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Differential association between apolipoprotein B and LDL cholesterol and cerebral atherosclerosis according to
Minyoul Baik1, Hyo Suk Nam2, Ji Hoe Heo2
1Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, South Korea.
Insights
Apolipoprotein B (ApoB) levels consistently associate with intracranial atherosclerotic stenosis (ICAS), even in patients taking statins. This suggests ApoB may better predict residual cardiovascular risk than LDL-C in certain patient groups.
Area of Science:
- Cardiology
- Neurology
- Biochemistry
Background:
- Cardiovascular risk reduction often targets low-density lipoprotein cholesterol (LDL-C) with statins, with apolipoprotein B (ApoB) as a secondary target.
- Investigating the relationship between atherosclerotic stenosis and lipid markers is crucial for refining cardiovascular risk assessment.
Purpose of the Study:
- To examine the association between atherosclerotic stenosis and both LDL-C and ApoB levels.
- To determine if pre-admission statin use influences the association between these lipid markers and stenosis.
Main Methods:
- Retrospective cross-sectional study of 6338 acute ischemic stroke patients.
- Patients categorized by stenosis location: normal, extracranial (ECAS), intracranial (ICAS), or combined (ECAS + ICAS).
- Subgroup analyses conducted based on pre-admission statin use.
Main Results:
- Both LDL-C and ApoB levels correlated with all stenosis locations.
- LDL-C association with stenosis was significant only in statin-naïve patients.
- ApoB consistently associated with ICAS (symptomatic and asymptomatic) in both statin-naïve and statin-treated patients.
Conclusions:
- Apolipoprotein B (ApoB) demonstrates a robust association with intracranial atherosclerotic stenosis (ICAS), irrespective of statin use.
- ApoB may be a more reliable marker for assessing residual cardiovascular risk in statin-treated patients compared to LDL-C.
Background And Aims:
To reduce cardiovascular risk, low-density lipoprotein cholesterol (LDL-C) is the primary target of statin treatment, while apolipoprotein B (ApoB) is secondary. We investigated the association between atherosclerotic stenosis and LDL-C or ApoB levels and whether a difference in association exists according to pre-admission statin use in ischemic stroke patients.
Methods:
This retrospective cross-sectional study included consecutive patients with acute ischemic stroke or transient ischemic attack who underwent lipid profile and angiographic testing. Patients were categorized into four groups according to stenosis location: normal, extracranial atherosclerotic stenosis (ECAS), intracranial atherosclerotic stenosis (ICAS), or ECAS + ICAS. Subgroup analyses were performed by pre-admission statin use.
Results:
Of the 6338 patients included, 1980 (31.2%) were in the normal group, 718 (11.3%) in the ECAS group, 1845 (29.1%) in the ICAS group, and 1795 (28.3%) in the ECAS + ICAS group. Both LDL-C and ApoB levels were associated with every location of stenosis. A significant interaction was found between pre-admission statin use and LDL-C level (p for interaction <0.05). LDL-C was associated with stenosis only in statin-naïve patients, whereas ApoB was associated with ICAS, with or without ECAS, in both statin-naïve and statin-treated patients. ApoB also showed a consistent association with symptomatic ICAS in both statin-treated and statin-naïve patients, whereas LDL-C did not.
Conclusions:
ApoB was consistently associated with ICAS, particularly symptomatic stenosis, in both statin-naïve and statin-treated patients. The close association between ApoB levels and residual risk in statin-treated patients could be partially explained by these results.
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