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J-shaped association between apolipoprotein B and CV outcomes in statin-treated patients with chronic coronary
Jining He1, Zhangyu Lin1, Chenxi Song1
1State Key Laboratory of Cardiovascular Disease, Beijing, China; Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Both low and high apolipoprotein B (apoB) levels increase cardiovascular risk in chronic coronary syndrome patients on statins. The risk is highest at very low or very high apoB levels, especially above 0.73g/L.
Area of Science:
- Cardiology
- Lipid Metabolism
- Clinical Research
Background:
- Residual cardiovascular (CV) risk in chronic coronary syndrome (CCS) patients on statin therapy is a significant clinical concern.
- The role of apolipoprotein B (apoB) in predicting this residual risk remains incompletely understood.
Purpose of the Study:
- To investigate the association between apolipoprotein B (apoB) levels and cardiovascular (CV) outcomes in patients with chronic coronary syndrome (CCS) receiving statin treatment.
- To determine the optimal apoB range for minimizing CV risk in this patient population.
Main Methods:
- A cohort of 8641 statin-treated CCS patients was analyzed.
- Patients were stratified into five groups based on baseline apoB quintiles.
- The primary endpoint was the occurrence of major CV events over a 3-year follow-up period.
Main Results:
- A J-shaped relationship was observed between apoB levels and 3-year CV events, indicating increased risk at both extremes of the apoB spectrum.
- CV risk remained stable until apoB levels exceeded 0.73 g/L, after which it significantly increased.
- Both very low (quintile 1, ≤0.57 g/L) and very high (quintile 5, >0.93 g/L) apoB levels were associated with a higher risk of major adverse cardiac events compared to the reference group (quintile 3).
Conclusions:
- Both low and high apolipoprotein B (apoB) levels are independently associated with increased cardiovascular risk in statin-treated chronic coronary syndrome patients.
- The findings suggest a potential need to optimize apoB levels beyond current LDL-C targets to further mitigate CV risk.
Introduction And Objectives:
The association between apolipoprotein B (apoB) and residual cardiovascular (CV) risk in patients with chronic coronary syndrome (CCS) remains unclear. We aimed to investigate the association between apoB levels and CV outcomes in statin-treated CCS patients.
Methods:
We enrolled 8641 statin-treated CCS patients at Fuwai Hospital. The patients were divided into 5 groups based on to apoB quintiles (Q1 to Q5). The primary endpoint was 3-year CV events, including CV death, nonfatal myocardial infarction, and nonfatal stroke.
Results:
During a median follow-up of 3.17 years, there were 232 (2.7%) CV events. After multivariable adjustment, a restricted cubic spline illustrated a J-shaped relationship between apoB levels and 3-year CV events, with the risk remaining flat until apoB levels exceeded 0.73g/L, after which the risk increased (nonlinear P <.05). Kaplan-Meier curves showed the lowest CV event rate in the Q3 group (0.68-0.78g/L). Compared with the Q3 group, multivariable Cox regression models revealed that both low (Q1, ≤0.57g/L) and high (Q5, >0.93g/L) apoB levels were associated with an increased risk of major adverse cardiac events (all P <.05). Notably, patients with low apoB levels (Q1) had the highest risk of CV death (HR, 2.44; 95%CI, 1.17-5.08).
Conclusions:
Our analysis indicates that both low and high levels of apoB are associated with elevated CV risk, with the risk being particularly pronounced at higher levels (> 0.73g/L).
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