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Cited by 181Lipoproteins and Cardiovascular HealthCardiac Imaging and DiagnosticsDiabetes, Cardiovascular Risks, and Lipoproteins

Discordance Between Apolipoprotein B and LDL-Cholesterol in Young Adults Predicts Coronary Artery Calcification

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Wilkins, John T., Li, Ron C., Sniderman, Allan, Chan, Cheeling, Lloyd-Jones, Donald M.·2016·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2015.10.055PMC PMC6613392
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Abstract

Background High levels of apolipoprotein B (apoB) have been shown to predict atherosclerotic cardiovascular disease (CVD) in adults even in the context of low levels of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C). Objectives This study aimed to quantify the associations between apoB and the discordance between apoB and LDL-C or non-HDL-C in young adults and measured coronary artery calcium (CAC) in midlife. Methods Data were derived from a multicenter cohort study of young adults recruited at ages 18 to 30 years. All participants with complete baseline CVD risk factor data, including apoB and year 25 (Y25) CAC score, were entered into this study. Presence of CAC was defined as having a positive, nonzero Agatston score as determined by computed tomography. Baseline apoB values were divided into tertiles of 4 mutually exclusive concordant/discordant groups, based on median apoB and LDL-C or non-HDL-C. Results Analysis included 2,794 participants (mean age: 25 ± 3.6 years; body mass index: 24.5 ± 5 kg/m(2); and 44.4% male). Mean lipid values were as follows: total cholesterol: 177.3 ± 33.1 mg/dl; LDL-C: 109.9 ± 31.1 mg/dl; non-HDL-C: 124.0 ± 33.5 mg/dl; HDL-C: 53 ± 12.8 mg/dl; and apoB: 90.7 ± 24 mg/dl; median triglycerides were 61 mg/dl. Compared with the lowest apoB tertile, higher odds of developing Y25 CAC were seen in the middle (odds ratio [OR]: 1.53) and high (OR: 2.28) tertiles based on traditional risk factor-adjusted models. High apoB and low LDL-C or non-HDL-C discordance was also associated with Y25 CAC in adjusted models (OR: 1.55 and OR: 1.45, respectively). Conclusions These data suggest a dose-response association between apoB in young adults and the presence of midlife CAC independent of baseline traditional CVD risk factors.

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  • apoB is a more accurate measure of the adequacy of lipid-lowering therapy than LDL-C or non-HDL-C.

    “given that apoB is a more accurate measure of the adequacy of lipid-lowering therapy than LDL-C or non-HDL-C,1,3–13,27”

    From Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention (2024) · cites this paper as [4]

    The Results (page not provided) show that, when the measures were discordant, high apoB was associated with greater odds of later coronary artery calcification even when LDL-C or non–HDL-C was low. That supports apoB’s value as a risk marker, but the paper does not establish that it measures the adequacy of lipid-lowering therapy more accurately; medication use was included only as an adjustment variable in the Methods. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • All reports since 2019, with one exception, including observational studies and randomized clinical trials, have confirmed that apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C.

    “Moreover, all reports since then, with one exception,2 including observational studies and randomized clinical trials,3–13 have confirmed that apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C, reinforcing the validity of the evaluation by the 2019 EAS/ESC Guidelines as to the superiority of apoB.”

    From Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention (2024) · cites this paper as [4]

    The Discussion reports that, in discordance analyses, apoB was more closely associated with atherosclerotic risk than LDL-C or non–HDL-C; the Results show this for midlife coronary artery calcification in the CARDIA cohort. But this 2016 observational study cannot substantiate a claim about all reports since 2019 or randomized clinical trials, and its outcome was a surrogate for clinical events. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Cites

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Cited by

Sorted by citations

Authors
Wilkins, J. T., Li, R. C., Sniderman, A., Chan, C., & Lloyd-Jones, D. M.
Affiliations
  • Northwestern University (US)
  • McGill University (CA)
Corresponding author
Wilkins, John T.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2016-01
Volume
67
Issue
2
Pages
193-201
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2015.10.055
PMC
PMC6613392
OpenAlex
W2235916715
Cited by
181
References
1
Citations by year
2026: 17 · 2025: 17 · 2024: 22 · 2023: 25 · 2022: 26 · 2021: 17 · 2020: 10 · 2019: 16 · 2018: 7 · 2017: 12 · 2016: 11
FWCI
16.99
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Johns Hopkins University (HHSN268200900041C)
  • Kaiser Foundation Research Institute (HHSN268201300029C, AG0005, HHSN268201300028C, HHSN268200900041C, HHSN268201300025C, HHSN268201300026C)
  • National Institute on Aging (HHSN268201300029C, HHSN268201300026C, AG 0005, HHSN268201300025C, HHSN268201300028C, HHSN268200900041C)
  • National Heart, Lung, and Blood Institute (HHSN268201300028C, HHS-N2-68201300029C, HHSN268201300027C, HHSN268200900041C, HHSN268201300026C, HHS-N2-68201300025C, AG0005)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
apolipoprotein B, LDL cholesterol, non-HDL cholesterol, coronary artery calcification, young adults, atherosclerotic cardiovascular disease, Agatston score, cardiovascular risk prediction, dose-response relationship, traditional risk factors, lipoprotein metabolism, coronary heart disease prevention
MeSH terms
Adult, Apolipoproteins B, Coronary Vessels, Female, Humans, Cholesterol, HDL, Cholesterol, LDL, Longitudinal Studies, Male, Predictive Value of Tests, Risk Factors, United States, Reproducibility of Results, Biomarkers, Body Mass Index, Odds Ratio, Vascular Calcification

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