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Apolipoproteins A-I and B as predictors of angiographically defined coronary artery disease
R A Reinhart1, K Gani, M R Arndt
1Department of Cardiology, Marshfield Clinic, WI 54449.
Insights
Apolipoprotein A-I and B levels, particularly their ratio, are stronger predictors of coronary artery disease than traditional lipid measures. These apolipoprotein measures remain reliable regardless of fasting status, aiding in accurate diagnosis.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Diagnostic Biomarkers
Background:
- Coronary artery disease (CAD) diagnosis relies on various risk factors and diagnostic procedures.
- Traditional lipid profiles are commonly used but can be influenced by patient's fasting status.
Purpose of the Study:
- To evaluate the predictive power of apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) concentrations in discriminating CAD.
- To compare the association strength of apolipoproteins with CAD against traditional risk factors.
Main Methods:
- 502 patients undergoing cardiac catheterization were analyzed for ApoA-I and ApoB levels.
- Coronary arteriography defined the presence or absence of CAD.
- Logistic regression adjusted for other CAD risk factors.
Main Results:
- ApoA-I and ApoB concentrations showed greater univariate differences between CAD and normal groups than standard lipoproteins.
- The ratio of ApoA-I to ApoB was the strongest predictor of CAD, followed by ApoB levels.
- Fasting status did not impact ApoA-I or ApoB concentrations.
Conclusions:
- ApoA-I and ApoB concentrations provide additional predictive information for CAD beyond standard lipid measures.
- Apolipoprotein measures are valuable when a patient's fasting status is uncertain.
Abstract:
Apolipoprotein A-I and B concentrations were measured in 502 patients undergoing diagnostic cardiac catheterization to assess the predictive power of apolipoproteins B and A-I to discriminate between patients with coronary artery disease and those with normal coronary arteries as defined by coronary arteriography. The strength of the associations was compared with that of the associations between traditional risk factors (eg, smoking status, cholesterol levels) and coronary artery disease. The study population consisted of 154 women (mean age, 62.9 years) and 348 men (mean age, 59.6 years). The apolipoprotein A-I concentration averaged (+/- SD) 124 +/- 25 mg/dL and the apolipoprotein B concentration, 98 +/- 24 mg/dL. In all cases, the apolipoprotein measures showed a larger univariate difference between the "normal" (no coronary artery disease) group (66 patients) and the group with coronary artery disease (436 patients) than did the corresponding standard lipoprotein measures. The variable with the strongest association with coronary artery disease was the ratio of apolipoprotein A-I to apolipoprotein B, followed by apolipoprotein B level. These findings were confirmed using logistic regression, adjusting for other coronary artery disease risk factors. Fasting status did not affect apolipoprotein A-I or B concentrations. We conclude that the use of apolipoprotein A-I and B concentrations gives additional information to that supplied by lipoprotein measures to help predict the presence of coronary artery disease. Since traditional lipid measures may be changed by a meal, apolipoproteins A-I and B might be more useful measures when the fasting status of a patient is in question.