ApoB no better than current lipid markers in CVD risk prediction

By Sally Robertson, B.Sc.Sep 11 2012

Assessment of apolipoprotein B (apoB) levels does not seem to improve cardiovascular disease (CVD) risk prediction over low-density lipoprotein cholesterol (LDL) and non-high-density lipoprotein (nonHDL) cholesterol, report researchers.

"It seems reasonable to continue to focus on the decrease in LDL cholesterol and non-HDL cholesterol levels for guiding the intensity of lipid-lowering therapy to decrease cardiovascular disease risk further," say Jennifer Robinson (University of Iowa, Iowa City, USA) and colleagues.

In a meta-analysis of 25 trials including 12 studies of statin regimens and 13 of nonstatin therapies including surgery, apoB decreases did not consistently improve CVD risk prediction beyond decreases in LDL and nonHDL cholesterol, over a mean follow-up period of 4.3 years.

In combined analysis of all treatment types, the magnitude of apoB decrease was significantly associated with the magnitude of decrease in coronary heart disease (CHD) and total CVD events but there was no association with decrease in stroke. Each 10 mg/dL decrease in apoB was associated with a significant 6.3% decrease in overall CVD risk and a 9.4% decrease in CHD risk.

In statin trials alone, this association was even more robust with each 10 mg/dL decrease in apoB associated with a 15.9% reduction in CHD risk and a 11.9% reduction in overall CVD risk.

However, apoB decrease did not add to information provided by decreases in LDL cholesterol, nonHDL cholesterol or the ratio of LDL-to-nonHDL cholesterol for the prediction of CVD risk across any of the treatment groups, including statin monotherapy.

Indeed, in the statin-only studies, nonHDL cholesterol decrease significantly outperformed apoB decrease in predicting major CVD risk.

"Given concerns regarding treatment regimen complexity, safety, and cost, strategies targeting apoB decrease in patients who have achieved their LDL cholesterol and nonHDL cholesterol goals need testing in clinical trials before implementation into clinical practice," concludes the team.

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