Apo B Versus Cholesterol in Estimating Cardiovascular Risk and in Guiding Therapy: Report of the Thirty-Person/Ten-Country Panel Publisher Pubmed



Barter PJ¹ ; Ballantyne CM² ; Carmena R³ ; Cabezas MC⁴ ; Chapman MJ⁵ ; Couture P⁶ ; De Graaf J⁷ ; Durrington PN⁸ ; Faergeman O⁹ ; Frohlich J¹⁰ ; Furberg CD¹¹ ; Gagne C¹² ; Haffner SM¹³ ; Humphries SE¹⁴ Show All Authors
Source: Journal of Internal Medicine Published:2006

Abstract

There is abundant evidence that the risk of atherosclerotic vascular disease is directly related to plasma cholesterol levels. Accordingly, all of the national and transnational screening and therapeutic guidelines are based on total or LDL cholesterol. This presumes that cholesterol is the most important lipoprotein-related proatherogenic risk variable. On the contrary, risk appears to be more directly related to the number of circulating atherogenic particles that contact and enter the arterial wall than to the measured concentration of cholesterol in these lipoprotein fractions. Each of the atherogenic lipoprotein particles contains a single molecule of apolipoprotein (apo) B and therefore the concentration of apo B provides a direct measure of the number of circulating atherogenic lipoproteins. Evidence from fundamental, epidemiological and clinical trial studies indicates that apo B is superior to any of the cholesterol indices to recognize those at increased risk of vascular disease and to judge the adequacy of lipid-lowering therapy. On the basis of this evidence, we believe that apo B should be included in all guidelines as an indicator of cardiovascular risk. In addition, the present target adopted by the Canadian guideline groups of an apo B <90 mg dL-1 in high-risk patients should be reassessed in the light of the new clinical trial results and a new ultra-low target of <80 mg dL-1 be considered. The evidence also indicates that the apo B/apo A-I ratio is superior q3to any of the conventional cholesterol ratios in patients without symptomatic vascular disease or diabetes to evaluate the lipoprotein-related risk of vascular disease. © 2006 Blackwell Publishing Ltd.