Closing the gaps in patient management of dyslipidemia: stepping into cardiovascular precision diagnostics with...

Area of Science:

• Biochemistry
• Cardiovascular Medicine
• Clinical Diagnostics

Background:

• Residual cardiovascular disease risk persists in dyslipidemia patients despite lipid-lowering therapies.
• Current risk prediction relies heavily on low-density lipoprotein cholesterol (LDL-c), which has clinical and metrological limitations, especially under intensive treatment.
• A need exists for more accurate, molecularly defined biomarkers for cardiovascular risk assessment.

Purpose of the Study:

• To review the scientific validity and physiological roles of nine key serum apolipoproteins in lipid metabolism.
• To assess the association of these apolipoproteins with cardiovascular disease.
• To evaluate their potential as superior cardiovascular risk markers compared to LDL-c, particularly when measured in a multiplex panel.

Main Methods:

• Literature review focusing on apolipoproteins involved in lipid metabolism and cardiovascular disease.
• Analysis of existing data on the clinical performance and metrological accuracy of apolipoproteins versus LDL-c.
• Synthesis of information on apolipoproteins Apo(a), ApoB, ApoC-I, ApoC-II, ApoC-III, ApoE, ApoA-I, ApoA-II, and ApoA-IV.

Main Results:

• Apolipoproteins, such as apolipoprotein B (ApoB), apolipoprotein(a) (Apo(a)), and apolipoprotein C-III (ApoC-III), demonstrate clinical utility exceeding LDL-c.
• Apolipoprotein B (ApoB) is present on all atherogenic lipoproteins and outperforms LDL-c in risk prediction.
• Other apolipoproteins like Apo(a) and ApoC-III are linked to specific cardiovascular risk factors and pathways.

Conclusions:

• Apolipoproteins represent promising, molecularly defined biomarkers for cardiovascular disease risk.
• Multiplex measurement of serum apolipoproteins offers a more accurate and personalized approach to risk assessment than LDL-c alone.
• Transitioning to molecularly measured biomarkers like apolipoproteins is crucial for advancing personalized medicine in cardiovascular care.