Update on apolipoprotein B.

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Atherosclerosis Research

Background:

• Current guidelines show differing recommendations for apolipoprotein B (apoB) in cardiovascular risk assessment.
• While European guidelines endorse apoB, American guidelines have a limited endorsement.
• Both guidelines retain low-density lipoprotein cholesterol (LDL-C) as the primary metric for guiding lipid-lowering therapies.

Purpose of the Study:

• To review recent advances in apolipoprotein B (apoB) knowledge.
• To emphasize Mendelian randomization studies and discordance analysis in patients on statin therapy.
• To argue for apoB as the primary metric for guiding lipid-lowering therapy, challenging the use of LDL-C.

Main Methods:

• Review of recent scientific literature on apoB.
• Analysis of Mendelian randomization studies.
• Discordance analysis in subjects undergoing statin therapy.

Main Results:

• A robust body of evidence supports apoB's superiority over LDL-C and non-HDL-C for cardiovascular risk.
• LDL-C is an inappropriate marker for assessing the benefits of statin, ezetimibe, and PCSK9 therapies.
• Using LDL-C to guide lipid-lowering therapy effectiveness is an interpretive error.

Conclusions:

• Apolipoprotein B (apoB) is a more accurate measure of cardiovascular risk.
• ApoB is a better guide to the adequacy of lipid-lowering therapy than LDL-C or non-HDL-C.
• ApoB should be the primary metric for guiding statin, ezetimibe, and PCSK9 therapy.