The Strengths and Limitations of the ApoB/apoA-I Ratio to Predict the Risk of Vascular Disease: a Hegelian Analysis

Overview

Journal Curr Atheroscler Rep

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2008 Jan 5

PMID 18173952

Citations 8

Authors

Allan D Sniderman

Robert S Kiss

Affiliations

Soon will be listed here.

Abstract

The levels of pro- and antiatherogenic lipoproteins are the most important risk factors for vascular disease, and there is now compelling evidence that the apolipoprotein (apo) B/apoA-I ratio is a better index of the likelihood of vascular events than any of the corresponding cholesterol indices: the total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, non-HDL-C/HDL-C ratio, or low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio. But are there any restrictions on the application of the apoB/apoA-I ratio to clinical practice? This article suggests that the answer is yes. Based on the available biologic and epidemiologic data, the relation between risk and apoB is continuous, whereas at the extremes of HDL concentration in plasma the relation to risk is not certain. Moreover, LDL plays a causal role in atherogenesis whereas HDL plays a contingent role. Appreciating these distinctions should allow appropriate use of the apoB/apoA-I ratio as a simple, single, summary index of the lipoprotein-related risk of vascular disease.

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References

Chan D, Watts G . Apolipoproteins as markers and managers of coronary risk. QJM. 2006; 99(5):277-87. DOI: 10.1093/qjmed/hcl027. View

Tall A, Yvan-Charvet L, Wang N . The failure of torcetrapib: was it the molecule or the mechanism?. Arterioscler Thromb Vasc Biol. 2007; 27(2):257-60. DOI: 10.1161/01.ATV.0000256728.60226.77. View

Kuivenhoven J, Pritchard H, Hill J, Frohlich J, Assmann G, Kastelein J . The molecular pathology of lecithin:cholesterol acyltransferase (LCAT) deficiency syndromes. J Lipid Res. 1997; 38(2):191-205. View

Barter P, Ballantyne C, Carmena R, Cabezas M, Chapman M, Couture P . Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J Intern Med. 2006; 259(3):247-58. DOI: 10.1111/j.1365-2796.2006.01616.x. View

Khuseyinova N, Koenig W . Apolipoprotein A-I and risk for cardiovascular diseases. Curr Atheroscler Rep. 2006; 8(5):365-73. DOI: 10.1007/s11883-006-0033-9. View

Kiss R, Kavaslar N, Okuhira K, Freeman M, Walter S, Milne R . Genetic etiology of isolated low HDL syndrome: incidence and heterogeneity of efflux defects. Arterioscler Thromb Vasc Biol. 2007; 27(5):1139-45. DOI: 10.1161/ATVBAHA.106.137646. View

Marcovina S, Packard C . Measurement and meaning of apolipoprotein AI and apolipoprotein B plasma levels. J Intern Med. 2006; 259(5):437-46. DOI: 10.1111/j.1365-2796.2006.01648.x. View

Nicholls S, Tuzcu E, Sipahi I, Grasso A, Schoenhagen P, Hu T . Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA. 2007; 297(5):499-508. DOI: 10.1001/jama.297.5.499. View

Hovingh G, de Groot E, van der Steeg W, Boekholdt S, Hutten B, Kuivenhoven J . Inherited disorders of HDL metabolism and atherosclerosis. Curr Opin Lipidol. 2005; 16(2):139-45. DOI: 10.1097/01.mol.0000162318.47172.ef. View

10.

Genest Jr J, Bard J, Fruchart J, Ordovas J, Schaefer E . Familial hypoalphalipoproteinemia in premature coronary artery disease. Arterioscler Thromb. 1993; 13(12):1728-37. DOI: 10.1161/01.atv.13.12.1728. View

11.

Thompson A, Danesh J . Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies. J Intern Med. 2006; 259(5):481-92. DOI: 10.1111/j.1365-2796.2006.01644.x. View

12.

Barter P, Rye K . The rationale for using apoA-I as a clinical marker of cardiovascular risk. J Intern Med. 2006; 259(5):447-54. DOI: 10.1111/j.1365-2796.2006.01647.x. View

13.

Walldius G, Jungner I, Aastveit A, Holme I, Furberg C, Sniderman A . The apoB/apoA-I ratio is better than the cholesterol ratios to estimate the balance between plasma proatherogenic and antiatherogenic lipoproteins and to predict coronary risk. Clin Chem Lab Med. 2004; 42(12):1355-63. DOI: 10.1515/CCLM.2004.254. View

14.

Rader D, Ikewaki K, Duverger N, Feuerstein I, ZECH L, Connor W . Very low high-density lipoproteins without coronary atherosclerosis. Lancet. 1993; 342(8885):1455-8. DOI: 10.1016/0140-6736(93)92933-k. View

15.

Attie A, Kastelein J, Hayden M . Pivotal role of ABCA1 in reverse cholesterol transport influencing HDL levels and susceptibility to atherosclerosis. J Lipid Res. 2001; 42(11):1717-26. View

16.

Tremblay A, Sniderman A, Gagne C, Bergeron J, Couture P . Differential impact of plasma triglycerides on HDL-cholesterol and HDL-apo A-I in a large cohort. Clin Biochem. 2006; 40(1-2):25-9. DOI: 10.1016/j.clinbiochem.2006.06.014. View

17.

Nicholls S, Dusting G, Cutri B, Bao S, Drummond G, Rye K . Reconstituted high-density lipoproteins inhibit the acute pro-oxidant and proinflammatory vascular changes induced by a periarterial collar in normocholesterolemic rabbits. Circulation. 2005; 111(12):1543-50. DOI: 10.1161/01.CIR.0000159351.95399.50. View

18.

Schaefer E, Heaton W, Wetzel M, BREWER Jr H . Plasma apolipoprotein A-1 absence associated with a marked reduction of high density lipoproteins and premature coronary artery disease. Arteriosclerosis. 1982; 2(1):16-26. DOI: 10.1161/01.atv.2.1.16. View

19.

Jansen A, van Aalst-Cohen E, Tanck M, Trip M, Lansberg P, Liem A . The contribution of classical risk factors to cardiovascular disease in familial hypercholesterolaemia: data in 2400 patients. J Intern Med. 2004; 256(6):482-90. DOI: 10.1111/j.1365-2796.2004.01405.x. View

20.

Hovingh G, Brownlie A, Bisoendial R, Dube M, Levels J, Petersen W . A novel apoA-I mutation (L178P) leads to endothelial dysfunction, increased arterial wall thickness, and premature coronary artery disease. J Am Coll Cardiol. 2004; 44(7):1429-35. DOI: 10.1016/j.jacc.2004.06.070. View