Background

Discordant levels of apolipoprotein B (apo B) relative to low-density lipoprotein cholesterol (LDL-C) or non–high-density lipoprotein cholesterol (non-HDL-C) may be associated with subclinical atherosclerotic cardiovascular disease (ASCVD).

Objective

The present study investigated whether discordance between apo B and LDL-C or non-HDL-C levels was associated with subclinical ASCVD measured by coronary artery calcium (CAC).

Methods

This study was conducted in a subpopulation of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, aged 45 to 84 years, free of ASCVD, and not taking lipid-lowering medications at the baseline (2000–2002) (prevalence analytic N = 4623; incidence analytic N = 2216; progression analytic N = 3947). Apo B discordance relative to LDL-C and non-HDL-C was defined using residuals and percentile rankings (>5/10/15 percentile). Associations with prevalent and incident CAC (CAC > 0 vs CAC = 0) were assessed using prevalence ratio/relative risk regression and CAC progression (absolute increase/year) using multinomial logistic regression.

Results

Higher apo B levels were associated with CAC prevalence, incidence, and progression. Apo B discordance relative to LDL-C or non-HDL-C was inconsistently associated with CAC prevalence and progression. Discordantly high apo B relative to LDL-C and non-HDL-C was associated with CAC progression. Associations for apo B discordance with non-HDL-C remained after further adjustment for metabolic syndrome components.

Conclusion

Apo B was associated with CAC among adults aged ≥45 years not taking statins, but provided only modest additional predictive value of apo B for CAC prevalence, incidence, or progression beyond LDL-C or non-HDL-C. Apo B discordance may still be important for ASCVD risk assessment and further research is needed to confirm findings.

中文翻译：

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在动脉粥样硬化的多种族研究 (MESA) 中，载脂蛋白 B 与低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇与冠状动脉钙化的不一致。

背景

载脂蛋白 B (apo B) 与低密度脂蛋白胆固醇 (LDL-C) 或非高密度脂蛋白胆固醇 (non-HDL-C) 水平不一致可能与亚临床动脉粥样硬化性心血管疾病 (ASCVD) 相关。

客观的

本研究调查了载脂蛋白 B 与 LDL-C 或非 HDL-C 水平之间的不一致是否与通过冠状动脉钙 (CAC) 测量的亚临床 ASCVD 相关。

方法

这项研究是在动脉粥样硬化多种族研究 (MESA) 队列的亚群中进行的，年龄 45 至 84 岁，无 ASCVD，并且在基线 (2000-2002) 时未服用降脂药物（患病率分析 N = 4623；发生率分析 N = 2216；进展分析 N = 3947）。相对于 LDL-C 和非 HDL-C 的 Apo B 不一致是使用残差和百分位排名（>5/10/15 个百分位）定义的。使用患病率/相对风险回归和使用多项逻辑回归的 CAC 进展（绝对增加/年）评估与流行和事件 CAC（CAC > 0 vs CAC = 0）的关联。

结果

较高的载脂蛋白 B 水平与 CAC 患病率、发病率和进展相关。与 LDL-C 或非 HDL-C 相关的 Apo B 不一致与 CAC 患病率和进展的相关性不一致。相对于 LDL-C 和非 HDL-C 不协调的高载脂蛋白 B 与 CAC 进展相关。在进一步调整代谢综合征成分后，apo B 与非 HDL-C 不一致的关联仍然存在。

结论

在 45 岁以上未服用他汀类药物的成年人中，载脂蛋白 B 与 CAC 相关，但载脂蛋白 B 对 CAC 患病率、发病率或超出 LDL-C 或非 HDL-C 的进展仅提供适度的额外预测价值。Apo B 不一致对于 ASCVD 风险评估可能仍然很重要，需要进一步研究以确认结果。