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APO B/APO AI Ratio with Coronary Artery Disease with Normal Lipid Profile in the Indian Population
Ranjan Modi1, V A Kothiwale2, Suresh Patted1
1DM Cardiology.
Insights
The apolipoprotein B/A ratio is a better predictor of coronary artery disease (CAD) than standard lipid profiles, even in patients with normal LDL levels or on statins.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Clinical Biochemistry
Background:
- Abnormal lipids are a key risk factor for coronary artery disease (CAD).
- Many patients develop CAD despite having a normal lipid profile.
- Apolipoprotein B (Apo B) and Apolipoprotein A (Apo A), and their ratio, show promise in predicting CAD risk.
Purpose of the Study:
- To evaluate the association between the Apo B/Apo A ratio and coronary artery disease (CAD) in patients presenting with a normal lipid profile.
- To determine if the Apo B/Apo A ratio offers superior risk stratification for CAD compared to conventional lipid parameters.
Main Methods:
- Analysis of data from 4232 patients with a history of CAD.
- Assessment of the Apo B/Apo A ratio in subgroups with normal LDL cholesterol (<100 mg/dL) and those on lipid-lowering therapy.
- Correlation of Apo B/Apo A ratio with the presence and severity of CAD.
Main Results:
- A significant majority (88%) of patients with CAD exhibited an abnormal Apo B/Apo A ratio.
- In patients with normal LDL levels, 91% had an abnormal Apo B/Apo A ratio and also had CAD.
- Among patients on lipid-lowering agents, 1819 (93.5%) had an abnormal Apo B/Apo A ratio, and all had CAD.
Conclusions:
- The Apo B/Apo A ratio is a more effective predictor of CAD and its severity than conventional lipid profiles.
- This ratio remains significant for CAD prediction in patients with normal LDL and even those on statins.
- Apo B and Apo A levels are crucial for assessing the atherogenic potential of lipid disorders, as statins may not adequately alter Apo B levels.
Background:
Abnormal lipids are an important risk factor for development of Coronary Artery Disease, significant patients have normal lipid profile and yet develop CAD. Apolipoproteins B, Apolipoproteins A and their ratio have been shown to be better predictor of risk of developing Coronary artery disease.
Objective:
Assess the Apo B / Apo A ratio with coronary artery disease in patients with normal lipid profile.
Methods And Results:
In 4232 patients with history of CAD 3724(88 %) had abnormal apo b / apo a ratio. Of 2920 patients with normal LDL levels (<100 mg), 2454 patients had abnormal apob/apoa ratio of which 2200 (91%) had CAD. In 1946 patients on lipid lowering agents 1819 had abnormal apo b/ apo a ratio and all had CAD.
Conclusion:
This study ascertains the importance Apo B, Apo A ratio over conventional lipid profile values for predicting CAD and its severity. Apo B/ Apo A ratio and CAD was found to be significant in patients with normal LDL, even in patients with history of dyslipidemia on statins this ratio was significant. Statins have been effective in lowering LDL, but have not shown changes in Apo B levels. Apo B and Apo A should be used to assess the atherogenic potential of lipid disorders.
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