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Cited by 48Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCardiac Imaging and Diagnostics

Apolipoprotein B discordance with low-density lipoprotein cholesterol and non–high-density lipoprotein cholesterol in relation to coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA)

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Cao, Jing, Nomura, Sarah O., Steffen, Brian T., Guan, Weihua, Remaley, Alan T., Karger, Amy B., Ouyang, Pamela, Michos, Erin D. +1 more·2020·Journal of Clinical Lipidology
DOI 10.1016/j.jacl.2019.11.005PMC PMC7085429
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Abstract

Background Discordant levels of apolipoprotein B (apo B) relative to low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C) may be associated with subclinical atherosclerotic cardiovascular disease (ASCVD). Objective The present study investigated whether discordance between apo B and LDL-C or non-HDL-C levels was associated with subclinical ASCVD measured by coronary artery calcium (CAC). Methods This study was conducted in a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, aged 45 to 84 years, free of ASCVD, and not taking lipid-lowering medications at the baseline (2000-2002) (prevalence analytic N = 4623; incidence analytic N = 2216; progression analytic N = 3947). Apo B discordance relative to LDL-C and non-HDL-C was defined using residuals and percentile rankings (>5/10/15 percentile). Associations with prevalent and incident CAC (CAC > 0 vs CAC = 0) were assessed using prevalence ratio/relative risk regression and CAC progression (absolute increase/year) using multinomial logistic regression. Results Higher apo B levels were associated with CAC prevalence, incidence, and progression. Apo B discordance relative to LDL-C or non-HDL-C was inconsistently associated with CAC prevalence and progression. Discordantly high apo B relative to LDL-C and non-HDL-C was associated with CAC progression. Associations for apo B discordance with non-HDL-C remained after further adjustment for metabolic syndrome components. Conclusion Apo B was associated with CAC among adults aged ≥45 years not taking statins, but provided only modest additional predictive value of apo B for CAC prevalence, incidence, or progression beyond LDL-C or non-HDL-C. Apo B discordance may still be important for ASCVD risk assessment and further research is needed to confirm findings.

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  • 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 [5]

    The Conclusions (page unavailable) say it remains unclear whether apoB adds predictive information beyond LDL-C or non-HDL-C for coronary artery calcification. The paper did not evaluate cardiovascular events, so its findings do not confirm the claimed superiority of apoB as a cardiovascular-risk marker. (LLM, conf=0.87)

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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 [5]

    The Introduction says apoB may be a better or additional marker for ASCVD risk assessment than LDL-C or non-HDL-C. But the Conclusions find its added value for predicting coronary artery calcification unclear in adults not taking lipid-lowering medication. The paper therefore does not establish that apoB more accurately measures the adequacy of lipid-lowering therapy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 31

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Cited by

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Authors
Cao, J., Nomura, S. O., Steffen, B. T., Guan, W., Remaley, A. T., Karger, A. B., Ouyang, P., Michos, E. D., & Tsai, M. Y.
Affiliations
  • Baylor College of Medicine (US)
  • University of Minnesota (US)
  • National Heart, Lung, and Blood Institute (US)
  • Johns Hopkins University (US)
Corresponding author
Tsai, Michael Y.
ORCID
Venue
Journal of Clinical Lipidology
Publisher
Elsevier BV
Published
2020-01
Volume
14
Issue
1
Pages
109-121.e5
ISSN
  • 1876-4789 (ISSN-L)
  • 1933-2874
DOI
10.1016/j.jacl.2019.11.005
PMC
PMC7085429
OpenAlex
W2990593561
Cited by
48
References
8
Citations by year
2026: 5 · 2025: 12 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 6 · 2020: 3
FWCI
3.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of clinical lipidology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
apolipoprotein B, LDL cholesterol, non-HDL cholesterol, coronary artery calcium, metabolic syndrome, cardiovascular risk assessment, Multi-Ethnic Study of Atherosclerosis
MeSH terms
Aged, Aged, 80 and over, Apolipoproteins B, Cholesterol, Coronary Artery Disease, Coronary Vessels, Female, Humans, Lipids, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Odds Ratio, Risk Assessment, Metabolic Syndrome, Atherosclerosis, Vascular Calcification

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