Lipoprotein Biomarkers and Risk of Cardiovascular Disease: A Laboratory Medicine Best Practices (LMBP) Systematic Review
Open accessAbstract
Background: Controversy exists about the incremental utility of nontraditional lipid biomarkers [e.g., apolipoprotein (apo) B, apo A-I, and non-HDL-C] in improving cardiovascular disease (CVD) risk prediction when added to a conventional model of traditional risk factors (e.g., total cholesterol, LDL cholesterol, HDL cholesterol, sex, age, smoking status, and blood pressure). Here we present a systematic review that was conducted to assess the use of nontraditional lipid biomarkers including apo B, apo A-I, apo B/A-I ratio, and non-HDL-C in improving CVD risk prediction after controlling for the traditional risk factors in populations at risk for cardiovascular events. Content: This systematic review used the Laboratory Medicine Best Practices (LMBP™) A-6 methods. A total of 9 relevant studies published before and including July 2015 comprised the evidence base for this review. Results from this systematic review indicated that after the adjustment for standard nonlipid and lipid CVD risk factors, nontraditional apolipoprotein biomarkers apo B (overall effect = relative risk: 1.31; 95% CI, 1.22–1.40; 4 studies) and apo B/apo A-I ratio (overall effect = relative risk: 1.31; 95% CI, 1.11–1.38; 7 studies) resulted in significant improvement in long-term CVD risk assessment. Summary: Available evidence showed that nontraditional lipid biomarkers apo B and apo B/apo I ratio can improve the risk prediction for cardiovascular events after controlling for the traditional risk factors for the populations at risk. However, because of insufficient evidence, no conclusions could be made for the effectiveness of apo A-I and non-HDL-C lipid markers to predict the CVD events, indicating a need for more research in this field.
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These 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 [12]
The Results (Apo B and Apo B/apo A-I) conclude that adding those biomarkers to traditional risk factors improves CVD risk prediction. But the Discussion (Best practices recommendations; Future research needs) says the review did not assess whether the biomarkers predict risk better than, or could replace, traditional measures. It also found insufficient evidence to draw that conclusion for apo A-I and non-HDL-C. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSystematic reviews found that Apo B100 and the Apo B100/Apo A1 ratio improved prediction of cardiovascular risk.
“Systematic reviews have examined the risk prediction power of Apo A1, A2 and B100 for cardiovascular risk and found Apo B100 and the Apo B100/Apo A1 ratio improved prediction [12–14].”
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- Authors
- Sandhu, P. K., Musaad, S. M. A., Remaley, A. T., Buehler, S. S., Strider, S., Derzon, J. H., Vesper, H. W., Ranne, A., Shaw, C. S., & Christenson, R. H.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of Illinois Urbana-Champaign (US)
- National Institutes of Health (US)
- Battelle (US)
- RTI International (US)
- University of Maryland, Baltimore (US)
- Corresponding author
- Sandhu, Paramjit K
- ORCID
- Venue
- The Journal of Applied Laboratory Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-09-01
- Volume
- 1
- Issue
- 2
- Pages
- 214-229
- ISSN
- 2475-7241 (ISSN-L)
- 2576-9456
- PMC
- PMC5103618
- OpenAlex
- W2518743504
- Cited by
- 55
- References
- 72
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 2 · 2021: 9 · 2020: 8 · 2019: 4 · 2018: 8 · 2017: 4 · 2016: 1
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Applied Laboratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Battelle
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- cardiovascular risk prediction, apolipoprotein B, apolipoprotein A-I, apolipoprotein B/A-I ratio, non-HDL cholesterol, traditional cardiovascular risk factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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