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Cited by 25Lipoproteins and Cardiovascular HealthCardiac Imaging and DiagnosticsDiabetes, Cardiovascular Risks, and Lipoproteins

Discordance between apolipoprotein B and low-density lipoprotein cholesterol and progression of coronary artery calcification in middle age

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Kim, Chan-Won, Hong, Sungwoo, Chang, Yoosoo, Lee, Jung Ah, Shin, Hocheol, Ryu, Seungho·2021·Circulation Journal
DOI 10.1253/circj.cj-20-0692
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Abstract

BACKGROUND: A high level of apolipoprotein B (apoB) is associated with incident coronary artery disease (CAD) when low-density lipoprotein cholesterol (LDL-C) level is discordantly low or concordantly high. However, data on the relationship of apoB with subclinical measure of CAD are limited. METHODS AND RESULTS: A total of 14,205 men (mean age 41.0 years) who were free of cardiovascular disease at baseline and who underwent a health checkup exam, including measurement of coronary artery calcium (CAC), were studied. Of the study group, 2,773 participants (19.5%) had CAC at baseline, and CAC progression was observed in 2,550 (18.0%). The multivariate-adjusted CAC score ratios (95% confidence interval) comparing discordantly high apoB/low LDL-C and concordantly high apoB/high LDL-C with concordantly low apoB/low LDL-C were 1.51 (0.98-2.32) and 2.70 (2.19-3.33), respectively. The corresponding relative risks for CAC progression were 1.26 (1.02-1.56) and 1.49 (1.34-1.66), respectively. These associations did not change appreciably after adjustment for insulin resistance and subclinical inflammation. CONCLUSIONS: Discordant analysis showed that a high apoB level was strongly associated with prevalence and progression of CAC independent of LDL-C in a large cohort of healthy adults. The present study results highlighted the importance of an apoB measure as a potential target for primary prevention of coronary atherosclerosis in healthy adults.

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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 [10]

    The Discussion (page unavailable) reports that one meta-analysis found apoB better than LDL-C and non-HDL-C at predicting vascular events, but also notes controversy and a meta-analysis finding statistically indistinguishable risk estimates. The paper studies coronary artery calcification in largely healthy adults; it does not establish that apoB more accurately measures the adequacy of lipid-lowering therapy. (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 [10]

    The Discussion (page unavailable) says this observational study suggests apoB is more predictive of coronary artery calcium progression than LDL-C; the Results say the associations were similar in analyses involving non-HDL-C. But the study measured a subclinical marker, not cardiovascular events, and it cannot establish that all reports since 2019—including randomized trials—confirmed apoB’s superiority. The Discussion also notes that another meta-analysis found statistically indistinguishable risk estimates. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 27

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Cited by

Sorted by citations

Authors
Kim, C.-W., Hong, S., Chang, Y., Lee, J. A., Shin, H., & Ryu, S.
Affiliations
  • Kangbuk Samsung Hospital (KR)
  • Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine
ORCID
Venue
Circulation Journal
Publisher
Japanese Circulation Society
Published
2021-05-25
Volume
85
Issue
6
Pages
900-907
ISSN
  • 1346-9843 (ISSN-L)
  • 1347-4820
DOI
10.1253/circj.cj-20-0692
OpenAlex
W3111396089
Cited by
25
References
3
Citations by year
2026: 4 · 2025: 7 · 2024: 5 · 2023: 8 · 2022: 1
FWCI
2.06
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Circulation Journal (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
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, coronary artery calcification, coronary artery calcium progression, subclinical coronary artery disease, middle-aged men, insulin resistance, subclinical inflammation
MeSH terms
Adult, Apolipoproteins B, Calcinosis, Coronary Artery Disease, Humans, Cholesterol, LDL, Male, Middle Aged, Risk Factors, Disease Progression

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