Apolipoprotein Ratio Better Than Cholesterol Ratios as Indicator of MI Risk

Last Updated: 2008-07-17 18:30:13 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The ratio of apolipoprotein B100 (ApoB) to apolipoprotein A1 (ApoA1) is superior to cholesterol ratios for estimating risk of acute myocardial infarction, the INTERHEART study investigators report in the July 19 issue of The Lancet.

The ApoB/ApoA1 ratio is an index of the proatherogenic and antiatherogenic lipoproteins in plasma, Dr. Matthew J. McQueen, at McMaster University in Hamilton, Ontario, Canada, and co-authors explain.

The study team obtained non-fasting blood samples from 9345 patients with a first acute MI and 12,120 age- and sex-matched controls from 52 countries, representing all major ethnic groups. Concentrations of plasma lipids, lipoproteins, and apolipoproteins were measured using standard assays.

The population-attributable risk of MI was substantially higher for the ApoB/ApoA1 ratio (54%) than for the ratio of total cholesterol/HDL cholesterol (TC/HDL, 32%, p < 0.001).

The odds ratio associated with a one standard-deviation change in the ratio of ApoB/ApoA1 (1.59) was also higher than that for TC/HDL (1.17, p < 0.001).

ApoB/ApoA1 was superior to cholesterol ratios for estimation of the risk of acute MI "in all ethnic groups, in both sexes, and at all ages, and it should be introduced into worldwide clinical practice," Dr. McQueen's group maintains.

As they note, "The clinical measurement of apolipoproteins is standardized, simple, inexpensive, and can be done with samples obtained from non-fasting individuals."

They also point out that their recommendation is in line with the recent joint Consensus Statement by the American Diabetes Association and the American College of Cardiology, that "ApoB should be the final test of adequacy of any LDL cholesterol-lowering treatment."

In an editorial, Dr. Lars Lind from University Hospital in Uppsala, Sweden, remarks that "the most important task is to ascertain that lipids are evaluated at all."

"Physicians and patients have taken decades to learn to measure lipids and treat hyperlipidaemia," he notes, predicting that "it will be a demanding but not impossible task of education to substitute traditional lipid measurements by the possibly somewhat better apolipoproteins."

Lancet 2008;372:185-186,224-233.

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