Apolipoprotein B, non-HDL cholesterol and LDL cholesterol for identifying individuals at increased cardiovascular risk

作者：Holewijn S^*; den Heijer M; Swinkels D W; Stalenhoef A F H; de Graaf J

来源：Journal of Internal Medicine, 2010, 268(6): 567-577.

DOI：10.1111/j.1365-2796.2010.02277.x

• (subclinical) atherosclerosis
• apoB
• cardiovascular disease
• LDL-c
• non-HDL-c
• noninvasive measurements

Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AFH, de Graaf J. (Address: Division of Vascular Medicine, Department of General Internal Medicine; Department of Epidemiology and Biostatistics; Department of Endocrinology; and Department of Laboratory Medicine; Laboratory of Clinical Chemistry, all at the Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands) Apolipoprotein B, non-HDL cholesterol and LDL cholesterol for identifying individuals at increased cardiovascular risk. J Intern Med 2010; 268: 567-577.
Background.
To compare apolipoprotein B (apoB), nonhigh-density lipoprotein-cholesterol (non-HDL-c) and low-density lipoprotein-cholesterol (LDL-c) for identifying individuals with a deteriorated cardiovascular (CV) risk profile, including a panel of subclinical atherosclerosis measurements and prevalent cardiovascular disease (CVD) in a Dutch population-based cohort.
Methods.
Clinical and biochemical measurements and a panel of noninvasive parameters of subclinical atherosclerosis were determined in 1517 individuals, aged 50-70 years.
Results.
Both men and women with increasing levels of apoB and non-HDL-c were more obese, had higher blood pressure and fasting glucose levels, and a more atherogenic lipid profile. Furthermore, compared to the reference group (composed of those with apoB, non-HDL-c and LDL-c levels in the bottom quartiles), participants with high apoB and high non-HDL-c levels had a lower ankle-brachial index at rest (-3.5% and -3.1%, respectively) and after exercise (-6.3% and -4.7%, respectively), a thicker near wall (+4.8% and +4.2%, respectively), far wall (both +6.2%), and mean intima-media thickness (+5.7% and +5.3%, respectively) and more plaques (+54.2% and +54.3%, respectively). In addition, they also showed increased stiffness parameters (e.g. pulse wave velocity both +3.6%). Less clear differences in CV risk profile and subclinical atherosclerosis parameters were observed when participants were stratified by LDL-c level. Furthermore, apoB but not LDL-c detected prevalent CVD, and non-HDL-c only detected prevalent CVD in men. The discriminatory power for prevalent CVD expressed as area under the receiver operating characteristic curve was 0.60 (P < 0.001) for apoB, 0.57 (P = 0.001) for non-HDL-c and 0.54 (P = 0.108) for LDL-c.
Conclusion.
Our data support the use of first apoB and secondly non-HDL-c above LDL-c for identifying individuals from the general population with a compromised CV phenotype.

• 出版日期2010-12