB, and apoA-I levels were measured; multivariate analysis was employed.
Main Results:
- Subjects with myocardial infarction had lower levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides compared to controls.
- Plasmatic levels of apoB were significantly higher (p=0.0001) and apoA-I lower (p=0.101) in myocardial infarction patients.
- Multivariate analysis confirmed apoB concentrations over 1.7 g/l (OR 3.96) and apoA-I (OR 0.72) as independent predictors of myocardial infarction, outperforming lipid ratios.
Conclusions:
- ApoB and apoA-I are significant independent risk factors for cardiovascular events.
- The predictive value of apoB and apoA-I for cardiovascular risk exceeds that of standard serum lipid fractions.
- Determination of apoA-I and apoB levels should be considered for routine clinical practice to enhance cardiovascular risk assessment.
Objectives:
To investigate if apoB, apoA-I and apoB/apoA-I ratios are independent risk factors for coronary heart disease and to determine their value in relationship with serum lipid fractions in evaluating the risk of coronary events.
Materials And Methods:
We carried out a comparative observational study on 289 subjects divided into two groups: 144 subjects with old myocardial infarction, and 145 subjects without coronary heart disease, but with cardiovascular risk factors. None of the subjects received lipid-lowering drugs in the previous 3 months.
Results:
The mean values of lipid fractions were lower in subjects with myocardial infarction than in subjects without coronary heart disease: total cholesterol (186.06 +/- 48.11 vs. 206.93 +/- 42.28 mg/dl, p = 0.0001), LDL-cholesterol (118.57 +/- 42.95 vs. 129.53 +/- 39.75 mg/dl, p = 0.023), HDL-cholesterol (43.64 +/- 12.32 vs. 50.48 +/- 21.09 mg/dl, p = 0.0008) and triglycerides (145.38 +/- 62.74 vs. 167.56 +/- 82.11 mg/dl, p = 0.01). The plasmatic levels of apoB were higher in subjects with myocardial infarction (1.12 +/- 0.57 vs. 0.86 +/- 0.27 g/l, p = 0.0001), but the apoA-I was lower (1.31 +/- 0.47 vs. 1.40 +/- 0.39 g/l, p = 0.101). The multivariate analysis indicated that plasmatic concentrations of apoB over 1.7 g/l are closely correlated with myocardial infarction (OR 3.96; 95% CI 2.87-5.02, p = 0.001) independent of other covariables such as age, smoking, diabetes, hypertension, lipid CT/HDL-C and the LDL-C/HDL-C ratio. The protective effect of apolipoprotein A1 against cardiovascular events after the adjustment for other cardiovascular risk factors (OR 0.72; 95% CI 0.57-0.83, p = 0.004) was also independent in multivariate analysis.
Conclusion:
These results highlight the significance of apoA-I and apoB in the evaluation of the cardiovascular risk. From this point of view, their predictive value is superior to that of serum lipid fractions. The data suggest that the determination of apoA-I and apoB is useful enough to be introduced in current clinical practice.
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