Hypercholesterolemia and hypertriglyceridemia—greatest cardiac risk in subjects with high apoB/apoA-I levels

Hypercholesterolemia and hypertriglyceridemia are risk factors for cardiovascular disease. The potentially atherogenic very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), large buoyant, and small dense low-density lipoprotein (LDL) particles are all transported by apolipoprotein (apo) B, one protein per particle. The anti-atherogenic HDL contains apoA-I. In the apolipoprotein-related mortality risk (AMORIS) study, 98,722 males and 76,831 females aged 20–80 years were investigated at health check-ups. They were followed for 98 months, and 1267 males and 586 females died from myocardial infarction. The aim of the study is to investigate if apoB and apoA-I are more closely related to cardiac risk than lipids. The most common lipid phenotype in those who died was combined hypercholesterol- and hypertriglyceridemia (type IIB, 48%), followed by isolated hypercholesterolemia (type IIA, 40%). However, irrespective of lipid phenotype, and also in subjects with normal lipids, the highest CV risk was seen in those with a high apoB/apoA-I (>0.9 in males, >0.8 in females) compared with those with values below these cut-points. It is concluded that the balance of apoB/apoA-I is a simple and precise indicator strongly reflecting CV risk irrespective of lipid levels or combinations of lipids. [Copyright &y& Elsevier]