Non-high-density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men
Abstract
Background— Apolipoprotein B (apoB) plasma levels reflect the concentration of proatherogenic lipoproteins very low-density lipoprotein and low-density lipoprotein (LDL), whereas non–high-density lipoprotein cholesterol (non–HDL-C) levels reflect the concentration of cholesterol transported by these particles. Methods and Results— The aim of our study was to compare apoB, non–HDL-C, LDL cholesterol (LDL-C), and other lipid markers as predictors of coronary heart disease (CHD) in a nested case-control study among 18 225 participants in the Health Professionals Follow-up Study. Among men who were free of diagnosed cardiovascular disease at the time of blood collection, 266 had nonfatal myocardial infarction or fatal CHD during 6 years of follow-up. Through the use of risk set sampling, control subjects were selected at a 2:1 ratio and matched with regard to age, date of blood collection, and smoking status. After adjustment for matching factors, the relative risk of CHD in the highest quintile compared with the lowest quintile was 2.76 (95% confidence interval [CI], 1.66 to 4.58) for non–HDL-C, 3.01 (95% CI, 1.81 to 5.00) for apoB, 1.81 (95% CI, 1.12 to 2.93) for LDL-C, 0.31 (95% CI, 0.18 to 0.52) for HDL-C, 2.41 (95% CI, 1.43 to 4.07) for triglycerides (all P trend <0.001), and 1.42 (95% CI, 0.86 to 2.32, P trend =0.19) for lipoprotein(a). When non–HDL-C and LDL-C were mutually adjusted, only non–HDL-C was predictive of CHD. When non–HDL-C and apoB were mutually adjusted, only apoB was predictive; the relative risk was 4.18 (95% CI, 1.30 to 13.49; P trend =0.02) for apoB compared with 0.70 (95% CI, 0.21 to 2.27; P trend =0.72) for non–HDL-C. Triglycerides added significant information to non–HDL-C but not to apoB for CHD risk prediction. Conclusions— Although non–HDL-C and apoB were both strong predictors of CHD in this male cohort, more so than LDL-C, the findings support the concept that the plasma concentration of atherogenic lipoprotein particles measured by apoB is more predictive in development of CHD than the cholesterol carried by these particles, measured by non–HDL-C.
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Apolipoproteins and the Apo B100/Apo A1 ratio have been investigated as biomarkers more sensitive to identifying cardiovascular disease risk than total cholesterol, triglycerides and LDL-C.
“Apolipoproteins and the Apo B100/Apo A1 ratio have been investigated as biomarkers more senstive to identifying CVD risk than TC, TRG and LDL-C [9–11].”
From Estimating the Effect of Aerobic Exercise Training on Novel Lipid Biomarkers: A Systematic Review and Multivariate Meta-Analysis of Randomized Controlled Trials (2023) · cites this paper as [9]
The Results and Discussion report that apoB was more strongly associated with coronary heart disease risk than LDL-C and triglycerides in the men studied. The paper measured apoB100 but did not evaluate the Apo B100/Apo A1 ratio; it says only that lipid ratios may improve prediction. The ratio-specific part of the claim is therefore not supported by this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThese cardiovascular disease risk biomarkers appear to be superior predictors of cardiovascular disease risk compared to the standard lipid profile.
“which appear to be superior predictors of CVD risk compared to the SLP [4, 5, 9–14].”
From Estimating the Effect of Aerobic Exercise Training on Novel Lipid Biomarkers: A Systematic Review and Multivariate Meta-Analysis of Randomized Controlled Trials (2023) · cites this paper as [9]
The Discussion reports that non-HDL-C was more strongly associated with coronary heart disease than LDL-C, and that apoB had the strongest association in this male cohort. That supports a comparison with LDL-C, but the paper does not establish that these biomarkers outperform the entire standard lipid profile for cardiovascular disease risk generally. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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- Authors
- Pischon, T., Girman, C. J., Sacks, F. M., Rifai, N., Stampfer, M. J., & Rimm, E. B.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 2005-11-29
- Volume
- 112
- Issue
- 22
- Pages
- 3375-3383
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2089103283
- Cited by
- 514
- References
- 53
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 12 · 2023: 20 · 2022: 18 · 2021: 19 · 2020: 26 · 2019: 16 · 2018: 21 · 2017: 15 · 2016: 26 · 2015: 22 · 2014: 21 · 2013: 37 · 2012: 37
- FWCI
- 31.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (submittedVersion)
- Funders
- National Institutes of Health (CA55075)
- National Institute on Alcohol Abuse and Alcoholism (AA-11181, R01AA011181)
- National Heart, Lung, and Blood Institute (R01HL035464, HL35464)
- National Cancer Institute (CA-55075)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- apolipoprotein B, non-HDL cholesterol, coronary artery disease, LDL cholesterol, HDL cholesterol, triglycerides, lipoprotein(a), cardiovascular risk prediction, myocardial infarction, men, Health Professionals Follow-up Study, proatherogenic lipoproteins, risk-set sampling, nested case-control study
- MeSH terms
- Adult, Aged, Apolipoproteins B, Cholesterol, Coronary Disease, Follow-Up Studies, Humans, Lipoproteins, Cholesterol, LDL, Male, Middle Aged, Predictive Value of Tests, Risk, Case-Control Studies
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