Apolipoproteins and Long-Term Prognosis in Coronary Heart Disease Patients

Michal Benderly, PhD; Valentina Boyko, MSc; Uri Goldbourt, PhD


Am Heart J. 2009;157(1):103-110. 

In This Article

Abstract and Introduction


Background: Apolipoproteins have been recently suggested as an alternative to lipoproteins in prediction of cardiovascular risk. Data regarding their added value in predicting the prognosis of coronary heart disease (CHD) patients are scarce. Our aim was to examine the association between lipoprotein cholesterol and related apolipoproteins with long-term mortality among CHD patients.
Methods: Patients (4,472 men; 624 women, 40–74 years old) with total cholesterol <270 mg/dL (<7.0 mmol/L), high-density lipoprotein cholesterol (HDL-C) <45 mg/dL (<1.16 mmol/L), and triglycerides <300 mg/dL (≤3.39 mmol/L); excluded from the Bezafibrate Infarction Prevention study; or included in the placebo arm were followed up for a median of 12.3 years.
Results: Among both men and women, the association of apolipoproteins A-I and B with mortality was comparable to their corresponding lipids (HDL-C, non–HDL-C respectively). Adjusting for age, disease history, comorbidities, smoking and baseline glucose, the risk associated with the upper versus the lower tertile (lower vs upper for HDL-C and apolipoprotein A-I) among men were 1.04 (95% CI 0.91–1.19) for non–HDL-C; 1.11 (0.97–1.27) for apolipoprotein B; 1.24 (1.09–1.41) for HDL-C; and 1.30 (1.14–1.49) for apolipoprotein A-I. Atherogenic to nonatherogenic particle ratios (lipids or apolipoproteins) were in line with the results of their individual components pointing to a less atherogenic profile among women. Models including either apolipoprotein or cholesterol subfractions had similar predictive power.
Conclusion: Lipoprotein cholesterol and associated apolipoprotein have comparable ability to predict long-term mortality. The measurement of apolipoproteins constitutes an acceptable alternative to the use of blood lipids in assessing prognosis for CHD patients.

Lipid and lipoprotein metabolism are at the heart of atherosclerotic disease. Furthermore, lipoprotein cholesterol (particularly low density lipoprotein cholesterol [LDL-C]) constitutes an established risk factors and a primary treatment target for the prevention of coronary heart disease (CHD). The third Adult treatment Panel of the National Cholesterol Education program (NCEP ATP-III) introduced non–high-density lipoprotein cholesterol (HDL-C) as a better risk predictor particularly among hypertriglyceridemic individuals.[1] Lately, considerable interest arose in apolipoproteins, mainly apolipoprotein B, the major protein in non–HDL-C atherogenic lipoprotein particles (including low-density lipoprotein [LDL], intermediate density lipoprotein, very low density lipoprotein, and Lp(a)) and apolipoprotein A-I, which is the major apolipoprotein constituent of high-density lipoprotein (HDL). Apolipoprotein B,[2,3,4] apolipoprotein A-I,[4,5] and even more so their ratio[6,7,8] have been suggested by a number of epidemiological and clinical studies as superior indicators of cardiovascular risk. A number of studies reported a similar predictive power for lipids and apolipoproteins.[9,10] Some argued that apolipoprotein add to prediction of the traditional lipids,[2] whereas others did not find apolipoprotein to have a predictive power beyond that of lipids.[11,12]

Although most of comparative studies of apolipoproteins A-I and B with lipids were conducted among healthy individuals, only a few studied the association between lipoprotein components and prognosis among CHD patients.[4,5,13,14] These studies did not compare men and women[4,5,14] or included a small number of patients.[13]

In the present study, we examined the association between lipoprotein cholesterol and associated apolipoprotein with long-term mortality among a large group men and women with CHD.


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