Article

Analyses using conventional statistical methodologies have yielded
conflicting results as to whether low-density lipoprotein cholesterol (LDL-C) or
non-high-density lipoprotein cholesterol (non-HDL-C) or apolipoprotein B (apoB)
is the best marker of the apoB-associated risk of coronary heart disease. The aim
of this study was to determine the additional value of apoB beyond LDL-C or
non-HDL-C as a predictor of coronary heart disease. METHODS : For each
patient from the Framingham Offspring Cohort aged 40-75 years (n = 2966), we
calculated the extent to which the observed apoB differed from the expected apoB
based on their LDL-C or non-HDL-C. We added this difference to a Cox model
predicting new onset coronary heart disease over a maximum of 20 years adjusting
for standard risk factors plus LDL-C or non-HDL. The difference between observed
and expected apoB over LDL-C or non-HDL-C was highly prognostic of future
coronary heart disease events: adjusted hazard ratios 1.26 (95% confidence
interval: 1.15, 1.37) and 1.20 (1.11, 1.29), respectively, for each standard
deviation increase beyond expected apoB levels. When this difference between
observed and expected apoB was added to standard coronary heart disease
prediction models including LDL-C or non-HDL-C, prediction improved significantly
(likelihood ratio test p-values <0.0001) and discrimination c-statistics
increased from 0.72 to 0.73. The corresponding relative integrated discrimination
improvements were 11% and 8%, respectively. CONCLUSIONS: apoB improves risk
assessment of future coronary heart disease events over and beyond LDL-C or
non-HDL-C, which is consistent with coronary risk being more closely related to
the number of atherogenic apoB particles than to the mass of cholesterol within
them.
CI - (c) The European Society of Cardiology 2015.

Langue : ANGLAIS