LDL-C or apoB as the Best Target for Reducing Coronary Heart Disease

Should Apob be Implemented into Clinical Practice?

Helena Vaverkova

Disclosures

Clin Lipidology. 2011;6(1):35-48. 

In This Article

Availability of apoB Estimation & Standardization of apoB

It is frequently argued that it is not possible to include apoB and apoA-I in the guidelines, as an estimation of these parameters is not well standardized and is not generally available for clinical practice. Nevertheless, methods for apoB and apoA-I measurement are available on most high volume analyzers, which are now in most laboratories.

In 1984, the International Federation of Clinical Chemistry (IFCC) established the Committee on Apolipoprotein Standardization, chaired by Santica Marcovina. They demonstrated that comparable apoB values were obtained among laboratories using the common reference material SP3-07 as the calibration material in different laboratories[67] and for apoA-I by using the common reference material SP1-01 as the calibration material.[68] These two reference materials were accepted by the WHO as the WHO/IFCC international reference material for apoB and apoA-I measurement. The availability of common reference materials for assigning values to the assay calibrators greatly improved agreement among laboratories, with the coefficient of variation for apoA-I levels ranging from 2.1 to 5.6% and for apoB levels from 3.1 to 6.7%. This was proven in large population studies that used methods standardized by the WHO/IFCC reference materials. Thus, the standardization of apoB is better than that of LDL-C (either calculated according to the Friedewald formula from total cholesterol, TGs and HDL-C or estimated directly by the homogenous method). Nevertheless, continual proficiency testing is also important to ensure that the apoB methods are standardized.

A further advantage of the apoB method is that the patient need not be fasting and high TGs do not interfere with apoB estimation.

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