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Discordance between Circulating Atherogenic Cholesterol Mass and Lipoprotein Particle Concentration in Relation to Future Coronary Events in Women
Open accessAbstract
BACKGROUND: It is uncertain whether measurement of circulating total atherogenic lipoprotein particle cholesterol mass [non–HDL cholesterol (nonHDLc)] or particle concentration [apolipoprotein B (apo B) and LDL particle concentration (LDLp)] more accurately reflects risk of incident coronary heart disease (CHD). We evaluated CHD risk among women in whom these markers where discordant. METHODS: Among 27533 initially healthy women in the Women's Health Study (NCT00000479), using residuals from linear regression models, we compared risk among women with higher or lower observed particle concentration relative to nonHDLc (highest and lowest residual quartiles, respectively) to individuals with agreement between markers (middle quartiles) using Cox proportional hazards models. RESULTS: Although all 3 biomarkers were correlated (r ≥ 0.77), discordance occurred in up to 20.2% of women. Women with discordant high particle concentration were more likely to have metabolic syndrome (MetS) and diabetes (both P < 0.001). Over a median follow-up of 20.4 years, 1246 CHD events occurred (514725 person-years). Women with high particle concentration relative to nonHDLc had increased CHD risk: age-adjusted hazard ratio (95% CI) = 1.77 (1.56–2.00) for apo B and 1.70 (1.50–1.92) for LDLp. After adjustment for clinical risk factors including MetS, these risks attenuated to 1.22 (1.07–1.39) for apo B and 1.13 (0.99–1.29) for LDLp. Discordant low apo B or LDLp relative to nonHDLc was not associated with lower risk. CONCLUSIONS: Discordance between atherogenic particle cholesterol mass and particle concentration occurs in a sizeable proportion of apparently healthy women and should be suspected clinically among women with cardiometabolic traits. In such women, direct measurement of lipoprotein particle concentration might better inform CHD risk assessment.
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“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 [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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 [3]
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“This study builds on prior work showing that apoB concentration is the most predictive parameter of CV risk,13,14,15”
From Association of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis (2022) · cites this paper as [13]
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Metadata
- Authors
- Lawler, P. R., Akinkuolie, A. O., Ridker, P. M., Sniderman, A. D., Buring, J. E., Glynn, R. J., Chasman, D. I., & Mora, S.
- Affiliations
- Brigham and Women's Hospital (US)
- McGill University Health Centre (CA)
- Corresponding author
- Mora, Samia
- ORCID
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-04-01
- Volume
- 63
- Issue
- 4
- Pages
- 870-879
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- PMC
- PMC5374022
- OpenAlex
- W2586930478
- Cited by
- 104
- References
- 26
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 7 · 2023: 15 · 2022: 14 · 2021: 16 · 2020: 6 · 2019: 10 · 2018: 13 · 2017: 8
- FWCI
- 10.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wisconsin Historical Society (CA047988, HL043851, HL080467, HL099355, UM1 CA182913)
- Molino Family Trust
- NIH T32 (HL007575)
- NIH LRP
- Brigham and Women's Hospital
- National Heart, Lung, and Blood Institute of the NIH under Award (R01HL117861)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
- Keywords
- non-HDL cholesterol, apolipoprotein B, coronary heart disease risk, women, metabolic syndrome, Women's Health Study
- MeSH terms
- Apolipoproteins B, Cholesterol, Coronary Disease, Female, Humans, Middle Aged, Risk Factors, Biomarkers, Women's Health, Controlled Clinical Trials as Topic, Atherosclerosis, Healthy Volunteers
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