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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
Authors
  1. Barter PJ1
  2. Ballantyne CM2
  3. Carmena R3
  4. Cabezas MC4
  5. Chapman MJ5
  6. Couture P6
  7. De Graaf J7
  8. Durrington PN8
  9. Faergeman O9
  10. Frohlich J10
  11. Furberg CD11
  12. Gagne C12
  13. Haffner SM13
  14. Humphries SE14
  15. Jungner I15, 16
  16. Krauss RM17
  17. Kwiterovich P18
  18. Marcovina S19
  19. Packard CJ20
  20. Pearson TA21
  21. Reddy KS22
  22. Rosenson R23
  23. Sarrafzadegan N24
  24. Sniderman AD25, 29
  25. Stalenhoef AF7
  26. Stein E26
  27. Talmud PJ14
  28. Tonkin AM27
  29. Walldius G28
  30. Williams KMS13
Show Affiliations
Authors Affiliations
  1. 1. Heart Research Institute, Sydney, NSW, Australia
  2. 2. Baylor College of Medicine, Houston, TX, United States
  3. 3. Department of Endocrinology and Nutrition, Facultad de Medicina Y Hospital Clinico Universitario, Valencia, Spain
  4. 4. St. Franciscus Gasthuis, Rotterdam, Netherlands
  5. 5. Hopital de la Pitie, Paris, France
  6. 6. Centre Hospitalier Universitaire de Quebec, Ste-Foy, Que., Canada
  7. 7. Radboud University, Nijmegen Medical Center, Nijmegen, Netherlands
  8. 8. Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, United Kingdom
  9. 9. Aarhus Amtssygehus University Hospital, Aarhus C, Denmark
  10. 10. University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
  11. 11. Wake Forest University, School of Medicine, Winston-Salem, NC, United States
  12. 12. Universite de Laval, Laval, Que., Canada
  13. 13. University of Texas, Health Science Center, San Antonio, TX, United States
  14. 14. Royal Free and University College Medical School, London, United Kingdom
  15. 15. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
  16. 16. CALAB Research, Stockholm, Sweden
  17. 17. Children's Hospital Oakland Research Institute, Oakland, CA, United States
  18. 18. Johns Hopkins Medication Institutions, Baltimore, MD, United States
  19. 19. University of Washington, Seattle, WA, United States
  20. 20. Glasgow Royal Infirmary, Glasgow, United Kingdom
  21. 21. University of Rochester, Rochester, NY, United States
  22. 22. All India Institutes of Medical Sciences, New Delhi, India
  23. 23. Northwestern University, Chicago, IL, United States
  24. 24. Isfahan Cardiovascular Research Center, Isfahan, Iran
  25. 25. Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University, Health Sciences Centre, Montreal, Que., Canada
  26. 26. Metabolic and Atherosclerosis Research Center, Cincinnati, OH, United States
  27. 27. Monash University, Vic., Australia
  28. 28. King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden
  29. 29. Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Royal Victoria Hospital, Montreal, Que. H3A 1A1, 687 Pine Avenue West, Canada

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.
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